RESPIRATORY SYSTEM 483

RUL right upper lobe (of lung) VT tidal volume—amount of air inhaled
RV residual volume—amount of air and exhaled during a normal
remaining in lungs at the end of ventilation
maximal expiration VATS video-assisted thoracic surgery
SCLC small cell lung cancer (thoracoscopy)

SOB shortness of breath VC vital capacity—equals inspiratory

reserve volume plus expiratory
TB tuberculosis reserve volume plus tidal volume
TLC total lung capacity—volume of gas in 12
V/Q scan ventilation-perfusion scan—radioactive
the lungs at the end of maximal test of lung ventilation and blood
inspiration; equals VC plus RV perfusion throughout the lung
URI upper respiratory infection capillaries (lung scan)

PRACTICAL APPLICATIONS
Reproduced here are actual medical reports using terms that you have studied in this
and previous chapters. Explanations of more difficult terms are added in brackets. Answers to the
questions for the autopsy report are on page 493.
CASE REPORT

A 22-year-old known heroin abuser was admitted to an emergency department comatose with shallow
respirations. Routine laboratory studies and chest x-ray studies were done after the patient was
aroused. He was then transferred to the ICU. He complained of left-sided chest pain. Examination of the
chest x-ray showed three fractured ribs on the right and a large right pleural effusion. Further ques-
tioning of a friend revealed that he had fallen and struck the corner of a table after injecting heroin.
The diagnosis was traumatic hemothorax secondary to rib fractures, and a chest tube was inserted
into the right pleural space. No blood could be obtained despite maneuvering of the tube. Another chest
x-ray showed that the tube was correctly placed in the right pleural space, but the fractured ribs and
pleural effusion were on the left. The radiologist then realized that he had reversed the first film. A
second tube was inserted into the left pleural space, and 1500 mL [6 to 7 cups] of blood was evacuated.

AUTOPSY REPORT

Adenocarcinoma, bronchogenic, left lung, with extensive mediastinal, pleural, and pericardial
involvement. Metastasis to tracheobronchial lymph nodes, liver, lumbar vertebrae. Pulmonary emboli,
multiple, recent, with recent infarct of left lower lobe. The tumor apparently originated at the left
main bronchus and extends peripherally. Parenchyma (alveoli) is particularly atelectatic with a centrally
located area of hemorrhage in the lower lobe.
Questions about the Autopsy Report
1. What was the patient’s primary disease?
a. Blood clots in the lung
b. Mediastinal, pleural, and pericardial inflammation
c. Lung cancer
2. Which was not an area of metastasis?
a. Backbones
b. Bone marrow
c. Hepatocytes
 484 RESPIRATORY SYSTEM

3. What event probably was the cause of death?

a. Infarction of lung tissue caused by pulmonary emboli
b. COPD
c. Myocardial infarction
4. What best describes the pulmonary parenchyma in the lower left lobe?
a. Alveoli are filled with tumor.
b. Alveoli are collapsed, with central area of bleeding.
c. Alveoli are filled with pus and blood.
12
X-RAY AND BRONCHOSCOPY REPORTS

1. CXR: Complete opacification of left hemithorax with deviation of mediastinal structures of right
side. Massive pleural effusion.
2. Chest tomograms: Mass most compatible with LUL bronchogenic carcinoma. Possible left
paratracheal adenopathy or direct involvement of mediastinum.
3. Bronchoscopy: Larynx, trachea, carina [area of bifurcation or forking of the trachea], and left lung
all within normal limits. On the right side there was irregularity and roughening of the bronchial
mucosa on the lateral aspect of the bronchial wall. This irregularity extended into the RUL, and
the apical and posterior segments [divisions of lobes of the lung] each contained inflamed
irregular mucosa. Conclusion: Suspicious for infiltrating tumor, but may be nonspecific
inflammation. Bronchial washings, brushings, and bxs [biopsies] taken. Bronchial biopsy diagnosis:
squamous cell carcinoma. Washings and brushings showed no malignant cells.
 RESPIRATORY SYSTEM 485

EXERCISES
Remember to check your answers carefully with the Answers to Exercises, page 492.

A Match the following anatomic structures with their descriptions below.

12
adenoids epiglottis paranasal sinuses
alveoli hilum parietal pleura
bronchi larynx pharynx
bronchioles mediastinum trachea
cilia palatine tonsils visceral pleura
1. outer fold of pleura lying closer to the ribs __________________________________________________________________________________________
2. collections of lymph tissue in the nasopharynx ___________________________________________________________________________________
3. windpipe __________________________________________________________________________________________________________________________________________________
4. lid-like piece of cartilage that covers the voice box _____________________________________________________________________________
5. branches of the windpipe that lead into the lungs ______________________________________________________________________________
6. region between the lungs in the chest cavity _______________________________________________________________________________________
7. air-containing cavities in the bones around the nose __________________________________________________________________________
8. thin hairs attached to the mucous membrane lining the respiratory tract
__________________________________________________________________________________________________________________________________________________________________

9. inner fold of pleura closer to lung tissue _____________________________________________________________________________________________

10. throat _______________________________________________________________________________________________________________________________________________________
11. air sacs of the lung _________________________________________________________________________________________________________________________________
12. voice box __________________________________________________________________________________________________________________________________________________
13. smallest branches of bronchi _________________________________________________________________________________________________________________
14. collections of lymph tissue in the oropharynx _____________________________________________________________________________________
15. midline region of the lungs where bronchi, blood vessels, and nerves enter and exit the lungs
__________________________________________________________________________________________________________________________________________________________________

B Complete the following sentences.

1. The apical part of the lung is the _________________________________________________________________________________________________________ .

2. The gas that passes into the bloodstream at the lungs is __________________________________________________________________ .

3. Breathing in air is called _______________________________________________________________________________________________________________________ .

4. Divisions of the lungs are known as ____________________________________________________________________________________________________ .

 486 RESPIRATORY SYSTEM

5. The gas produced by cells and exhaled through the lungs is ____________________________________________________________ .

6. The space between the visceral and the parietal pleura is the ___________________________________________________________ .

7. Breathing out air is called ____________________________________________________________________________________________________________________ .

8. The essential tissues of the lung that perform its main function are pulmonary
_________________________________________________________________________________________________________________________________________________________________ .

12 9. The exchange of gases in the lung is respiration.

10. The exchange of gases at the tissue cells is respiration.

C Give meanings for the following terms relating to respiratory disorders and structures.

1. bronchiectasis _________________________________________________________________________________________________________________________________________

2. pleuritis ___________________________________________________________________________________________________________________________________________________

3. pneumothorax _________________________________________________________________________________________________________________________________________

4. anosmia ___________________________________________________________________________________________________________________________________________________

5. laryngectomy __________________________________________________________________________________________________________________________________________

6. nasopharyngitis _______________________________________________________________________________________________________________________________________

7. phrenic ____________________________________________________________________________________________________________________________________________________

8. alveolar ____________________________________________________________________________________________________________________________________________________

9. glottis _______________________________________________________________________________________________________________________________________________________

10. tracheal stenosis _____________________________________________________________________________________________________________________________________

D Complete the medical terms for the following respiratory symptoms.

1. excessive carbon dioxide in the blood: hyper

2. breathing is easiest or possible only in an upright position: pnea

3. difficult breathing: pnea

4. condition of blueness of skin: osis

5. spitting up blood: hemo

6. deficiency of oxygen: hyp

7. condition of pus in the pleural cavity: pyo or em

8. hoarseness; voice impairment: dys

9. blood in the pleural cavity: hemo

10. nosebleed: epi

 RESPIRATORY SYSTEM 487

E Give the meanings of the following medical terms.

1. rales (crackles) ________________________________________________________________________________________________________________________________________
2. auscultation ____________________________________________________________________________________________________________________________________________
3. sputum ____________________________________________________________________________________________________________________________________________________
4. percussion _______________________________________________________________________________________________________________________________________________
5. rhonchi ____________________________________________________________________________________________________________________________________________________ 12
6. pleural rub _______________________________________________________________________________________________________________________________________________
7. purulent ___________________________________________________________________________________________________________________________________________________
8. paroxysmal nocturnal dyspnea ______________________________________________________________________________________________________________
9. hydrothorax _____________________________________________________________________________________________________________________________________________
10. pulmonary infarction _____________________________________________________________________________________________________________________________
11. stridor ______________________________________________________________________________________________________________________________________________________
12. wheeze _____________________________________________________________________________________________________________________________________________________

F Match the following terms with their descriptions below.

asbestosis croup infiltrate
asthma cystic fibrosis lung cancer
atelectasis diphtheria pertussis
chronic bronchitis emphysema sarcoidosis

1. acute infectious disease of the throat caused by Corynebacterium

2. acute respiratory syndrome in children and infants that is marked by obstruction of the larynx
and stridor
3. hyperinflation of air sacs with destruction of alveolar walls
4. inflammation of tubes that lead from the trachea; over a long period of time

5. chronic inflammatory disorder characterized by airway obstruction

6. lung or a portion of a lung is collapsed
7. malignant neoplasm originating in a lung or bronchus
8. whooping cough
9. a collection of fluid or other material within the lung as seen on chest film, CT scan, or other
radiologic study
10. inherited disease of exocrine glands; mucous secretions lead to airway obstruction

11. type of pneumoconiosis; dust particles are inhaled

12. inflammatory disease in which small nodules form in lungs and lymph nodes
 488 RESPIRATORY SYSTEM

G Use the following terms and abbreviations to complete the sentences below.
CPAP fibrosis PaO2
DLCO obstructive lung disease palliative
exudate OSA restrictive lung disease
FEV1 PaCO2 rhonchi

1. Sarah had a pulmonary function test in which she inhaled as much air as she could and the air
12 that she expelled in the first second was measured. The result of this PFT is a/an
.
2. Dr. Smith heard loud when he auscultated Kate’s chest. Her
bronchial tubes were obstructed with thick mucous secretions.
3. Karl was asked to breathe in a small amount of carbon monoxide and then blood samples were
taken to detect the gas in his bloodstream. This PFT assesses how well gases can diffuse across
the alveolar membrane, and the result of the test is called .
4. Formation of scar tissue in the connective tissue of the lungs is pulmonary
.
5. A purulent consists of white blood cells, microorganisms (dead and
alive), and other debris.
6. Myasthenia gravis and muscular dystrophy are examples of neuromuscular conditions that
produce .
7. Chronic bronchitis and asthma are examples of .
8. Patients with a small pharyngeal airway that closes during sleep may experience
.
9. With nasal , positive pressure (air coming from a compressor) opens
the oropharynx and nasopharynx, preventing obstructive sleep apnea.
10. Doctors realized that they could not cure Jean’s adenocarcinoma of the lung. They used
measures to relieve her uncomfortable symptoms.
11. During an apneic period, a patient experiences severe hypoxemia (decreased
) and hypercapnia (increased ).

H Give the meanings of the following medical terms.

1. pulmonary abscess __________________________________________________________________________________________________________________________________

2. pulmonary edema ___________________________________________________________________________________________________________________________________

3. pneumoconiosis ______________________________________________________________________________________________________________________________________

4. pneumonia ______________________________________________________________________________________________________________________________________________

5. pulmonary embolism _____________________________________________________________________________________________________________________________

 RESPIRATORY SYSTEM 489

6. tuberculosis _____________________________________________________________________________________________________________________________________________

7. pleural effusion _______________________________________________________________________________________________________________________________________

8. pleurisy ____________________________________________________________________________________________________________________________________________________

9. anthracosis ______________________________________________________________________________________________________________________________________________

10. mesothelioma __________________________________________________________________________________________________________________________________________

11. adenoid hypertrophy ______________________________________________________________________________________________________________________________ 12

12. pleurodynia _____________________________________________________________________________________________________________________________________________

13. expectoration __________________________________________________________________________________________________________________________________________

14. tachypnea ________________________________________________________________________________________________________________________________________________

I Match the clinical procedure or abbreviation with its description.

bronchioalveolar lavage laryngoscopy tracheostomy

bronchoscopy mediastinoscopy tube thoracostomy
CT pulmonary angiography pulmonary function tests tuberculin tests
endotracheal intubation thoracentesis V/Q scan

1. placement of a tube through the mouth into the trachea to establish an airway

2. injection or inhalation of radioactive material and recording images of its distribution in the

lungs

3. PPD, tine, and Mantoux tests

4. puncture of the chest wall to obtain fluid from the pleural cavity

5. tests that measure the ventilation mechanics of the lung

6. creation of an opening into the trachea through the neck to establish an airway

7. visual examination of the bronchi

8. injection of fluid into the bronchi, followed by withdrawal of the fluid for examination

9. insertion of an endoscope into the larynx to view the voice box

10. combination of computer-generated x-ray images and recording (with contrast) of blood flow in

the lung

11. visual examination of the area between the lungs

12. continuous drainage of the pleural spaces from a chest tube placed through a small skin

incision
 490 RESPIRATORY SYSTEM

J Give the meanings of the following abbreviations and then select the letter of the sentences
that follow that is the best association for each.

COLUMN I COLUMN II

1. DOE A. Patients with congestive heart failure and

pulmonary edema experience this symptom
2. PND when they recline in bed.
12 3. VATS B. Chronic bronchitis and emphysema are
examples.
4. CPR C. Substance used in the test for tuberculosis.
D. Adenocarcinoma and squamous cell carcinoma
5. NSCLC are types.
E. Visual examination of the chest via endoscope
6. ARDS
and a video monitor.
7. COPD F. Injection in an infant to provide immunity.
G. A spirometer is used for these respiratory tests.
8. PFTs H. This symptom means that a patient has
difficulty breathing and becomes short of
9. PPD
breath when exercising.
10. DPT I. Three basic steps: A, airway opened by tilting
the head; B, breathing restored by mouth-to-
mouth breathing; C, circulation restored by
external cardiac compression.
J. A group of symptoms resulting in acute
respiratory failure.

K Match the respiratory system procedures with their meanings.

laryngectomy rhinoplasty thoracotomy

lobectomy thoracentesis tonsillectomy
pneumonectomy thoracoscopy (thorascopy)
1. removal of lymph tissue in the oropharynx
2. surgical puncture of the chest to remove fluid from the pleural space

3. surgical repair of the nose

4. incision of the chest

5. removal of the voice box

6. removal of a region of a lung

7. endoscopic examination of the chest

8. pulmonary resection
 RESPIRATORY SYSTEM 491

L Circle the boldface term that best completes the meaning of each sentence.

1. Ruth was having difficulty taking a deep breath, and her chest x-ray showed accumulation of
fluid in her pleural spaces. Dr. Smith ordered (PPD, tracheotomy, thoracentesis) to relieve the
pressure on her lungs.

2. Dr. Wong used her stethoscope to perform (percussion, auscultation, thoracentesis) on the
patient’s chest.

3. Before making a decision to perform surgery on Mrs. Hope, an 80-year-old woman with lung 12
cancer, her physicians ordered (COPD, bronchoscopy, PFTs) to determine the functioning of
her lungs.

4. Sylvia produced yellow-colored sputum and had a high fever. Her physician told her that she
probably had (pneumonia, pulmonary embolism, pneumothorax) and needed antibiotics.

5. The night before her thoracotomy for lung biopsy, Mrs. White was told by her anesthesiologist
that he would place a/an (thoracostomy tube, mediastinoscope, endotracheal tube) down her
throat to keep her airways open during surgery.

6. Early in her pregnancy, Sonya had a routine (PET scan, CXR, MRI) that revealed a/an
(epiglottic, alveolar, mediastinal) mass in the area between her lungs. After delivery of her child,
the mass was removed, and biopsy revealed a malignant thymoma (tumor of the thymus gland).

7. Five-year-old Seth was allergic to cats and experienced wheezing, coughing, and difficult
breathing at night when he was trying to sleep. After careful evaluation by a (cardiologist,
pulmonologist, neurologist), his parents were told that Seth had (pleurisy, sarcoidosis, asthma)
involving inflammation of his (nasal passages, pharynx, bronchial tubes).

8. Six-year-old Daisy had a habit of picking her nose. During the winter months, heat in her
family’s house caused drying of her nasal (mucus, mucous, pleural) membranes. She had
frequent bouts of (epistaxis, croup, stridor).

9. Seventy-five-year-old Beatrice had been a pack-a-day smoker all of her adult life. Over the
previous 3 months she noticed a persistent cough, weight loss, blood in her sputum
(hemoptysis, hematemesis, asbestosis), and dyspnea. A chest CT scan revealed a mass. Biopsy
confirmed the diagnosis of (tuberculosis, pneumoconiosis, adenocarcinoma), which is a type of
(small cell, non–small cell, lymph node) lung cancer.

10. Carrie’s lungs were normal at birth, but thick bronchial secretions soon blocked her (arterioles,
venules, bronchioles), which became inflamed. She was losing weight, and tests revealed
inadequate amounts of pancreatic enzymes necessary for digestion of fats and proteins. Her
pediatrician diagnosed her hereditary condition as (chronic bronchitis, asthma, cystic fibrosis).