Advanced Pathophysiology - Week 6: Pulmonary System
2026 |Maryville UPDATED ACTUAL Exam Questions and
CORRECT Answers
1. Which of the following occurs during a right shift in the oxyhemoglobin
dissociation curve?
A. Hemoglobin has a higher affinity for oxygen.
B. Oxygen is more easily released to the tissues.
C. The patient is likely experiencing alkalosis.
D. There is a decrease in 2,3-DPG levels.
Answer: B
Rationale: A right shift in the oxyhemoglobin dissociation curve indicates a decreased
affinity of hemoglobin for oxygen, meaning oxygen is more easily released to the tissues.
This is typically caused by acidosis, hypercapnia, increased temperature, and increased 2,3-
DPG.
2. In the context of Starling’s forces, what is the primary cause of pulmonary
edema in a patient with left-sided heart failure?
A. Decreased capillary oncotic pressure.
B. Increased capillary permeability.
C. Lymphatic obstruction.
D. Increased pulmonary capillary hydrostatic pressure.
Answer: D
Rationale: Left-sided heart failure leads to a backup of blood into the pulmonary
circulation, increasing the pulmonary capillary hydrostatic pressure, which forces fluid into
the interstitial and alveolar spaces.
,3. A deficiency in which of the following substances is most closely linked to the
development of early-onset panacinar emphysema, especially in non-smokers?
A. Alpha-1 antitrypsin
B. Surfactant
C. Glutathione
D. Carbonic anhydrase
Answer: A
Rationale: Alpha-1 antitrypsin is a protease inhibitor that protects the lungs from
neutrophil elastase. A deficiency leads to unchecked proteolysis of alveolar walls, resulting
in emphysema.
4. Which cell type in the alveoli is responsible for the production of surfactant?
A. Type I alveolar cells
B. Alveolar macrophages
C. Type II alveolar cells
D. Goblet cells
Answer: C
Rationale: Type II alveolar cells secrete surfactant, a lipoprotein that reduces surface
tension within the alveoli, preventing collapse (atelectasis) during expiration.
5. What is the hallmark physiological finding in a patient with Acute Respiratory
Distress Syndrome (ARDS)?
A. Refractory hypoxemia.
B. Increased lung compliance.
C. Hypoxemia that responds well to supplemental oxygen.
D. Decreased pulmonary artery pressure.
Answer: A
, Rationale: Refractory hypoxemia (hypoxemia that does not improve with high
concentrations of oxygen) is a hallmark of ARDS due to massive shunting and alveolar
collapse.
6. During the early (exudative) phase of ARDS, which of the following occurs?
A. Resolution of pulmonary edema.
B. Extensive pulmonary fibrosis.
C. Development of hyaline membranes.
D. Proliferation of Type II pneumocytes.
Answer: C
Rationale: The exudative phase is characterized by inflammatory injury to the alveolar-
capillary membrane, leading to protein-rich fluid leakage and the formation of hyaline
membranes.
7. Which of the following describes a ‘shunt’ in terms of ventilation-perfusion
(V/Q) relationships?
A. Poor ventilation with adequate perfusion.
B. Adequate ventilation with poor perfusion.
C. Adequate ventilation with adequate perfusion.
D. Absence of both ventilation and perfusion.
Answer: A
Rationale: A shunt occurs when blood flows through pulmonary capillaries that are in
contact with non-ventilated alveoli (V/Q ratio of 0). This is common in atelectasis or
pneumonia.
2026 |Maryville UPDATED ACTUAL Exam Questions and
CORRECT Answers
1. Which of the following occurs during a right shift in the oxyhemoglobin
dissociation curve?
A. Hemoglobin has a higher affinity for oxygen.
B. Oxygen is more easily released to the tissues.
C. The patient is likely experiencing alkalosis.
D. There is a decrease in 2,3-DPG levels.
Answer: B
Rationale: A right shift in the oxyhemoglobin dissociation curve indicates a decreased
affinity of hemoglobin for oxygen, meaning oxygen is more easily released to the tissues.
This is typically caused by acidosis, hypercapnia, increased temperature, and increased 2,3-
DPG.
2. In the context of Starling’s forces, what is the primary cause of pulmonary
edema in a patient with left-sided heart failure?
A. Decreased capillary oncotic pressure.
B. Increased capillary permeability.
C. Lymphatic obstruction.
D. Increased pulmonary capillary hydrostatic pressure.
Answer: D
Rationale: Left-sided heart failure leads to a backup of blood into the pulmonary
circulation, increasing the pulmonary capillary hydrostatic pressure, which forces fluid into
the interstitial and alveolar spaces.
,3. A deficiency in which of the following substances is most closely linked to the
development of early-onset panacinar emphysema, especially in non-smokers?
A. Alpha-1 antitrypsin
B. Surfactant
C. Glutathione
D. Carbonic anhydrase
Answer: A
Rationale: Alpha-1 antitrypsin is a protease inhibitor that protects the lungs from
neutrophil elastase. A deficiency leads to unchecked proteolysis of alveolar walls, resulting
in emphysema.
4. Which cell type in the alveoli is responsible for the production of surfactant?
A. Type I alveolar cells
B. Alveolar macrophages
C. Type II alveolar cells
D. Goblet cells
Answer: C
Rationale: Type II alveolar cells secrete surfactant, a lipoprotein that reduces surface
tension within the alveoli, preventing collapse (atelectasis) during expiration.
5. What is the hallmark physiological finding in a patient with Acute Respiratory
Distress Syndrome (ARDS)?
A. Refractory hypoxemia.
B. Increased lung compliance.
C. Hypoxemia that responds well to supplemental oxygen.
D. Decreased pulmonary artery pressure.
Answer: A
, Rationale: Refractory hypoxemia (hypoxemia that does not improve with high
concentrations of oxygen) is a hallmark of ARDS due to massive shunting and alveolar
collapse.
6. During the early (exudative) phase of ARDS, which of the following occurs?
A. Resolution of pulmonary edema.
B. Extensive pulmonary fibrosis.
C. Development of hyaline membranes.
D. Proliferation of Type II pneumocytes.
Answer: C
Rationale: The exudative phase is characterized by inflammatory injury to the alveolar-
capillary membrane, leading to protein-rich fluid leakage and the formation of hyaline
membranes.
7. Which of the following describes a ‘shunt’ in terms of ventilation-perfusion
(V/Q) relationships?
A. Poor ventilation with adequate perfusion.
B. Adequate ventilation with poor perfusion.
C. Adequate ventilation with adequate perfusion.
D. Absence of both ventilation and perfusion.
Answer: A
Rationale: A shunt occurs when blood flows through pulmonary capillaries that are in
contact with non-ventilated alveoli (V/Q ratio of 0). This is common in atelectasis or
pneumonia.
