Kathleen Jackson
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Module 2 EOT Exam Revision

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Kathleen Jackson
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2808NRS Human Pathophysiology and Pharmacology 2 (Module 2)

Question 1 of 89

1

What is a low level of arterial oxygen termed?

Select one of the following:

  • hypocapnia

  • hypoxaemia

  • normoxia

  • hypoxia

Explanation

Question 2 of 89

1

Central cyanosis:

Select one of the following:

  • is due to the formation of excess oxyhaemoglobin

  • describes bluing colouration in the lips and linings of the mouth

  • is a consequence of cyanide poisoning

  • all answers are correct

Explanation

Question 3 of 89

1

Blood is considered to be acidotic as soon as:

Select one of the following:

  • blood pH remains at 7.4, but signs of acidosis are otherwise evident

  • blood pH rises above 7.4

  • blood pH falls below 7.0

  • blood pH falls below 7.35

Explanation

Question 4 of 89

1

Orthopnoea is:

Select one of the following:

  • noisy breathing with stridor or rhonchi.

  • difficulty breathing when lying down.

  • waking up suddenly, coughing, and struggling for breath.

  • very deep, rapid respirations.

Explanation

Question 5 of 89

1

Digital clubbing is a sign of:

Select one of the following:

  • chronic hypocapnia

  • chronic hyperoxia

  • chronic hypoxia

  • chronic hypercapnia

Explanation

Question 6 of 89

1

A 65-year-old female with emphysema presents to the ED for difficulty breathing. Physical exam reveals bluish skin and mucous membranes. This condition is referred to as:

Select one of the following:

  • haemoptysis

  • hypothermia

  • cyanosis

  • haematemesis

Explanation

Question 7 of 89

1

A 10-year-old female develops pneumonia following a urinary tract infection. Physical exam reveals subcostal and intercostal retractions. She reports that breathing is difficult and she feels she cannot get enough air. This condition is referred to as:

Select one of the following:

  • hyperpnoea

  • dyspnoea

  • orthopnoea

  • cyanosis

Explanation

Question 8 of 89

1

Reduced oxygenation of arterial blood is called:

Select one of the following:

  • hypoxaemia

  • ischaemia

  • hypoxia

  • hypocapnia

Explanation

Question 9 of 89

1

Paroxysmal nocturnal dyspnoea generally occurs with:

Select one of the following:

  • left ventricular failure

  • hypertension

  • pulmonary fibrosis

  • asthma

Explanation

Question 10 of 89

1

A 30-year-old male is experiencing respiratory failure. Which of the following lab values would be expected?

Select one of the following:

  • low Pa O2

  • normal blood pH

  • low PaCO2

  • electrolyte imbalances

Explanation

Question 11 of 89

1

A 1-year-old female is diagnosed with croup. Which of the following symptoms is most likely present?

Select one of the following:

  • respiratory stridor and barking cough

  • haemoptysis and mucus production

  • high fever and dry cough

  • drooling and snoring

Explanation

Question 12 of 89

1

A 30-year-old male prison inmate contracted tuberculosis during an outbreak. The organism that caused this condition is a:

Select one of the following:

  • fungus

  • bacterium

  • parasite

  • virus

Explanation

Question 13 of 89

1

A 1-year-old female is diagnosed with croup. The most likely cause of this disease is:

Select one of the following:

  • acute hyperventilation

  • bacterial infection

  • viral infection

  • allergy

Explanation

Question 14 of 89

1

A 6-month-old female presents with rhinorrhoea, cough, poor feeding, lethargy and fever. She is diagnosed with bronchiolitis. Which of the following is most likely causing her condition?

Select one of the following:

  • parainfluenza virus

  • respiratory syncytial virus

  • group A beta-haemolytic streptococcus

  • haemophilus B influenzae

Explanation

Question 15 of 89

1

This condition is an inflammatory response with extensive mucus production and submucosal oedema, resulting in widespread obstruction of bronchioles. It is of particular concern when present in infants.

Select one of the following:

  • bronchiolitis

  • tonsillitis

  • histoplasmosis

  • pneumonia

Explanation

Question 16 of 89

1

Pneumonia is caused by:

Select one of the following:

  • chronic lung changes seen with ageing

  • atelectasis

  • viral or bacterial infections

  • use of anaesthetic agents in surgery

Explanation

Question 17 of 89

1

What disease of the lungs is a contagious, airborne bacterial infection that causes fibrotic, calcified lesions that are visible on an X-ray?

Select one of the following:

  • legionellosis

  • tuberculosis

  • diphtheria

  • lobar pneumonia

Explanation

Question 18 of 89

1

This condition involves inflammation of the larynx, trachea and bronchi; is also known as laryngotracheobronchitis; involves copious mucus secretion; has a distinctive barking cough; and is potentially dangerous in infants.

Select one of the following:

  • rhinitis

  • laryngeal pneumonia

  • croup

  • pertussis

Explanation

Question 19 of 89

1

A 50-year-old male with a 30-year history of smoking was diagnosed with lung cancer. He was previously exposed to air pollution, asbestos and radiation at his job. Which of the following most likely had the greatest impact on development of his cancer?

Select one of the following:

  • radiation

  • cigarette smoke

  • asbestos

  • air pollution

Explanation

Question 20 of 89

1

Which type of lung cancer is most commonly associated with a history of smoking?

Select one of the following:

  • small cell carcinoma

  • squamous cell carcinoma

  • mesothelioma

  • adenocarcinoma

Explanation

Question 21 of 89

1

Clinical manifestations of acute sinusitis usually include:

Select one of the following:

  • bad breath and sore throat

  • copious frothy sputum and dyspnoea

  • severe localized pain in the facial bone and tenderness in the face

  • serous nasal discharge and chronic cough

Explanation

Question 22 of 89

1

What are typical signs and symptoms of epiglottitis?

Select one of the following:

  • Sudden fever, sore throat, and drooling saliva

  • Hyperinflation of the chest and stridor

  • Hoarse voice and barking cough

  • Sneezing, mild cough, and fever

Explanation

Question 23 of 89

1

A nurse is providing care for an older, previously healthy adult male has been diagnosed with pneumococcal pneumonia. Which of the following signs and symptoms is the nurse most likely to encounter?

Select one of the following:

  • The patient will lack lung consolidation and will have little sputum production.

  • High fever and chills, productive cough, crackles progressing to absence of breath sounds in affected lobes.

  • Copious bloody sputum and diffuse chest pain and may lose his cough reflex.

  • Hypotensive and afebrile and may manifest cognitive changes.

Explanation

Question 24 of 89

1

What would be the most effective compensation for chronic respiratory acidosis?

Select one of the following:

  • The kidneys reabsorbing more hydrogen ions

  • The kidneys producing more lactic acid

  • The kidneys eliminating more bicarbonate ions

  • The kidneys producing more bicarbonate ions

Explanation

Question 25 of 89

1

Which patient is most likely to have abnormalities in breathing regulation?

Select one of the following:

  • A 23-year-old male who has an injury to his frontal lobe following a sports injury

  • A 66-year-old male with temporal lobe infarcts secondary to a stroke

  • A 34-year-old male with damage to his upper and lower pons following a blow to the back of the head

  • A 45-year-old female with a spinal cord injury at C7 following a motor vehicle accident

Explanation

Question 26 of 89

1

The production of yellowish-green, cloudy, thick sputum is often an indication of:

Select one of the following:

  • damage of lung tissue due to smoking

  • emphysema

  • bacterial infection

  • cancer tumour

Explanation

Question 27 of 89

1

A 50-year-old male with diabetes did not take his medication and is now in metabolic acidosis. He is experiencing Kussmaul respirations that can be characterised by:

Select one of the following:

  • very slow inhalations and rapid expirations.

  • rapid respirations with periods of apnoea.

  • an increased ventilatory rate, large tidal volumes and no expiratory pause.

  • audible wheezing or stridor.

Explanation

Question 28 of 89

1

Which of the following describes lobar pneumonia?

Select one of the following:

  • Opportunistic bacteria causing low-grade fever with cough and thick greenish sputum

  • Viral infection causing nonproductive cough and pleuritic pain

  • Insidious onset, diffuse interstitial infection

  • Sudden onset of fever and chills, with rales and rusty sputum

Explanation

Question 29 of 89

1

What are early signs and symptoms of infectious rhinitis?

Select one of the following:

  • Copious purulent sputum, particularly in the morning.

  • Serous nasal discharge, congestion, and sneezing.

  • Harsh barking cough and wheezing.

  • Purulent nasal discharge and periorbital pain.

Explanation

Question 30 of 89

1

Anxiety-provoked hyperventilation will:

Select one of the following:

  • increase PCO2 quite markedly, and increase PO2 to a similar extent

  • decrease PCO2 quite markedly, and increase PO2 to small extent

  • increase PO2 significantly, and increase PCO2 slightly

  • will not affect PCO2 but will increase PO2 significantly

Explanation

Question 31 of 89

1

A 20-year-old male is in acute pain. An arterial blood gas reveals decreased carbon dioxide levels. Which of the following is the most likely cause?

Select one of the following:

  • hypoventilation

  • hyperventilation

  • pain neurons producing bicarbonate buffer

  • apnoea

Explanation

Question 32 of 89

1

Changes in PCO2 tend to affect the pH of blood.

Select one of the following:

  • False, blood pH is largely unaffected by PCO2.

  • True, and decreases in PCO2 tend to decrease pH.

  • True, and increases in PCO2 tend to decrease blood pH.

  • True, and increases in PCO2 tend to increase pH.

Explanation

Question 33 of 89

1

Obstruction in the upper airway is usually indicated by:

Select one of the following:

  • rales

  • wheezing

  • stridor

  • orthopnoea

Explanation

Question 34 of 89

1

A 28-year-old male complains to his GP that he has had a cold for a week and is coughing up bloody secretions. This condition is referred to as:

Select one of the following:

  • haematemesis.

  • haemoptysis.

  • cyanosis.

  • rhinitis.

Explanation

Question 35 of 89

1

How does severe hypoxia develop with pneumonia?

Select one of the following:

  • Oxygen diffusion is impaired by the congestion

  • Acidosis depresses respirations

  • Too painful to breath

  • Inflammatory exudate absorbs oxygen from the alveolar air

Explanation

Question 36 of 89

1

A 20-year-old male presents to his GP complaining of shortness of breath when lying down. This condition is referred to as:

Select one of the following:

  • dyspnoea on exertion.

  • orthostatic tachypnoea.

  • orthopnoea.

  • sleep apnoea.

Explanation

Question 37 of 89

1

A pneumonia that occurs 48 hours or more after admission to the hospital is considered

Select one of the following:

  • hospital-acquired pneumonia.

  • health care–associated.

  • viral pneumonia.

  • community-acquired pneumonia.

Explanation

Question 38 of 89

1

What would hypercapnia cause?

Select one of the following:

  • Respiratory acidosis

  • Decreased respirations

  • Decreased carbonic acid in the blood

  • Increased blood Ph

Explanation

Question 39 of 89

1

Light bubbly or crackling breathing sounds associated with serous secretions are called:

Select one of the following:

  • rhonchi

  • wheezing

  • rales

  • stridor

Explanation

Question 40 of 89

1

The extrinsic form of asthma is characterised by:

Select one of the following:

  • the release of chemical mediators from immune cells in lung tissue

  • an autonomic nervous system imbalance

  • the dominance of the parasympathetic stimulation of the airways

  • a tendency to develop in older individuals

Explanation

Question 41 of 89

1

Which one of the following antiasthma agents acts directly on intracellular cAMP levels?

Select one of the following:

  • Methylxanthines

  • β agonists

  • Leukotriene receptor antagonists

  • Muscarinic antagonists

Explanation

Question 42 of 89

1

A 13-year-old female is diagnosed with asthma. Which of the following should she recognise as part of an asthmatic attack?

Select one of the following:

  • bradycardia

  • headache

  • chest pain

  • wheezing

Explanation

Question 43 of 89

1

Asthma is thought to be caused by:

Select one of the following:

  • an autosomal recessive trait.

  • excessive use of antibiotics as a young child.

  • interactions between genetic and environmental factors.

  • autoimmunity.

Explanation

Question 44 of 89

1

In asthma, _____ is (are) reduced.

Select one of the following:

  • dead space

  • expiratory flow rates

  • lung volumes

  • air trapping

Explanation

Question 45 of 89

1

A 52-year-old female presents with chronic bronchitis. Tests reveal closure of the airway during expiration. This condition is most likely caused by:

Select one of the following:

  • thinning smooth muscle in the bronchioles

  • hyperventilation

  • ventilation-perfusion mismatch

  • thick mucus from hypertrophied glands

Explanation

Question 46 of 89

1

Individuals with a recent diagnosis of emphysema most often present with:

Select one of the following:

  • dyspnoea

  • cyanosis

  • cor pulmonale

  • a productive cough

Explanation

Question 47 of 89

1

A 53-year-old male with a 20-year history of smoking is diagnosed with emphysema. His airways are obstructed because of:

Select one of the following:

  • infection and inflammation

  • airway oedema

  • excessive mucous production

  • loss of elastic recoil

Explanation

Question 48 of 89

1

A 60-year-old female with emphysema is having difficulty expiring a given volume of air. She is most likely experiencing _____ pulmonary disease.

Select one of the following:

  • restrictive

  • pleuritic

  • atelectatic

  • obstructive

Explanation

Question 49 of 89

1

A 45-year-old male presents with chronic bronchitis of 5 months’ duration. Which of the following is most likely to cause this condition?

Select one of the following:

  • cigarette smoke

  • chronic asthma

  • air pollution

  • recurrent pneumonia

Explanation

Question 50 of 89

1

Which of the following activities does NOT require muscle contractions and energy?

Select one of the following:

  • Forced expiration

  • Quiet expiration

  • Quiet inspiration

  • Forced inspiration

Explanation

Question 51 of 89

1

Which of the following causes bronchodilation?

Select one of the following:

  • Drugs that block b2-adrenergic receptors

  • Noradrenaline

  • Histamine

  • Parasympathetic nervous system

Explanation

Question 52 of 89

1

What is the pathophysiology of an acute attack of extrinsic asthma?

Select one of the following:

  • Hyporesponsive mucosa

  • Continuous severe attacks unresponsive to medication

  • A hypersensitivity reaction involving release of chemical mediators

  • Gradual degeneration and fibrosis

Explanation

Question 53 of 89

1

Which of the following is typical of progressive emphysema?

Select one of the following:

  • Tidal volume increases.

  • Forced expiratory volume increases.

  • Residual lung volume increases.

  • Vital capacity increases.

Explanation

Question 54 of 89

1

Cystic fibrosis is transmitted as a/an:

Select one of the following:

  • chromosomal defect.

  • X-linked recessive gene.

  • autosomal dominant gene.

  • autosomal recessive gene.

Explanation

Question 55 of 89

1

Infant respiratory distress syndrome is initiated by:

Select one of the following:

  • excessive production of mucus and elastic tissue

  • insufficient production of mucus and elastic tissue

  • excessive production of surfactant

  • insufficient production of surfactant

Explanation

Question 56 of 89

1

An iatrogenic cause of pulmonary oedema is:

Select one of the following:

  • left sided heart failure

  • trauma resulting in pulmonary bleeding

  • incorrect insertion of nasogastric feeding tube

  • kidney failure

Explanation

Question 57 of 89

1

The term atelectasis describes:

Select one of the following:

  • fibrotic restriction on lung expansion

  • over inflation of the lungs

  • dilation of bronchi, but not of alveoli

  • partial or complete collapse of a lung

Explanation

Question 58 of 89

1

These inhaled particles are not able to be removal via phagocytosis, an are able to penetrate the alveolar wall. Prolonged exposure may lead to mesothelioma.

Select one of the following:

  • asbestos fibres

  • coal dust particles

  • silicate particles

  • all answers are correct

Explanation

Question 59 of 89

1

Restrictive lung disorders may be divided into two groups based on:

Select one of the following:

  • patient history of obesity and exposure to other COPD.

  • previous lung disease and cardiovascular disorders.

  • anatomical abnormality and lung disease damage, impairing expansion.

  • smoking history and congenital defects.

Explanation

Question 60 of 89

1

Which of the following is a manifestation of a simple closed pneumothorax?

Select one of the following:

  • Asymmetrical chest movements

  • Tracheal deviation toward the unaffected lung

  • Increased breath sounds on the affected side

  • Decreased respiratory rate

Explanation

Question 61 of 89

1

What is caused by frequent inhalation of irritating particles such as silica?

Select one of the following:

  • Frequent bronchospasm

  • Fibrosis and loss of compliance

  • Distorted shape of the thorax

  • Increased number of mucus-producing glands

Explanation

Question 62 of 89

1

Pulmonary oedema causes severe hypoxia because of:

Select one of the following:

  • interference with expansion of the lungs

  • decreased diffusion of carbon dioxide from the alveoli

  • decreased recoil of lungs and ineffective expiration

  • constant cough and haemoptysis

Explanation

Question 63 of 89

1

A COPD patient asks what medications are prescribed to help his breathing.

Select one of the following:

  • Atenolol, a beta-blocker

  • Salbutemol, a bronchodilator

  • Alprazolam, a benzodiazepine

  • Sildenafil, a vasodilator

Explanation

Question 64 of 89

1

Which of the following residents of a long-term care facility is most likely to be exhibiting the signs and symptoms of chronic obstructive pulmonary disease (COPD)?

Select one of the following:

  • An 81-year-old male who has a productive cough and recurrent respiratory infections

  • A 79-year-old lifetime smoker who is complaining of shortness of breath and pain on deep inspiration

  • An 81-year-old smoker who has increased exercise intolerance, a fever, and increased white blood cells

  • An 88-year-old female who experiences acute shortness of breath and airway constriction when exposed to tobacco smoke

Explanation

Question 65 of 89

1

The primary pathophysiological problem faced by sufferers of emphysema is:

Select one of the following:

  • bronchoconstriction

  • lack of expiratory recoil

  • inability to draw sufficient air into the upper airways

  • occlusion due to excessive mucus production

Explanation

Question 66 of 89

1

Which of the following should not be applied, or advised, to someone suffering chronic bronchitis?

Select one of the following:

  • keep well hydrated

  • cough suppressant

  • bronchodilator

  • mucolytic agents

Explanation

Question 67 of 89

1

A patient is in an urgent care center with an acute asthma attack, which medication will be used for initial treatment?

Select one of the following:

  • An anticholinergic such as ipratropium

  • A short-acting beta2 agonist

  • A corticosteroid

  • A long-acting beta2 agonist

Explanation

Question 68 of 89

1

A group of common chronic respiratory disorders characterized by tissue degeneration and respiratory obstruction is called:

Select one of the following:

  • Mesothelioma

  • COPD

  • CF

  • Pulmonary fibrosis

Explanation

Question 69 of 89

1

All of the following are expected with infant respiratory distress syndrome EXCEPT:

Select one of the following:

  • fluid and protein in the alveoli

  • pulmonary vasoconstriction

  • severe hypoxia

  • respiratory alkalosis

Explanation

Question 70 of 89

1

________ describes any parenchymal lung disease caused by inhalation of inorganic dusts.

Select one of the following:

  • Pneumonia

  • Infant Respiratory Distress syndrome

  • Pneumoconiosis

  • Hypersensitive pneumonitis

Explanation

Question 71 of 89

1

Which of the following clinical findings would be most closely associated with a client who has interstitial lung disease in comparison to chronic obstructive pulmonary disease (COPD)?

Select one of the following:

  • Increased FVC

  • Reduced FEV1/FVC

  • Decreased total lung capacity

  • Reduced expiratory flow rates

Explanation

Question 72 of 89

1

Transudative pleural effusion arises because of:

Select one of the following:

  • constriction of bronchial airways

  • decreased levels of proteins in blood

  • decreased capillary hydrostatic pressure

  • all answers are correct

Explanation

Question 73 of 89

1

Cystic fibrosis, as manifested in the lungs, is characterised by:

Select one of the following:

  • hyperplasia of smooth muscle cells

  • presence of abnormally viscous mucus

  • an abnormal fibrotic response

  • production of copious watery mucus

Explanation

Question 74 of 89

1

Which of the following is NOT a cause of pulmonary oedema?

Select one of the following:

  • Hyperproteinemia

  • Left-sided congestive heart failure

  • Inhalation of toxic gases

  • Excessive blood volume (overload)

Explanation

Question 75 of 89

1

Which statement does NOT apply to emphysema?

Select one of the following:

  • The surface area available for gas exchange is greatly reduced.

  • A genetic defect may lead to breakdown of elastic fibers.

  • Expiration is impaired.

  • The ventilation/perfusion ratio remains constant.

Explanation

Question 76 of 89

1

During an acute asthma attack, how does respiratory obstruction occur?
1. Relaxation of bronchial smooth muscle
2. Edema of the mucosa
3. Increased secretion of thick, tenacious mucus
4. Contraction of elastic fibers

Select one of the following:

  • 1, 2

  • 1, 3

  • 2, 3

  • 2, 4

Explanation

Question 77 of 89

1

Alpha-1 antitrypsin deficiency is associated with:

Select one of the following:

  • asthma

  • emphysema

  • cystic fibrosis

  • chronic bronchitis

Explanation

Question 78 of 89

1

Why does asthma result in fluid accumulation in the pulmonary interstitium?

Select one of the following:

  • because of pulmonary artery hypotension.

  • because of increased capillary permeability.

  • because of increased, internal mucous secretion.

  • None of the above; fluid may accumulate within the lumen of the airways, but it does not accumulate in the lung interstitium.

Explanation

Question 79 of 89

1

A patient is admitted for a relapse for sarcoidosis. Knowing this is usually caused by an inflammatory process, the nurse can anticipate administering.

Select one of the following:

  • a corticosteroid.

  • an salmeterol inhaler.

  • aspirin.

  • a bronchodilator.

Explanation

Question 80 of 89

1

Which of the following statements best captures the etiology of the acute response phase of extrinsic (atopic) asthma?

Select one of the following:

  • Chemical mediators are released from presensitized mast cells.

  • IgG production is heightened as a consequence of exposure to an allergen.

  • Epithelial injury and edema occur along with changes in mucociliary function.

  • Airway remodeling results in airflow limitations.

Explanation

Question 81 of 89

1

What is the cause of chronic bronchitis?

Select one of the following:

  • Deficit of enzymes, preventing tissue degeneration.

  • Hypersensitivity to parasympathetic stimulation in the bronchi.

  • Chronic irritation, inflammation, and recurrent infection of the larger airways.

  • A genetic defect causing excessive production of mucus.

Explanation

Question 82 of 89

1

Destruction of alveolar walls and septae is a typical change in:

Select one of the following:

  • cystic fibrosis.

  • emphysema.

  • acute asthma.

  • chronic bronchitis.

Explanation

Question 83 of 89

1

With a tension pneumothorax, which factors contribute to severe hypoxia?

Select one of the following:

  • More air leaving the pleural cavity on expiration than entering with inspiration.

  • Shift of the mediastinal contents toward the affected lung.

  • Decreasing compression of the inferior vena cava.

  • Continually increasing pressure on the unaffected lung.

Explanation

Question 84 of 89

1

Hypertrophy of goblet cells, decreased activity of the mucociliary escalator, and cor pulmonale, are most likely to occur in:

Select one of the following:

  • acute bronchitis

  • chronic bronchitis

  • asthma

  • early stage emphysema

Explanation

Question 85 of 89

1

Why does cor pulmonale develop with chronic pulmonary disease?

Select one of the following:

  • Demands on the left ventricle are excessive.

  • Pulmonary fibrosis and vasoconstriction increase vascular resistance.

  • Blood viscosity is increased, adding to cardiac workload.

  • The right ventricle pumps more blood than the left ventricle.

Explanation

Question 86 of 89

1

Loss of interstitial elasticity in the lungs is a hallmark of:

Select one of the following:

  • emphysema

  • chronic bronchitis

  • asthma

  • all of the above

Explanation

Question 87 of 89

1

Which of the following is typical of chronic bronchitis?

Select one of the following:

  • Decreased activity of the mucous glands

  • Overinflation of bronchioles

  • Air trapping by excessive mucus plugs

  • Formation of blebs or bullae on the lung surface

Explanation

Question 88 of 89

1

A physician is providing care for a child who has a diagnosis of cystic fibrosis (CF). Place the following pathphysiological events of CF in chronological order.
1) Airway obstruction
2) Recurrent pulmonary infections
3) Impaired Cl transport
4) Decreased water content of mucociliary blanket
5) Increased Na+ absorption

Select one of the following:

  • 1,4,3,5,2

  • 5,3,4,1,2

  • 3,5,4,1,2

  • 3,4,5,1,2

Explanation

Question 89 of 89

1

What causes the expanded anteroposterior (A-P) thoracic diameter (barrel chest) in patients with emphysema?

Select one of the following:

  • Dilated bronchi and increased mucous secretions

  • Recurrent damage to lung tissues

  • Air trapping and hyperinflation

  • Persistent coughing to remove mucus

Explanation

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