Download Pulmonary Physiology Question Set

Pulmonary Physiology Question Set
PH97E3Q27
The following data are consistent with a person who has been
A. hyperventilating for a day.
B. hypoventilating for a day.
C. mountain climbing for a day.
D. breathing 100% oxygen for therapy.
E. suffering from moderate to severe COPD.
PH97E3Q28
A chronically bed ridden patient will be susceptible to
A. hypervolemia from over hydration.
B. red cell mass increase due to hypoxemia.
C. carpal tunnel syndrome from computer use.
D. kidney stone formation because of bone resorption.
E. hypoventilation.
Page 1 of 76
PH97E3Q29
Which of the following is not caused by rapid ascent from 20 min. at 100 ft. while scuba diving without exhaling?
A. Bends
B. Pneumothorax
C. Cerebral edema
D. Vision impairment
E. Helium bubble formation
PH97E3Q30
The greatest resistance to airflow occurs
A. in airways with laminar flow.
B. during inspiration.
C. in the restrictive diseases.
D. in the upper generations where the individual airways are large.
E. in the lower generations where the individual airways are small.
Page 2 of 76
PH97E3Q31
During a normal respiratory cycle, increased activation of the inspiratory muscles normally is accompanied by
A. inspired air being added to the RV.
B. inspired air being added to the FRC.
C. the pleural pressure first becoming negative, then positive.
D. alveolar pressure dropping from –5 mmHg to –9 mmHg.
E. increased resistance to airflow.
PH97E3Q32
You monitored static lung volumes and capacities on a patient sitting in your office, and again a week later lying
in a hospital bed. The second time you expect the ___________
to have increased.
A. IRV
B. FRC
C. TV
D. TLC
E. RV
Page 3 of 76
PH97E3Q33
Which of the following measures typically is increased in a patient with a restrictive disease?
A. FEV1
B. FEV1/FVC
C. RV
D. VC
E. pulmonary compliance
PH97E3Q34
At end-inspiration, the gas composition in the anatomic dead space is most similar to
A. venous blood.
B. arterial blood.
C. alveolar air.
D. pulmonary capillary blood.
E. atmospheric air.
Page 4 of 76
PH97E3Q35
What causes PaCO2 to fall to half its normal value?
A. The addition of 47 mmHg water vapor to the inspired air
B. Doubling the PIO2
C. Doubling the total minute ventilation
D. Halving the total minute ventilation
E. Doubling the alveolar ventilation
PH97E3Q36
The action of surfactant in reducing alveolar surface tension is
A. identical to that of detergent.
B. most effective at small alveolar volumes.
C. to produce a lowered, but constant, surface tension.
D. augmented in respiratory distress syndrome.
E. responsible for decreasing lung compliance at volumes near TLC.
Page 5 of 76
PH97E3Q37
Small airways close earlier during expiration in emphysemic patients because
A. the intrapleural pressure becomes too negative.
B. the pulmonary elastic recoil contribution to airway pressure is diminished.
C. pulmonary compliance has decreased.
D. extracellular fluid collects around the airways.
E. there is no effort-independent portion of the flow-volume loop in this
disease.
PH97E3Q38
Pulmonary wedge pressure is an indicator of
A. pulmonary arterial pressure.
B. right ventricular contractile function.
C. left ventricular preload.
D. central venous pressure.
E. right atrial pressure.
Page 6 of 76
PH97E3Q39
Which of the following is associated with minimal pulmonary vascular resistance?
A. Decreased cardiac output
B. Being at high lung volume
C. Being at low lung volume
D. Lungs being at FRC
E. Alveolar hypoxia
PH97E3Q40
In individuals who live at high altitudes, the generalized alveolar hypoxia causes
A. reduced pulmonary resistance and pulmonary arterial pressure.
B. a shift to the right of the ECG mean electrical axis.
C. a decrease in RV afterload.
D. a decrease in RV systolic pressure.
E. dilation of pulmonary arterioles.
Page 7 of 76
PH97E3Q41
Which of the following factors would not promote pulmonary edema formation?
A. Increased capillary colloid osmotic pressure, e.g., dehydration
B. Increased capillary hydrostatic pressure, e.g., myocardial infarction
C. Reduced lymph drainage, e.g., increased CVP
D. Decreased interstitial pressure, e.g., rapid pulmonary hyperinflation
E. Increased capillary permeability, e.g., sepsis
PH97E3Q42
Pulmonary zones 1, 2, and 3 refer to
A. large, medium, and small airways.
B. pulmonary areas responsible for TV, FRC, and TLC, respectively.
C. lung zones in which blood flow is controlled by the interactions of Pa, Pv,
and PA.
D. lung areas in which the effect of alveolar hypoxia becomes progressively
more potent.
Page 8 of 76
PH97E3Q43
A patient is breathing 100% oxygen (FIO2 = 1.0) so that the PaO2 was increased to 600 mmHg. How much
additional oxygen (above normal) is being carried in the blood?
A. 0.3 ml/dl
B. 1.5 ml/dl
C. 5.0 ml/dl
D. 15 ml/dl
E. 21 ml/dl
PH97E3Q44
Which of the following factors does not change as one ascends higher in altitude?
A. Total barometric pressure
B. Atmospheric partial pressure of oxygen
C. Percentage (fraction) of oxygen in the atmospheric air
D. PaO2
E. PvO2
Page 9 of 76
PH97E3Q45
What is the arterial oxygen content when PaO2 is 80 mmHg and hemoglobin content is normal (15 gm/dl)?
A. 0.24 ml/dl
B. 0.3 ml/dl
C. 5.2 ml/dl
D. 21.2 ml/dl
E. cannot calculate without further information
PH97E3Q46
Which of the following describes the plateau of the oxyhemoglobin dissociation curve?
A. Relatively small changes in oxygen content cause large changes in PaO2.
B. Promotes the release of oxygen to the tissues with small changes in PO2.
C. The P50 normally is found within the range of the plateau.
D. The presence of CO2 and H+ have a profound effect on the shape and
placement of the plateau phase.
Page 10 of 76
PH97E3Q47
A patient with polycythemia vera has which of the following characteristic blood gas values.
A. Increased PaO2 and increased arterial oxygen content
B. Increased percent arterial Hb saturation and decreased arterial oxygen
content
C. Normal PaO2 and increased arterial oxygen content
D. Decreased PaO2 and increased arterial oxygen content
E. Normal PaO2 and decreased arterial oxygen content
PH97E3Q48
In which of the hypoxia types would the PvO2 be above normal?
A. Stagnant
B. Hypoxic
C. Histotoxic
D. Anemic
Page 11 of 76
PH97E3Q49
Erythrocytes are necessary for the adequate transport of CO2 because
A. carbonic anhydrase within those cells catalyze the formation of HCO3from CO2.
B. the bulk of the CO2 is carried physically dissolved in the RBCs.
C. the bulk of the CO2 is carried attached to the external surface of the
plasma membrane.
D. most of the CO2 is carried on the Hb molecule.
E. the energy for the active transport of CO2 from the tissues to the blood is
provided by the RBC mitochondria.
PH97E3Q50
The statement “the presence of CO2 and H+ promotes the release of oxygen from oxyhemoglobin” is a
description of the
A. Haldane effect.
B. Hering-Breuer reflex.
C. Valsalva maneuver.
D. action of the pulmonary J-receptors.
E. Bohr effect.
Page 12 of 76
PH97E3Q51
A comparison of the oxyhemoglobin and carbon dioxide dissociation curves reveals that
A. doubling alveolar ventilation doubles PaCO2.
B. doubling alveolar ventilation doubles PaO2.
C. doubling alveolar ventilation drops both PaCO2 and PaO2.
D. arterial blood carries more total CO2 than oxygen.
E. doubling alveolar ventilation desaturates oxyhemoglobin.
PH97E3Q52
Pick the corresponding hypoxemia cause.:Always causes an increased PaCO2
A. hypoventilation
B. O2 diffusion defect
C. shunt
D. V/Q mismatch
E. depressed cardiac output
Page 13 of 76
PH97E3Q53
Pick the corresponding hypoxemia cause. Hypoxemia cannot be relieved by breathing 100% oxygen
A. hypoventilation
B. O2 diffusion defect
C. shunt
D. V/Q mismatch
E. depressed cardiac output
PH97E3Q54
Pick the corresponding hypoxemia cause. Has a normal P(A-a)O2 (alveolar to arterial gradient)
A. hypoventilation
B. O2 diffusion defect
C. shunt
D. V/Q mismatch
E. depressed cardiac output
Page 14 of 76
PH97E3Q55
Oxygen exchange across the alveolocapillary membrane
A. normally takes 0.75-0.85 sec.
B. is independent of total lung surface area.
C. is decreased if PAO2 is increased.
D. can be diffusion limited and/or perfusion limited.
E. is maximal in the pulmonary apex.
PH97E3Q56
Cardiopulmonary shunts
A. do not exist in the healthy subject.
B. depress PaO2 according to the severity of the shunts.
C. can be estimated by having the patient breathe a small concentration of
CO and measuring PaO2 15 minutes later.
D. include deoxygenated blood that empties into the right ventricle.
E. are the most common cause of hypoxemia.
Page 15 of 76
PH97E3Q57
The PO2 and PCO2 of blood leaving a pulmonary region are determined only by the
A. absolute amount of air going to that region.
B. total minute ventilation and cardiac output.
C. regional stroke volume and tidal volume.
D. PO2 and PCO2 of the pulmonary arterial blood, and of the inspired air,
entering that region (regional V/Q)
E. size of the anatomical dead space.
PH97E3Q58
Pleural pressure is most negative at
A. residual volume.
B. functional residual capacity.
C. end of tidal volume.
D. total lung capacity.
E. expiratory capacity.
Page 16 of 76
PH97E3Q59
In which of the following pulmonary disorders is the lung most likely to show a steep compliance curve?
A. Edema
B. Fibrosis
C. Emphysema
D. Congestion
PH97E3Q60
In normal individuals, the major cause of an P(A-a)O2 gradient is that
A. the diffusing capacity for oxygen is less than that for CO2.
B. there is a regional spread of the V/Q ratio in the lung.
C. no gas exchange occurs in the conducting airway.
D. there is a right-to-left shunt.
E. cardiac output is depressed.
Page 17 of 76
PH97E3Q61
Generation of the basic cyclic pattern of breathing requires participation of
A. the pontine respiratory group.
B. vagal afferent input to the pons.
C. vagal afferent input to the medulla.
D. an inhibitory loop in the medulla.
E. an intact spinal cord.
PH97E3Q62
Quiet expiration is associated with
A. a brief early burst by inspiratory neurons.
B. active abduction of the vocal cords.
C. an early burst of activity by expiratory muscles.
D. reciprocal inhibition of inspiratory and expiratory centers.
E. increased activity of slowly adapting receptors.
Page 18 of 76
PH97E3Q63
Which of the following periodic breathing patterns may be normal under certain conditions?
A. Apneustic breathing
B. Kussmaul’s breathing
C. Biot’s breathing
D. Cheyne-Stokes respiration
PH97E3Q64
Moderate hypoxemia’s most profound effect on the ventilatory control system is to
A. strongly stimulate the central chemoreceptors.
B. first stimulate, then inhibit, ventilation when PaO2 drops below 60 mmHg.
C. augment the system’s response to hypercapnia.
D. produce inspiratory gasps, each followed by a short period of exhalation.
E. increase ventilation in response to decreased arterial oxygen content, not
to decreased PO2.
Page 19 of 76
PH97E3Q65
A decrease in PvO2 below 40 mmHg
A. is dangerous because intracellular processes require a PO2 of at least 40
mmHg.
B. may occur when there is increased tissue extraction of oxygen.
C. is directly related to inadequate diffusion of oxygen in the alveoli.
D. is indicative of pulmonary right-to-left shunts.
E. occurs when blood stays in the lungs too long.
PH97E3Q66
After 10 minutes of breathing 100% oxygen, a patient’s PaO2 was found to be 104 mmHg. The patient most likely
has
A. a cardiopulmonary right-to-left shunt.
B. emphysema.
C. pulmonary fibrosis.
D. an abnormal hemoglobin.
E. no significant pulmonary abnormality.
Page 20 of 76
PH97E3Q67
Calculate the ventilation-perfusion (VA/Q) ration from the following data.
A. 0.75
B. 0.80
C. 0.90
D. 1.0
E. 1.5
PH97E3Q68
Both ______________ are greater at the base of the lung, whereas ____________ are greater in the apex.
A. the V/Q ratio and PAO2; perfusion and ventilation
B. PAO2 and PACO2; V/Q and perfusion
C. ventilation and perfusion; V/Q and PAO2
D. V/Q and ventilation; PACO2 and perfusion
E. perfusion and PAO2; ventilation and PACO2
Page 21 of 76
PH97E3Q69
Which of the following is an abnormal pulmonary function value?
A. V/Q = 0.2
B. PaO2 = 94 mmHg
C. FEV1/FVC = 81%
D. PvCO2 = 46 mmHg
E. P(A-a)O2 gradient = 8 mmHg
PH97E3Q70
A patient is hypoxemic while breathing air. You suspect either (1) a reduced diffusing capacity, or (2) a patent
foramen ovale. Which of the following distinguishes these two
causes of hypoxemia?
A. in 1 only, there will be a low PaO2
B. in 1 only, there will be a low PAO2
C. in 1 only, there will be an increased P(A-a)O2 gradient
D. in 2 only, there will be a low PaO2
E. in 2 only, the patient will remain hypoxemic when breathing 100% oxygen
Page 22 of 76
PH97E3Q71
Of the following pair of cardiopulmonary functions, in which is the first value greater than the second?
A. PaO2; PAO2
B. tidal volume; functional residual capacity
C. normal FEV1/FVC; emphysemic FEV1/FVC
D. V/Q in pulmonary base; V/Q in pulmonary apex
E. PvO2; PaO2
PH97E3Q72
In the fetus, the lungs
A. and chest do not show ventilatory motions.
B. receive little pulmonary blood flow.
C. present a low resistance to pulmonary blood flow.
D. contain a higher concentration of surfactant than the adult.
E. provide the fetus with oxygen.
Page 23 of 76
PH97E3Q73
The plasma blood supplying the fetus has an oxygen partial pressure of approximately
A. 30 mmHg.
B. 56 mmHg.
C. 72 mmHg.
D. 88 mmHg.
E. 102 mmHg.
PH97E3Q74
Which of the following pulmonary physiological measures decreases as one ages from approximately 25 to 60
years old?
A. Proportion of alveoli with high V/Q ratios
B. Proportion of alveoli with low V/Q ratios
C. Alveolocapillary membrane surface area and diffusion capacity
D. P(A-a)O2
E. Residual volume
Page 24 of 76
PH97E3Q75
To determine if your patient’s hypoxemia is due to hypoventilation, you want to calculate the P(A-a)O2. What
formula would you use?
A. Vco2/PaCO2
B. V1(C1-C2)/C2
C. (PaCO2 – PECO2)/PaCO2
D. [PIO2 – (PaCO2/R) – PaO2
E. Vgas/(P1-P2)
PH97E4Q26
The following graph depicting the relationships between arterial plasma PCO2, bicarbonate concentration, and
pH. An otherwise normal individual who has been hyperventilating
for 5 minutes.
Page 25 of 76
PH97E4Q27
The following graph depicting the relationships between arterial plasma PCO2, bicarbonate concentration, and
pH. An individual suffering from chronic alveolar edema and lactic
Acidosis
PH97E4Q28
The following graph depicting the relationships between arterial plasma PCO2, bicarbonate concentration, and
pH. An individual who has been vomiting his stomach contents for
3 days and whose respiratory system has partially compensated for the vomiting.
Page 26 of 76
PH97E4Q50
Which of the following typically is increased in a patient with restrictive disease?
A. FEV1
B. FEV1/FVC
C. FVC
D. RV
E. IC
PH97E4Q51
At end-inspiration, the gas composition in the anatomic dead space is most similar to:
A. alveolar air
B. venous blood
C. atmospheric air
D. pulmonary capillary blood
E. arterial blood
Page 27 of 76
PH97E4Q52
The action of surfactant in reducing alveolar surface tension is:
A. To produce a lowered, but constant surface tension
B. Augmented in respiratory distress syndrome
C. Responsible for decreasing lung compliance at volumes near TLC
D. Identical to that of detergent
E. Most effective at small alveolar volumes
PH97E4Q53
A patient with anemia has which of the following characteristic blood gas values?
A. increased PaO2 and increased arterial oxygen content
B. increased percent arterial Hb saturation, and decreased arterial oxygen
saturation
C. normal PaO2 and increased arterial oxygen content
D. decreased PaO2 and increased arterial oxygen content
E. normal PaO2 and decreased arterial oxygen content
Page 28 of 76
PH97E4Q54
Which of the following describes the plateau phase of oxyhemoglobin dissociation curve?
A. Relatively large changes in PO2 result in relatively small changes in O2
content
B. Promotes the release of oxygen to tissues with small changes in PO2
C. The P50 normally is found within the range of the plateau
D. The presence of CO2 and H+ have a profound effect on the shape and
placement of the plateau phase
PH97E4Q55
Pleural pressure is most negative at:
A. residual volume
B. Functional residual capacity
C. End of tidal volume
D. Total lung capacity
E. Expiratory capacity
Page 29 of 76
PH97E4Q56
Which of the following periodic breathing patterns may be normal under certain conditions?
A. apneustic breathing
B. Kussmaul breathing
C. Biot's breathing
D. Cheyne-Stokes respiration
PH97E4Q57
Moderate hypoxemia's most profound effect on the ventilatory control system is to:
A. Strongly stimulate the central chemoreceptors
B. First stimulate, then inhibits, ventilation when PaO2 drops below 60 mmHg
C. Augment the system's response to hypercapnia
D. Produce inspiratory gasps, each followed by a short period of exhalation
E. Increase ventilation in response to decreased arterial oxygen content, not
to decreased PO2.
Page 30 of 76
PH97E4Q58
Which of the following pathological conditions would not cause an increase in the P(A-a)O2?
A. Hypoventilation
B. Diffusion effect
C. Shunt
D. VA/Q mismatch
E. Depressed cardiac output
PH98E2Q05
Which of the following situations is responsible for decreased flux of oxygen from the alveolus of the lung to the
pulmonary capillary blood when pulmonary edema is present?
A. A decrease in lipid content of the pulmonary endothelial cell membrane
B. An increase in pulmonary blood flow
C. An increase in the distance between the capillary and the alveolus
D. A decrease in the size of endothelial clefts or pores
E. A decrease in the rate of oxygen transport by water crossing the
pulmonary capillary
Page 31 of 76
PH98E2Q31
An anxious patient became dizzy after hyperventilating for several minutes due to cerebral vascular
A. hypoxia (a decrease in arterial PO2).
B. hyperoxia (an increase in arterial PO2).
C. hypocapnia (a decrease in arterial PCO2).
D. hypercapnia (an increase in arterial PCO2).
E. endothelial release of nitric oxide (NO).
PH98E3Q01
In the lung, gas exchange between the air and blood occurs in the
A. terminal bronchioles.
B. trachea.
C. bronchii.
D. conducting zone.
E. respiratory zone.
Page 32 of 76
PH98E3Q02
Collapse of the main bronchii is prevented by _______ when intrathoracic pressure is increased above airway
pressure.
A. elastic tissue of the lung parenchyma
B. the bronchial circulatory tree
C. the pulmonary circulatory tree
D. u-shaped cartilage surrounding the conducting tube
E. lung elasticity resisting the increased pressure
PH98E3Q03
The blood-gas interface of the lung is largest at the
A. bronchial circulation.
B. alveolar capillary membrane.
C. juncture of the conducting zone to the respiratory zone.
D. bifurcation of the main bronchii.
E. respiratory bronchiole.
Page 33 of 76
PH98E3Q04
Lung transmural pressure is
A. always negative.
B. equal to interpleural pressure minus atmospheric pressure.
C. equal to interpleural pressure minus alveolar pressure.
D. equal to alveolar pressure minus interpleural pressure.
E. independent of lung volume when the muscles are relaxed.
PH98E3Q05
During inspiration, as the diaphragm contracts, the pressure in the interpleural space becomes
A. equal to zero.
B. more positive.
C. more negative.
D. equal to alveolar pressure.
E. equal to atmospheric pressure.
Page 34 of 76
PH98E3Q06
At the end of inspiration, the average pleural pressure is –8 cmH2O. What is the transpulmonary pressure in
cmH2O?
A. 0
B. –8
C. +8
D. –5
E. +5
PH98E3Q07
A patient with poor lung ventilation requires a measurement of FRC. Which test does the physician order?
A. FEV1.0
B. TLC
C. Helium-dilution spirometry
D. FEF25-75
E. body plethysmography
Page 35 of 76
PH98E3Q08
A patient with restrictive lung disease typically has a(n)
A. increased FEV1.0.
B. increased FEV1.0/FVC.
C. increased TLC.
D. decreased FEF25-75.
E. increased RV.
PH98E3Q09
A 70 year old female patient has chronic lung disease and hypercapnia and requires surgery. To insure she has
adequate alveolar ventilation during surgery, which of the following should be available?
A. A tank supplying 100% O2
B. A tank supplying an 80%/20% helium-oxygen mixture
C. An EKG machine
D. Mechanical respirator
E. A tank supplying 95% O2 and 5% CO2
Page 36 of 76
PH98E3Q10
A 45 year-old male patient is examined and found to have a respiratory rate of 15 breaths/min, a tidal volume of
0.5 L, and a dead space of 200 ml. When the patient is asked to increase his respiratory rate to 30 breaths/min,
his tidal volume is measured at 350 ml. Assuming no change in dead space, which of the following is true
regarding alveolar PCO2?
A. PCO2 will increase because of the decreased ventilation.
B. PCO2 will decrease because of the increased ventilation.
C. PCO2 will not change because it is not affected by respiration.
D. PCO2 will not change because alveolar ventilation remains constant.
E. The arterial blood pH will decrease because of the increased ventilation.
PH98E3Q11
The respiratory system is at the equilibrium position in all of the following conditions EXCEPT
A. at the end of a normal expiration.
B. when the transrespiratory pressure is zero.
C. when lung recoil is balanced by chest wall expansion.
D. when lung volume is at residual volume.
E. when the respiratory muscles are relaxed and the airway is open.
Page 37 of 76
PH98E3Q12
A lack of normal surfactant results in
A. an increased lung compliance.
B. stabilization of alveolar volume.
C. an increased retractive force of the lungs.
D. a reduced alveolar to arterial PO2 difference.
E. a decrease in the filtration forces in the pulmonary capillaries.
PH98E3Q13
Two alveoli with surfactant are joined and interconnected. If alveolus A ahas a surface tension of 100 dynes/cm
and a radius of 1.0 mm and alveolus B has a surface tension of 50
dynes/cm and a radius of 5.0 mm, then alveolus B will
A. increase in radius.
B. decrease in radius.
C. remain the same.
D. collapse.
E. explode.
Page 38 of 76
PH98E3Q14
The compliance of the respiratory system is
A. greater than the compliance of the chest wall.
B. greater than the compliance of the lungs.
C. equal to the compliance of the chest wall.
D. equal to the compliance of the lungs.
E. less than the compliance of the chest wall.
PH98E3Q15
FEV1 is used to evaluate the
A. flow resistance properties of the airways.
B. compliance properties of the lungs.
C. pulmonary blood flow resistance.
D. elastance properties of the lungs.
E. ventilation: perfusion ratio.
Page 39 of 76
PH98E3Q16
Airway resistance of the small peripheral airways (less than 2 mm in diameter) is
A. high because of the small diameter of each tube.
B. high due to the velocity of flow.
C. high due to the high viscosity of gas.
D. low because of the turbulent flow that is normally present.
E. low because of their large total cross sectional area.
PH98E3Q17
During the effort-independent portion of a forced vital capacity, the expiratory flow rate
A. varies as a function of the pleural pressure.
B. is limited by compression of the airways.
C. depends on the alveolar pressure.
D. is maximal for that individual.
E. is constant.
Page 40 of 76
PH98E3Q18
Pulmonary vascular resistance is
A. decreased at low lung volumes.
B. decreased by breathing low oxygen.
C. unaffected by high lung volumes.
D. decreased with increased pulmonary arterial pressure.
E. increased by parasympathetic stimulation.
PH98E3Q19
The pulmonary and systemic circulations have the same
A. mean pressure.
B. vascular resistance.
C. compliance.
D. flow per minute.
E. hypoxic vasoconstrictor response.
Page 41 of 76
PH98E3Q20
Normal O2 delivery to the tissues would be halved by a 50% decrease in
A. arterial PO2.
B. minute ventilation.
C. hemoglobin concentration.
D. alveolar ventilation.
E. inspired PO2.
PH98E3Q21
When arterial PO2 decreases from 100 mmHg to 27 mmHg, given an arterial pH of 7.4 and PaCO2 of 40 mmHg,
the O2 content in the blood will decrease by
A. 10%
B. 25%
C. 35%
D. 50%
E. 75%
Page 42 of 76
PH98E3Q22
A reduction of arterial PO2 is typical of
A. anemia
B. CO poisoning.
C. moderate exercise.
D. cyanide poisoning.
E. hypoventilation.
PH98E3Q24
The pH of venous blood, compared to the pH of arterial blood, is
A. higher because of the additional CO2.
B. lower because of the additional CO2.
C. higher because of the removal of O2.
D. lower because of the removal of O2.
E. exactly the same.
Page 43 of 76
PH98E3Q25
The variation in the ventilation:perfusion ratio in different areas of the normal lung is due primarily to the effects
of
A. neural control on the distribution of blood flow.
B. neural control on the distribution of tidal volume.
C. gravity.
D. the hemoglobin dissociation curve.
E. CO2 on smooth muscle in the lungs.
PH98E3Q26
The alveolar PO2 in the apex of a vertical lung is high because the apex of the lung
A. has a low metabolic rate.
B. receives a high blood flow.
C. has a high ventilation:perfusion ratio.
D. receives the major portion of the tidal volume.
E. does not participate in gas exchange.
Page 44 of 76
PH98E3Q27
A patient’s PaCO2 is 65 mmHg and the PaO2 is 40 mmHg. The patient has a normal A-a O2 gradient. These
findings indicate a
A. low VA/Q ratio.
B. shunt.
C. generalized hypoventilation.
D. diffusion impairment for O2.
E. diffusion impairment for CO2.
PH98E3Q28
The most common cause of hypoxemia is
A. hypoventilation
B. ventilation-perfusion imbalance.
C. Anemia
D. anatomic shunt.
E. hyperventilation.
Page 45 of 76
PH98E3Q29
The following data are collected from a 40 year-old male patient. These data indicate that this patient most likely
has a(n)
A. arterial PCO2 less than 40mmHg.
B. arterial PO2 less than 85 mmHg.
C. mean pulmonary artery pressure less than 15 mmHg.
D. total work of breathing less than normal.
E. arterial [HCO3-:[H2CO3 ratio greater than 20:1.
PH98E3Q30
PCO2 affects respiration primarily by stimulating the
A. carotid and aortic bodies
B. mechanoreceptors.
C. medullary chemoreceptors.
D. baroreceptors.
E. hypoglossal nerve.
Page 46 of 76
PH98E3Q31
Generation of the signal for a cyclic pattern of breathing in the CNS requires participation of
A. the pontine respiratory group.
B. vagal afferent input to the pons.
C. vagal afferent input to the medulla.
D. an inhibitory loop in the medulla.
E. an intact spinal cord.
PH98E3Q32
Match each person described below with the set of blood data that best coincides with that person’s condition.
Arterial PO2(mmHg) / Arterial PCO2(mmHg) / O2 Content(ml/dl) /Arterial pH A normal 40 year-old man who has
been mountain climbing in the Andes for two days
Page 47 of 76
PH98E3Q33
Match each person described below with the set of blood data that best coincides with that person’s condition.
Arterial PO2(mmHg) / Arterial PCO2(mmHg) / O2 Content(ml/dl) /Arterial pH A 30 year-old anemic woman
PH98E3Q34
Match each person described below with the set of blood data that best coincides with that person’s condition.
Arterial PO2(mmHg) / Arterial PCO2(mmHg) / O2 Content(ml/dl) /Arterial pH A 73 year-old man who is
hypoventilating
Page 48 of 76
PH98E3Q35
Match each person described below with the set of blood data that best coincides with that person’s condition.
Arterial PO2(mmHg) / Arterial PCO2(mmHg) / O2 Content(ml/dl) /Arterial pH A 45 year-old woman who is
hyperventilating
PH98E3Q36
Match each person described below with the set of blood data that best coincides with that person’s condition.
Arterial PO2(mmHg) / Arterial PCO2(mmHg) / O2 Content(ml/dl) /Arterial pH A 56 year-old man with moderately
severe obstructive lung disease
Page 49 of 76
PH98E3Q37
An increased airway resistance is caused by all of the following factors EXCEPT
A. increased lung volume.
B. parasympathetic stimulation.
C. aging.
D. chronic bronchitis.
E. asthma.
PH98E4Q52
The volume of gas in the lungs at the end of a normal expiration is referred to as the
A. residual volume.
B. Expiratory reserve volume.
C. Functional residual capacity.
D. Inspiratory reserve volume.
E. Total lung capacity.
Page 50 of 76
PH98E4Q53
Which of the following statements best characterizes the relationship between alveolar ventilation (VA) and
alveolar PCO2 (PACO2)?
A. An increase in VA causes a decrease in PACO2.
B. An increase in VA causes an increase in PACO2.
C. A decrease in VA causes a decrease in PACO2.
D. VA has no effect on PACO2.
E. VA has no effect on PAO2.
PH98E4Q54
The distribution of pulmonary blood flow is
A. equal throughout the lungs.
B. Increased in the dependent portions of the lung.
C. Not affected by changes in pulmonary vascular resistance.
D. Not affected by changes in alveolar pressure.
E. Not affected by changes in interpleural pressure.
Page 51 of 76
PH98E4Q55
Carbon dioxide from the tissues is transported to the lungs primarily
A. as carbamino hemoglobin.
B. As bicarbonate.
C. In white blood cells.
D. As dissolved CO2.
E. In red blood cells.
PH98E4Q56
Lowering pulmonary venous pressure will have the greatest effect on regional blood flow in
A. zone 1.
B. Zone 2.
C. Zone 3.
D. Zones 1 and 2 equally.
E. Zones 2 and 3 equally.
Page 52 of 76
PH98E4Q57
Which of the following is true about cerebrospinal fluid?
A. Its protein content is equal to that of plasma.
B. Its PCO2 equals that of systemic arterial blood.
C. It is freely accessible to blood hydrogen ions.
D. Its composition is essentially that of a plasma ultrafiltrate.
E. Its pH is a function of PaCO2.
PH98E4Q58
The slope of the pressure-volume curve of the lung represents
A. resistance.
B. Compliance.
C. Conductance.
D. Reluctance.
E. Inductance.
Page 53 of 76
PH98E4Q59
A patient presents with crushing chest pain, shortness of breath, and marked anxiety. A preliminary diagnosis of
acute myocardial infarction is made. Physical examination reveals evidence of pulmonary edema, cardiomegaly,
peripheral edema, and pulmonary hypertension. Arterial blood gas analysis on room air, reveals the following:
This patient’s blood data are most indicative of
A. a diffusion abnormality.
B. Hypoventilation.
C. A ventilation:perfusion abnormality.
D. Left-to-right cardiac shunt.
E. Hyperventilation.
PH98E4Q60
A patient presents with crushing chest pain, shortness of breath, and marked anxiety. A preliminary diagnosis of
acute myocardial infarction is made. Physical examination
reveals evidence of pulmonary edema, cardiomegaly, peripheral edema, and pulmonary hypertension. Arterial
blood gas analysis on room air, reveals the following: This patient
is admitted to the Critical Care Unit, sedated, and given 40% O2 by respirator, which is set to deliver a tidal
volume of 0.6 L at a rate of 16 breaths/min. An inspiratory pressure of
20 mm Hg is required to deliver the tidal volume. If the patient’s predicted dead space is 150 mL, then his
calculated alveolar ventilation is approximately
A. 5 L/min.
B. 7 L/min.
C. 9 L/min.
D. 12 L/min.
E. 16 L/min.
Page 54 of 76
PH99E3Q30
A 50 year old woman, Sanora Lot, has obstructive sleep apnea, causing her upper airway to occlude for 30-60 sec
periods during sleep. These periods of apnea will cause an increase in arterial ___________ and provoke a
chemoreceptor-mediated ____________.
A. PCO2; peripheral vasodilation
B. PCO2; increase in respiratory drive
C. pH; increase in pleural pressure
D. PO2; increase in systemic vascular resistance
E. PO2; decrease in phrenic nerve activity
PH99E3Q31
Which statement about the lung is true for a seated person?
A. at total lung capacity, the volume of an alveolus is greater at the apex
than at the base
B. airflow is distributed preferentially to the base where regional compliance
is greatest
C. during inspiration, the change in alveolar volume is greatest in the apex
D. at end expiration, the alveoli are smaller at the apex than in the base
E. distension of the lung closes small airways in the apex limiting airflow
distribution to the apex
Page 55 of 76
PH99E3Q32
Pulmonary vascular resistance is LOWEST at
A. residual volume
B. functional residual capacity
C. total lung capacity
D. the end of a normal inspiration
E. inspiratory capacity
PH99E3Q33
A shift of the oxygen-hemoglobin curve to the left reflects a(n) __________ in the affinity of hemoglobin for
oxygen and a(n) __________ in the oxygen released to the tissue.
A. increase; decrease
B. increase; increase
C. decrease; decrease
D. decrease; increase
E. no change; no change
Page 56 of 76
PH99E3Q34
The oxygen content of blood at a PaO2 of 55 mmHg is greater in a(n)
A. alkalotic patient than in an acidotic patient
B. anemic person than in a normal person
C. hyperthermic patient than in a patient with normal body temperature
D. hypoventilating patient than in a hyperventilating patient
E. patient with elevated circulating 2, 3 DPG than in a normal person
PH99E3Q35
A decrease in PaO2, from 95 to 65 mmHg results in approximately a __________ in arterial O2 content.
A. <10% decrease
B. 25% decrease
C. 50% decrease
D. 75% increase
E. 25% increase
Page 57 of 76
PH99E3Q36
The respiratory response to hypoxemia _________ with _________ in PaCO2.
A. increases; increases
B. increases; decreases
C. decreases; increases
D. remains the same; decreases
E. remains the same; increases
PH99E3Q37
Delivery of O2 to the tissues decreases by 50% if
A. PAO2 decreases from 100 to 50 mm Hg
B. VR decreases from 10 to 5 L/min
C. One lung is removed
D. Hemoglobin concentration decreases from 15 to 7.5 mg/dl
E. PaO2 decreases from 100 to 50 mm Hg
Page 58 of 76
PH99E3Q38
Airway resistance increases with which of the following conditions?
A. aging
B. restrictive lung disease
C. airway dilation
D. increasing lung volume
E. increasing cardiac output
PH99E3Q39
The affinity of hemoglobin for oxygen increases with increases in
A. temperature
B. CO
C. PCO2
D. 2, 3 DPG
E. H+ concentration
Page 59 of 76
PH99E3Q40
A person with normal lung function who is mountain climbing.
A. PaO2 - 98 : PaCO2 - 40
B. PaO2 - 98 : PaCO2 - 30
C. PaO2 - 40 : PaCO2 - 80
D. PaO2 - 80 : PaCO2 - 50
E. PaO2 - 40 : PaCO2 - 25
PH99E3Q41
A person with normal lung function near sea level.
A. PaO2 - 98 : PaCO2 - 40
B. PaO2 - 98 : PaCO2 - 30
C. PaO2 - 40 : PaCO2 - 80
D. PaO2 - 80 : PaCO2 - 50
E. PaO2 - 40 : PaCO2 - 25
Page 60 of 76
PH99E3Q42
A normal person who is hypoventilating.
A. PaO2 - 98 : PaCO2 - 40
B. PaO2 - 98 : PaCO2 - 30
C. PaO2 - 40 : PaCO2 - 80
D. PaO2 - 80 : PaCO2 - 50
E. PaO2 - 40 : PaCO2 - 25
PH99E3Q43
A person who is hyperventilating.
A. PaO2 - 98 : PaCO2 - 40
B. PaO2 - 98 : PaCO2 - 30
C. PaO2 - 40 : PaCO2 - 80
D. PaO2 - 80 : PaCO2 - 50
E. PaO2 - 40 : PaCO2 - 25
Page 61 of 76
PH99E3Q44
A person with pulmonary edema.
A. PaO2 - 98 : PaCO2 - 40
B. PaO2 - 98 : PaCO2 - 30
C. PaO2 - 40 : PaCO2 - 80
D. PaO2 - 80 : PaCO2 - 50
E. PaO2 - 40 : PaCO2 - 25
PH99E3Q45
Lower than normal V/Q ratio ___________ PaO2, and higher than normal V/Q ratio ________ PaO2.
A. decreases; increases
B. decreases; does not significantly affect
C. does not significantly affect; decreases
D. increases; decreases
E. increases; increases
Page 62 of 76
PH99E3Q46
Increasing FIO2,will NOT improve the hypoxemia caused by
A. diffusion impairment
B. hypoventilation
C. shunt
D. hyperventilation
E. CO poisoning
PH99E3Q47
CO2 transport in blood
A. is enhanced by anemia
B. is independent of HCO3C. is entirely in the form of dissolved CO2
D. is independent of Hb
E. is less in oxygenated than deoxygenated blood
Page 63 of 76
PH99E3Q48
Small airways close earlier during expiration in emphysemic patients because
A. the intrapleural pressure becomes too negative
B. the pulmonary elastic recoil contribution to airway pressure is diminished
C. pulmonary compliance has decreased
D. extracellular fluid collects around the airways
E. there is no effort-independent portion of the flow-volume loop in this
disease
PH99E3Q49
During a forced expiratory maneuver,
A. airway resistance decreases as the lung empties
B. expiratory muscle force is less important than elastic recoil of lung at 50%
of vital capacity
C. peak flow rates depend completely on effort at 50% of vital capacity
D. maximal flow rates are lower near total lung capacity than at 50% of vital
capacity
E. at the same lung volume, maximal flow rates are lower in resistive than
obstructive disease
Page 64 of 76
PH99E3Q50
During exercise, pulmonary blood flow
A. increases because pulmonary capillary resistance increases
B. decreases with the distension of pulmonary capillaries
C. increases as pulmonary artery pressure increases
D. decreases even with decreases in pulmonary capillary resistance
E. increases but pulmonary artery resistance does not change
PH99E3Q51
During resting ventilation, pleural pressure
A. is the same during inspiration as expiration at any given lung volume
B. is approximately +5 cm H2O at function residual capacity
C. is more negative at end inspiration than at end expiration
D. is more negative at the bottom of the lung than at the top of the lung
E. is positive during expiration
Page 65 of 76
PH99E3Q52
A patient swallows a balloon into his esophagus allowing pleural pressure to be measured. At rest, with the
glottis open, pleural pressure is –4 cm H2O and lung volume is 2.5 L.
After inhalation to a volume of 5.0 L, the patient maintains that volume while opening his glottis. His pleural
pressure is –16.5 cm H2O. During this inhalation from 2.5 to 5.0 L,
A. airway resistance increases
B. the elastic recoil of the lungs decrease
C. transpulmonary pressure increases
D. lung compliance increases
E. pulmonary vascular resistance decreases
PH99E3Q53
A patient swallows a balloon into his esophagus allowing pleural pressure to be measured. At rest, with the
glottis open, pleural pressure is –4 cm H2O and lung volume is 2.5 L.
After inhalation to a volume of 5.0 L, the patient maintains that volume while opening his glottis. His pleural
pressure is –16.5 cm H2O. While still at the lung volume of 5.0 L, the
same patient closes the glottis and relaxes all the respiratory muscles. Pleural pressure rises to +2 cm H2O.
Which of the following statements is true?
A. alveolar pressure is +18.5 cm H2O
B. the thoracic cavity returns to its resting volume
C. the elastic recoil of the lung decreases
D. the chest wall is recoiling outward
E. transpulmonary pressure decreases
Page 66 of 76
PH99E3Q54
A patient swallows a balloon into his esophagus allowing pleural pressure to be measured. At rest, with the
glottis open, pleural pressure is –4 cm H2O and lung volume is 2.5 L.
After inhalation to a volume of 5.0 L, the patient maintains that volume while opening his glottis. His pleural
pressure is –16.5 cm H2O. The patient contracts his expiratory
muscles against a closed glottis, and pleural pressure increases to +14 cm H2O. Then the patient opens his
glottis and exhales forcefully. During this exhalation from 5.0 to 2.5 L,
A. alveolar pressure increases
B. pleural pressure may equal or exceed their airway pressure limiting airflow
C. abdominal and internal intercostals muscles are relaxed
D. expiratory airflow is greatest as patient approaches 2.5 L
E. airway resistance decreases progressively during this expiration
PH99E3Q55
Pulmonary surfactant
A. lowers surface tension uniformly across alveoli
B. acts identically to detergent
C. is most effective at small lung volumes
D. is optimally effective in the second trimester of fetal development
E. does not explain the hysteresis in the lung pressure volume curve
Page 67 of 76
PH99E3Q56
A patient with anemia has which of the following characteristics?
A. increased PaO2 and increased arterial O2 content
B. normal PaO2 and decreased arterial O2 content
C. decreased PaO2 and increased arterial O2 content
D. increased arterial Hb saturation but decreased arterial O2 content
E. decreased arterial Hb saturation and decreased arterial O2 content
PH99E3Q57
You suspect a patient has emphysema if
A. FEV1 is increased
B. FEV1/FVC is increased
C. RV is decreased
D. FRC is increased
E. TLC is decreased
Page 68 of 76
PH99E3Q58
You suspect a patient has restrictive lung disease if
A. FEV1 is increased
B. FEV1/FVC is increased
C. RV is increased
D. FRC is increased
E. FEV1 is greater than TLC
PH99E3Q59
At end inspiration, the gas composition in the anatomic dead space is most similar to
A. alveolar air
B. venous blood
C. hydrated atmospheric air
D. arterial blood
E. pulmonary capillary bed
Page 69 of 76
PH99E3Q60
In the neural control of respiration,
A. the repetitive signal requires rhythmic sensory input from the lungs
B. the rhythmic repetitive signal is generated in the brainstem
C. the rhythmic repetitive signal is generated in the spinal cord
D. respiratory drive decreases with input from peripheral chemoreceptors
E. respiratory drive increases with the transition from wakefulness to NREM
sleep
PH99E4Q01
The fetus compensates for its hypoxic environment by _____ hemoglobin concentration with a(n) _____ oxygen
affinity.
A. increased; decreased
B. increased; increased
C. decreased; decreased
D. decreased; increased
E. unchanged; unchanged
Page 70 of 76
PH99E4Q02
In the fetus, blood flow is diverted from the lungs by the _____ and _____, and by_____ pulmonary vascular
resistance.
A. ductus venosus; forman ovale; low
B. ductus venosus; forman ovale; high
C. ductus arteriosus; ductus venosus; low
D. ductus arteriosus; ductus venosus; high
E. ductus arteriosus; forman ovale; high
PH99E4Q03
A leftward shift of the oxygen-hemoglobin dissociation curve naturally occurs in the _____. This reflects
a(n)_____ in the affinity of hemoglobin for oxygen and a(n)_____ in the blood oxygen content at a given PaO2.
A. lungs; increase; decrease
B. tissue; increase; increase
C. lungs; increase; increase
D. tissue; decrease; increase
E. lungs; decrease; decrease
Page 71 of 76
PH99E4Q04
The respiratory response to hypoxemia _____ with _____ in PaCO2.
A. increases; increases
B. increases; decreases
C. decreases; increases
D. remains the same; decreases
E. remains the same; increases
PH99E4Q05
In the lung, a high V/Q mismatch _____ blood oxygen content and _____ PaO2 in that area.
A. increase; increases
B. increases; has a minimal effect on
C. decreases; decreases
D. decreases; has a minimal effect on
E. does not change; has a minimal effect on
Page 72 of 76
PH99E4Q06
In the lung, a low V/Q mismatch _____ blood oxygen content and _____ PaO2 in that area.
A. increases; increases
B. increases; has a minimal effect on
C. decreases; decreases
D. decreases; has a minimal effect on
E. does not change; has a minimal effect on
PH99E4Q07
The most common indicator of carbon monoxide poisoning is
A. low PaO2
B. an abnormal A-a oxygen gradient
C. hyperventilation
D. hypertension
E. headache
Page 73 of 76
PH99E4Q08
In an exercising muscle, O2 release from hemoglobin _____ because _____ increases.
A. decreases; temperature
B. remains the same; ventilation
C. increases; pH
D. increases; 2,3 DPG
E. increases; PaCO2
PH99E4Q09
A patient has a low PaO2 and a normal A-a oxygen gradient. This person is
A. hyperventilating
B. anemic
C. mountain climbing
D. breathing 100% oxygen
E. at sea level
Page 74 of 76
PH99E4Q10
The most common cause of a low PaO2 and an abnormal A-a oxygen gradient is _____ and should be corrected
by supplemental oxygen.
A. hypoventilation
B. anemia
C. V/Q mismatch
D. Shunt
E. Diffusion barrier
PH99E4Q11
A patient with a low PaO2 and abnormal A-a oxygen gradient receives supplemental oxygen. The PaO2 remains
low, indicating the presence of
A. shunt
B. anemia
C. V/Q mismatch
D. fetal hemoglobin
E. hyperventilation
Page 75 of 76
PH99E4Q12
This patient is then given a very small amount of carbon monoxide. A sample of the exhaled gas contains no
carbon monoxide, indicating the presence of
A. a shunt
B. a diffusion barrier
C. V/Q mismatch
D. fetal hemoglobin
E. hyperventilation
Page 76 of 76
Pulmonary
Question
Set
Answer Key
PH97E3Q27 C
PH97E3Q28 D
PH97E3Q29 E
PH97E3Q30 D
PH97E3Q31 B
PH97E3Q32 A
PH97E3Q33 B
PH97E3Q34 E
PH97E3Q35 E
PH97E3Q36 B
PH97E3Q37 B
PH97E3Q38 C
PH97E3Q39 D
PH97E3Q40 B
PH97E3Q41 A
PH97E3Q42 C
PH97E3Q43 B
PH97E3Q44 C
PH97E3Q45 E
PH97E3Q46 A
PH97E3Q47 C
PH97E3Q48 C
PH97E3Q49 A
PH97E3Q50 E
PH97E3Q51 D
PH97E3Q52 A
PH97E3Q53 C
PH97E3Q54 A
PH97E3Q55 D
PH97E3Q56 B
PH97E3Q57 D
PH97E3Q58 D
PH97E3Q59 C
PH97E3Q60 B
PH97E3Q61 D
PH97E3Q62 A
PH97E3Q63 D
PH97E3Q64 C
PH97E3Q65 B
PH97E3Q66 A
PH97E3Q67 C
PH97E3Q68 C
PH97E3Q69 A
PH97E3Q70 E
PH97E3Q71 C
PH97E3Q72 B
PH97E3Q73 A
PH97E3Q74 C
PH97E3Q75 D
PH97E4Q26 D
PH97E4Q27 C
PH97E4Q28 A
PH97E4Q50 B
PH97E4Q51 C
PH97E4Q52 E
PH97E4Q53 E
PH97E4Q54 A
PH97E4Q55 D
PH97E4Q56 D
PH97E4Q57 C
PH97E4Q58 A
PH98E2Q05 C
PH98E2Q31 C
PH98E3Q01 E
PH98E3Q02 D
PH98E3Q03 B
PH98E3Q04 D
PH98E3Q05 C
PH98E3Q06 C
PH98E3Q07 E
PH98E3Q08 B
PH98E3Q09 D
PH98E3Q10 D
PH98E3Q11 D
PH98E3Q12 C
PH98E3Q13 C
PH98E3Q14 E
PH98E3Q15 A
PH98E3Q16 E
PH98E3Q17 B
PH98E3Q18 D
PH98E3Q19 D
PH98E3Q20 C
PH98E3Q21 D
PH98E3Q22 E
PH98E3Q24 B
PH98E3Q25 C
PH98E3Q26 C
PH98E3Q27 C
PH98E3Q28 B
PH98E3Q29 B
PH98E3Q30 C
PH98E3Q31 D
PH98E3Q32 E
PH98E3Q33 A
PH98E3Q34 B
PH98E3Q35 D
PH98E3Q36 C
PH98E3Q37 A
PH98E4Q52 C
PH98E4Q53 A
PH98E4Q54 B
PH98E4Q55 B
PH98E4Q56 C
PH98E4Q57 E
PH98E4Q58 B
PH98E4Q59 C
PH98E4Q60 B
PH99E3Q30 B
PH99E3Q31 B
PH99E3Q32 B
PH99E3Q33 A
PH99E3Q34 A
PH99E3Q35 A
PH99E3Q36 A
PH99E3Q37 D
PH99E3Q38 A
PH99E3Q39 B
PH99E3Q40 E
PH99E3Q41 A
PH99E3Q42 C
PH99E3Q43 B
PH99E3Q44 D
PH99E3Q45 A B
PH99E3Q46 C
PH99E3Q47 E
PH99E3Q48 B
PH99E3Q49 B
PH99E3Q50 C
PH99E3Q51 C
PH99E3Q52 C
PH99E3Q53 A
PH99E3Q54 B
PH99E3Q55 C
PH99E3Q56 B
PH99E3Q57 D
PH99E3Q58 B
PH99E3Q59 C
PH99E3Q60 B
PH99E4Q01 B
PH99E4Q02 E
PH99E4Q03 C
PH99E4Q04 A
PH99E4Q05 *
PH99E4Q06 C
PH99E4Q07 E
PH99E4Q08 E
PH99E4Q09 C
PH99E4Q10 C
PH99E4Q11 A
PH99E4Q12 A