NRMS 5190 Advanced Pathophysiology Exam 2 Review Questions and Answers with
Rationales | 2026/27 Update | 100% Correct -SUNY Downstate Medical Center
Section I — Respiratory Physiology &
Respiratory Disorders
Questions 1–30
1. Which muscle is principally responsible for normal inspiration?
A. Internal intercostal
B. Diaphragm
C. Rectus abdominis
D. Sternocleidomastoid
Answer: B. Diaphragm
Rationale: Contraction of the diaphragm enlarges the thoracic cavity and decreases intrathoracic
pressure, drawing air into the lungs. The study guide specifically identifies it as the principal
inspiratory muscle.
2. Type II alveolar cells primarily function to produce:
A. Mucus
B. Surfactant
C. Immunoglobulin E
D. Carbon dioxide
Answer: B. Surfactant
Rationale: Type II pneumocytes synthesize surfactant, which reduces alveolar surface tension
and improves lung compliance.
3. What is the major physiologic effect of pulmonary surfactant?
A. Increase alveolar surface tension
B. Decrease lung compliance
C. Reduce alveolar surface tension
D. Constrict pulmonary arterioles
,Answer: C. Reduce alveolar surface tension
Rationale: By reducing surface tension, surfactant decreases the pressure required to keep
alveoli open and helps prevent alveolar collapse.
4. Tidal volume is defined as:
A. Air remaining after maximal expiration
B. Air moved during a normal breath
C. Maximum volume inhaled after normal inspiration
D. Total lung volume following maximal inspiration
Answer: B. Air moved during a normal breath
Rationale: Tidal volume is the amount of air moving into and out of the lungs during quiet,
normal breathing.
5. Which is a principal function of the conducting airways?
A. Exchange oxygen directly with hemoglobin
B. Warm, humidify, and filter inspired air
C. Produce pulmonary capillary blood
D. Perform most carbon dioxide diffusion
Answer: B. Warm, humidify, and filter inspired air
Rationale: The conducting zone transports air but does not perform significant gas exchange. It
conditions incoming air through warming, humidification, and filtration.
6. The mucociliary blanket protects the respiratory tract primarily by:
A. Increasing alveolar pressure
B. Trapping particles and moving them toward the oropharynx
C. Increasing surfactant secretion
D. Dilating pulmonary capillaries
Answer: B. Trapping particles and moving them toward the oropharynx
Rationale: Mucus traps organisms and debris while coordinated ciliary movement transports the
material upward for swallowing or expectoration.
,7. Effective pulmonary respiration requires which three processes?
A. Ventilation, perfusion, and diffusion
B. Filtration, secretion, and absorption
C. Ventilation, coagulation, and filtration
D. Diffusion, digestion, and osmosis
Answer: A. Ventilation, perfusion, and diffusion
Rationale: Ventilation supplies alveolar gas, perfusion supplies pulmonary capillary blood, and
diffusion allows O₂ and CO₂ to cross the alveolar-capillary membrane.
8. Gas exchange occurs predominantly across the:
A. Tracheal mucosa
B. Nasal epithelium
C. Alveolar-capillary membrane
D. Mainstem bronchi
Answer: C. Alveolar-capillary membrane
Rationale: Oxygen and carbon dioxide diffuse between alveolar gas and pulmonary capillary
blood across the thin respiratory membrane.
9. What is the most common viral cause of the common cold?
A. Influenza A
B. Rhinovirus
C. Epstein-Barr virus
D. Varicella-zoster virus
Answer: B. Rhinovirus
Rationale: Rhinoviruses account for a substantial proportion of uncomplicated upper respiratory
infections and are specifically emphasized in the course notes.
10. Which presentation is more suggestive of acute rhinosinusitis than an
uncomplicated common cold?
, A. Clear rhinorrhea alone
B. Mild throat irritation
C. Facial pain with fever
D. Sneezing alone
Answer: C. Facial pain with fever
Rationale: Facial pain/pressure and fever are more characteristic of rhinosinusitis, particularly
when symptoms persist or worsen.
11. The primary pathologic event in typical bacterial pneumonia is:
A. Destruction of the pituitary gland
B. Inflammatory exudate filling alveolar spaces
C. Permanent dilation of the bronchi
D. Loss of pleural fluid
Answer: B. Inflammatory exudate filling alveolar spaces
Rationale: Bacterial proliferation within alveoli produces inflammation, leukocyte recruitment,
and protein-rich exudation that interferes with gas exchange.
12. Which feature contributes substantially to the virulence of Streptococcus
pneumoniae?
A. Polysaccharide capsule
B. Lack of cell membrane
C. Absence of antigenic proteins
D. Production of pulmonary surfactant
Answer: A. Polysaccharide capsule
Rationale: Its capsule interferes with effective phagocytosis, allowing the organism to evade
host defenses.
13. Pneumonia that develops more than 48 hours after hospital admission is
generally classified as:
A. Community-acquired pneumonia
B. Hospital-acquired pneumonia
Rationales | 2026/27 Update | 100% Correct -SUNY Downstate Medical Center
Section I — Respiratory Physiology &
Respiratory Disorders
Questions 1–30
1. Which muscle is principally responsible for normal inspiration?
A. Internal intercostal
B. Diaphragm
C. Rectus abdominis
D. Sternocleidomastoid
Answer: B. Diaphragm
Rationale: Contraction of the diaphragm enlarges the thoracic cavity and decreases intrathoracic
pressure, drawing air into the lungs. The study guide specifically identifies it as the principal
inspiratory muscle.
2. Type II alveolar cells primarily function to produce:
A. Mucus
B. Surfactant
C. Immunoglobulin E
D. Carbon dioxide
Answer: B. Surfactant
Rationale: Type II pneumocytes synthesize surfactant, which reduces alveolar surface tension
and improves lung compliance.
3. What is the major physiologic effect of pulmonary surfactant?
A. Increase alveolar surface tension
B. Decrease lung compliance
C. Reduce alveolar surface tension
D. Constrict pulmonary arterioles
,Answer: C. Reduce alveolar surface tension
Rationale: By reducing surface tension, surfactant decreases the pressure required to keep
alveoli open and helps prevent alveolar collapse.
4. Tidal volume is defined as:
A. Air remaining after maximal expiration
B. Air moved during a normal breath
C. Maximum volume inhaled after normal inspiration
D. Total lung volume following maximal inspiration
Answer: B. Air moved during a normal breath
Rationale: Tidal volume is the amount of air moving into and out of the lungs during quiet,
normal breathing.
5. Which is a principal function of the conducting airways?
A. Exchange oxygen directly with hemoglobin
B. Warm, humidify, and filter inspired air
C. Produce pulmonary capillary blood
D. Perform most carbon dioxide diffusion
Answer: B. Warm, humidify, and filter inspired air
Rationale: The conducting zone transports air but does not perform significant gas exchange. It
conditions incoming air through warming, humidification, and filtration.
6. The mucociliary blanket protects the respiratory tract primarily by:
A. Increasing alveolar pressure
B. Trapping particles and moving them toward the oropharynx
C. Increasing surfactant secretion
D. Dilating pulmonary capillaries
Answer: B. Trapping particles and moving them toward the oropharynx
Rationale: Mucus traps organisms and debris while coordinated ciliary movement transports the
material upward for swallowing or expectoration.
,7. Effective pulmonary respiration requires which three processes?
A. Ventilation, perfusion, and diffusion
B. Filtration, secretion, and absorption
C. Ventilation, coagulation, and filtration
D. Diffusion, digestion, and osmosis
Answer: A. Ventilation, perfusion, and diffusion
Rationale: Ventilation supplies alveolar gas, perfusion supplies pulmonary capillary blood, and
diffusion allows O₂ and CO₂ to cross the alveolar-capillary membrane.
8. Gas exchange occurs predominantly across the:
A. Tracheal mucosa
B. Nasal epithelium
C. Alveolar-capillary membrane
D. Mainstem bronchi
Answer: C. Alveolar-capillary membrane
Rationale: Oxygen and carbon dioxide diffuse between alveolar gas and pulmonary capillary
blood across the thin respiratory membrane.
9. What is the most common viral cause of the common cold?
A. Influenza A
B. Rhinovirus
C. Epstein-Barr virus
D. Varicella-zoster virus
Answer: B. Rhinovirus
Rationale: Rhinoviruses account for a substantial proportion of uncomplicated upper respiratory
infections and are specifically emphasized in the course notes.
10. Which presentation is more suggestive of acute rhinosinusitis than an
uncomplicated common cold?
, A. Clear rhinorrhea alone
B. Mild throat irritation
C. Facial pain with fever
D. Sneezing alone
Answer: C. Facial pain with fever
Rationale: Facial pain/pressure and fever are more characteristic of rhinosinusitis, particularly
when symptoms persist or worsen.
11. The primary pathologic event in typical bacterial pneumonia is:
A. Destruction of the pituitary gland
B. Inflammatory exudate filling alveolar spaces
C. Permanent dilation of the bronchi
D. Loss of pleural fluid
Answer: B. Inflammatory exudate filling alveolar spaces
Rationale: Bacterial proliferation within alveoli produces inflammation, leukocyte recruitment,
and protein-rich exudation that interferes with gas exchange.
12. Which feature contributes substantially to the virulence of Streptococcus
pneumoniae?
A. Polysaccharide capsule
B. Lack of cell membrane
C. Absence of antigenic proteins
D. Production of pulmonary surfactant
Answer: A. Polysaccharide capsule
Rationale: Its capsule interferes with effective phagocytosis, allowing the organism to evade
host defenses.
13. Pneumonia that develops more than 48 hours after hospital admission is
generally classified as:
A. Community-acquired pneumonia
B. Hospital-acquired pneumonia
