Problem:

Answer the following questions in detail:

Question 1: Why would a chest x-ray examination reveal an infiltrate in the basilar segments of the left lower lobe ?

Question 2: A 52-year-old man who has smoked two packs of cigarettes per day for the past 20 years (40 pack years) experiences increased cough productive of copious amounts of yellow-green mucus and increased shortness of breath. Which of the following statements about [Vdot]/[Qdot] is most likely true?

Perfusion to the lung will be increased while ventilation will be normal( Why is this answer true ? )

Question 3: A 30-year-old man presents with infertility due to immotile sperm. This condition affects all ciliated structures within the body.

He is at risk for abnormalities in immune defense in association with changes in mucociliary transport resulting in mucus retention and secondary infection. ( Why is this true ? )

Question 4: A 77-year-old man complains of shortness of breath with activities of daily living. He has smoked one pack of cigarettes per day for the past 55 years (55 pack years). He has a barrel chest and breath sounds are distant, especially over the apices. His FVC, FEV1, and FEV1/FVC are markedly reduced with a significant elevation in the RV/TLC due to a marked increase in RV. His diffusion capacity for carbon monoxide (DLCO) is reduced. What lung disease is most likely?On chest x-ray, what would most likely be found?

Emphysema, A flattened diaphragm with bullae in the apices and few visible lung markings

( Why is this the answer? )

Question 5: A 59-year-old man is admitted to the ICU for shortness of breath caused by an exacerbation of emphysema. He previously smoked two packs of cigarettes per day for 40 years (80 pack years). His respiratory rate is 40breaths/min with accessory muscle use. His physician decides to mechanically ventilate him and temporarily paralyze him with medication. The ventilator is set for 12breaths/min with tidal volume of 1000mL. The ventilator measures airway pressures at the end of each delivered breath (no airflow), giving an airway pressure of 25cm H2O. The ventilator then allows him to passively exhale, and the airway pressure returns to zero (PB). What is the compliance of his respiratory system?40mL/cm H2O ( Why is this the answer?)

A patient is placed on a ventilator set at 12breaths/min with a tidal volume of 1000mL. The ventilator measures airway pressures at the end of each delivered breath (no airflow), giving an airway pressure of 25cm H2O. The ventilator then allows him to passively exhale, and the airway pressure returns to zero (PB). On further examination, the physician notes that the patient has bilateral wheezes when she listens to his chest. His RAW is measured ((Pao - Palv)/Flow). The peak airway pressure is 35cm H2O and the airflow is 1L/sec. The physician occludes the airway at the point of peak airway pressure (end inspiration), and measures 25cm H2O. what is the total RAW, including the endotracheal tube?

10cm H2O/L/sec Why is this the answer?

Question 6: A 30-year-old woman, nonsmoker, presents with a 1-week history of an upper respiratory tract (URT) infection and coughing up blood (hemoptysis). She has a history of two previous episodes of pneumonia in the right lung. On physical examination, her pulse is 90/min, respirations are 24/min, and blood pressure is 110/72. On lung auscultation, inspiratory and expiratory wheezes are noted over the right upper lobe. On the chest radiograph, a small patchy infiltrate in the right upper lobe with a suggestion of a mass lesion and volume loss is observed. On bronchoscopy, a nodular tumor mass protruding into the lumen of the right upper lobe bronchus is found. Which of the following is most likely?

If esophageal pressure changes from -5cm H2O to -10cm H2O as a patient breaths (change in 1L), what is the compliance?

Obstructive pulmonary disease associated with an increase in airway resistance;0.2L/cm H2O

Why is this the answer?

Question 7: A 16-year-old athlete presents with chest tightness during activity and occasionally at rest. On physical exam, the lungs are clear. A grade 1/6 systolic murmur is noted along the right border of the heart without radiation. During a pulmonary function test, FEF25-75 is decreased but significantly improves with inhalation of albuterol. Which of the following is most likely?

Obstructive pulmonary disease with reversibility( Why is this the case?)

Question 8: A 18-year-old female with asthma presents with acute asthma exacerbation of moderate severity. Pulmonary function tests at this time might reveal:

Decreased FVC, FEV1, FEV1/FVC, expiratory flow rates with increased RV Why is this the case?

Question 9: A 35-year-old man is seen for a physical exam. History is remarkable for a 15- year history of smoking one pack of cigarettes per day (15 pack-years). He denies any respiratory symptoms including cough or increased mucous production. He is physically active and denies physical limitation. Which of the following is most likely true?

Pulmonary function tests will reveal early airway obstruction with decreased expiratory flow rates

Why is this the case?

Please provide discription of all the answers.