Emergency Care in the Streets 10th
Edition | Chapter 16 Respiratory
Emergencies Revised Exam Questions
2026 Update
1. Which of the following best describes the primary function of the respiratory
system?
A) To regulate body temperature
B) To exchange oxygen and carbon dioxide between the environment and the blood
C) To filter toxins from the blood
D) To produce red blood cells
Answer: B
Rationale: The primary function of the respiratory system is gas exchange—
bringing oxygen into the body and eliminating carbon dioxide. This occurs through
ventilation (air movement), diffusion (gas transfer across the alveolar-capillary
membrane), and perfusion (blood flow through the lungs).
2. A patient with a severe asthma exacerbation is likely to have difficulty with
which phase of respiration?
A) Inhalation only
B) Exhalation primarily, due to airway obstruction and air trapping
C) Both equally
D) Neither; only gas exchange is affected
,Answer: B
Rationale: In asthma, bronchoconstriction, mucus plugging, and airway edema
increase resistance, particularly during exhalation. This leads to air trapping,
hyperinflation, and increased work of breathing.
3. A paramedic is assessing a patient with shortness of breath. The patient can
speak in full sentences and has a respiratory rate of 18 breaths/min. This
indicates:
A) Severe respiratory distress
B) Mild to moderate respiratory distress
C) Respiratory failure
D) Normal breathing without distress
Answer: B
Rationale: The ability to speak in full sentences, along with a slightly elevated
respiratory rate, indicates mild to moderate distress. As distress worsens, patients
progress to speaking in phrases, then words, and finally may become unable to
speak.
4. Which breath sounds are typically heard in a patient with an acute asthma
exacerbation?
A) Rhonchi and crackles
B) Wheezing, often with a prolonged expiratory phase
C) Stridor
D) Pleural friction rub
,Answer: B
Rationale: Asthma causes bronchoconstriction and airway narrowing, producing
high-pitched, musical wheezes predominantly on expiration. Prolonged expiratory
phase is a hallmark of lower airway obstruction.
5. A silent chest in a severe asthmatic patient indicates:
A) Resolution of bronchospasm
B) Severe obstruction with minimal airflow, a pre-arrest sign
C) Pneumonia
D) Pleural effusion
Answer: B
Rationale: The absence of breath sounds in a patient with severe asthma suggests
such poor air movement that wheezing is no longer audible. This is a life-
threatening sign of impending respiratory arrest.
6. Which of the following arterial blood gas (ABG) findings is consistent with an
acute asthma attack in its early stages?
A) Increased PaO₂, decreased PaCO₂
B) Decreased PaO₂, decreased PaCO₂ (hypocapnia from hyperventilation)
C) Increased PaO₂, increased PaCO₂
D) Normal PaO₂, normal PaCO₂
Answer: B
Rationale: Early in an asthma attack, hyperventilation causes a decreased PaCO₂
(respiratory alkalosis) due to increased minute ventilation, even as oxygenation
may start to drop. Rising PaCO₂ indicates impending respiratory failure.
, 7. A 65-year-old male with a history of COPD presents with increased dyspnea,
productive cough with green sputum, and a temperature of 38.5°C. What is the
most likely trigger for his exacerbation?
A) Pulmonary embolism
B) Acute myocardial infarction
C) Respiratory infection (bronchitis/pneumonia)
D) Allergic reaction
Answer: C
Rationale: The most common cause of COPD exacerbation is a respiratory tract
infection. The presence of fever and purulent sputum strongly suggests an
infectious etiology.
8. What is the primary pathophysiologic mechanism of hypoxemia in a patient
with COPD?
A) Ventilation/perfusion (V/Q) mismatch due to airway obstruction and alveolar
destruction
B) Diffusion defect from thickened alveolar membrane
C) Right-to-left shunt
D) Hypoventilation only
Answer: A
Rationale: In COPD, mucus plugging, airway narrowing, and destruction of alveolar
walls lead to areas of lung that are poorly ventilated but well perfused, creating a
V/Q mismatch. This is the main cause of chronic hypoxemia.
Edition | Chapter 16 Respiratory
Emergencies Revised Exam Questions
2026 Update
1. Which of the following best describes the primary function of the respiratory
system?
A) To regulate body temperature
B) To exchange oxygen and carbon dioxide between the environment and the blood
C) To filter toxins from the blood
D) To produce red blood cells
Answer: B
Rationale: The primary function of the respiratory system is gas exchange—
bringing oxygen into the body and eliminating carbon dioxide. This occurs through
ventilation (air movement), diffusion (gas transfer across the alveolar-capillary
membrane), and perfusion (blood flow through the lungs).
2. A patient with a severe asthma exacerbation is likely to have difficulty with
which phase of respiration?
A) Inhalation only
B) Exhalation primarily, due to airway obstruction and air trapping
C) Both equally
D) Neither; only gas exchange is affected
,Answer: B
Rationale: In asthma, bronchoconstriction, mucus plugging, and airway edema
increase resistance, particularly during exhalation. This leads to air trapping,
hyperinflation, and increased work of breathing.
3. A paramedic is assessing a patient with shortness of breath. The patient can
speak in full sentences and has a respiratory rate of 18 breaths/min. This
indicates:
A) Severe respiratory distress
B) Mild to moderate respiratory distress
C) Respiratory failure
D) Normal breathing without distress
Answer: B
Rationale: The ability to speak in full sentences, along with a slightly elevated
respiratory rate, indicates mild to moderate distress. As distress worsens, patients
progress to speaking in phrases, then words, and finally may become unable to
speak.
4. Which breath sounds are typically heard in a patient with an acute asthma
exacerbation?
A) Rhonchi and crackles
B) Wheezing, often with a prolonged expiratory phase
C) Stridor
D) Pleural friction rub
,Answer: B
Rationale: Asthma causes bronchoconstriction and airway narrowing, producing
high-pitched, musical wheezes predominantly on expiration. Prolonged expiratory
phase is a hallmark of lower airway obstruction.
5. A silent chest in a severe asthmatic patient indicates:
A) Resolution of bronchospasm
B) Severe obstruction with minimal airflow, a pre-arrest sign
C) Pneumonia
D) Pleural effusion
Answer: B
Rationale: The absence of breath sounds in a patient with severe asthma suggests
such poor air movement that wheezing is no longer audible. This is a life-
threatening sign of impending respiratory arrest.
6. Which of the following arterial blood gas (ABG) findings is consistent with an
acute asthma attack in its early stages?
A) Increased PaO₂, decreased PaCO₂
B) Decreased PaO₂, decreased PaCO₂ (hypocapnia from hyperventilation)
C) Increased PaO₂, increased PaCO₂
D) Normal PaO₂, normal PaCO₂
Answer: B
Rationale: Early in an asthma attack, hyperventilation causes a decreased PaCO₂
(respiratory alkalosis) due to increased minute ventilation, even as oxygenation
may start to drop. Rising PaCO₂ indicates impending respiratory failure.
, 7. A 65-year-old male with a history of COPD presents with increased dyspnea,
productive cough with green sputum, and a temperature of 38.5°C. What is the
most likely trigger for his exacerbation?
A) Pulmonary embolism
B) Acute myocardial infarction
C) Respiratory infection (bronchitis/pneumonia)
D) Allergic reaction
Answer: C
Rationale: The most common cause of COPD exacerbation is a respiratory tract
infection. The presence of fever and purulent sputum strongly suggests an
infectious etiology.
8. What is the primary pathophysiologic mechanism of hypoxemia in a patient
with COPD?
A) Ventilation/perfusion (V/Q) mismatch due to airway obstruction and alveolar
destruction
B) Diffusion defect from thickened alveolar membrane
C) Right-to-left shunt
D) Hypoventilation only
Answer: A
Rationale: In COPD, mucus plugging, airway narrowing, and destruction of alveolar
walls lead to areas of lung that are poorly ventilated but well perfused, creating a
V/Q mismatch. This is the main cause of chronic hypoxemia.
