280 Image-Based Questions

1. Compliance curve of the lung given below. Curve A 3. Difference in trajectory between inspiratory loop and the
CHAPTER 7  RESPIRATORY PHYSIOLOGY

signifies which of the followings:  (AIIMS Nov 2018) expiratory loop in the curve is due to  (AIIMS Nov 2017)

a. Difference in alveolar pressure during inspiration

a. Pulmonary fibrosis b. Atelectasis
c. Emphysema d. ARDS
and expiration
b. Difference in conc. of surfactant during inspiration
and expiration
c. Difference in airway resistance during inspiration
and expiration
d. Inspiration is active and expiration is passive

2. Calculated FEV1 from the below spirometry reading? 4. Calculate the minute ventilation from the spirogram
 (AIIMS May 2017) assuming the respiratory rate as 12/min

C
R
I a. 1 L/min
S a. 60 – 69% b. 70-79%


b.
c.
2 L/min
4 L/min
P c. 80-89% d. 90-99% d. 6 L/min
 5. A 76-year-old man has a lung tumor that pushes against an 7. The curve in question mark is caused by?
airway, obstructing air flow to the distal alveoli. Which 281
point on the V/Q line of the O2-CO2 diagram above
corresponds to the alveolar gas of these distal alveoli?

IMAGE-BASED QUESTIONS
a. Bronchial asthma
a. Point A b. Point B b. Emphysema
c. Point C d. Point D c. Pulmonary fibrosis
d. Chronic bronchitis

6. In the following diagram, the curve “X” represents the 8. Using this instrument, one can measure:
normal relationship of alveolar ventilation with PaCO2,
when PaO2 is 100 mmHg. If pH changed from 7.4 to 7.3,
change in alveolar ventilation will shift to which of the
curve?

C
R


a. Residual volume
b. FRC
I
a. Curve B b. Curve C


c. Total lung capacity
d. Tidal volume
S
c. Curve D d. Curve E
P
 9. Arrow shift of the curve is not due to: 11. The volume in question mark is after:
282
CHAPTER 7  RESPIRATORY PHYSIOLOGY

a. Maximum inspiration
b. Maximum expiration
a. Increased hydrogen ions c. Normal inspiration
b. Decreased carbon dioxide d. Normal expiration
c. Increased temperature
d. Increased BPG

10. Normal value of the lung capacity is: 12. In the expiratory flow volume loop shown below, what is
the vital capacity:

a. 1200 ml b. 2500 ml
c. 3600 ml d. 4600 ml
a. 1 liter b. 5.5 liters
c. 3 liters d. 4.5 liters

13. Condition causing the green colored curve:

C
R
I
S

a. Tuberculosis
c. Emphysema
b. Asbestosis
d. Silicosis
P
 Answers of Image-Based Questions
283
1. Ans. (c)  Emphysema pressure is required to open a previously closed airway,
owing to a deficit of surfactant at the air-water interface,
(Ref: Ganong 25 ed p.629)
th
than to keep an open airway from closing, reflecting
Conditions causing increase in compliance (Curve shifted abundant surfactant

ANSWERS OF IMAGE-BASED QUESTIONS

upwards and to the left) •• Compliance is the slope ΔV/ΔP
•• As a part of normal aging. Compliance of lung increases in •• The lung volume at any given pressure is greater during
old age expiration than during inspiration
•• Emphysema •• Compliance is greatest at mid pressure range
ƒƒ In emphysema there is loss of elastic recoil of lung
ƒƒ Emphysematous lung is easy to inflate (overdistension) 4. Ans. (d)  6 L/min
but because of the loss of elastic recoil, additional effort
(Ref: Guyton,13th ed.P.503)
must be given to force air out of lung
•• Minute ventilation = tidal volume × respiratory rate
2. Ans. (c)  80-89% •• Here tidal volume is 500 ml (in the graph,it is seen as 3 L
to 3.5 L)
(Ref: Ganong, 25th ed/p.630)
•• So, Minute ventilation = 500 × 12 = 6L/min
Forced vital capacity (FVC)
•• It is the volume of air in liters that can be forcefully and 5. Ans. (a)  Point A
maximally exhaled after a maximal inspiration
(Ref: Guyton,11th ed p.500)
Forced Expiratory Volume in the 1st Second (FEV1)
•• It is the volume of air that is exhaled in the 1st second of •• This diagram is called O2- CO2 diagram or Ventilation
the FVC perfusion (V/Q) diagram
•• Normally it is around 80% of the FVC
Here, in this question:

•• Obstruction of airways limits ventilation. So,V/Q becomes

0
•• Without any alveolar ventilation—the air in the alveolus
•• FVC = 5 L comes to equilibrium with the blood oxygen and carbon
•• FEV1 = 4 L dioxide. So, the answer is point A that corresponds to a PO2
•• So, FEV1 = 4/5 = 80% of FVC 0f 40 mm Hg and PCO2 of 45 mm Hg
•• Also remember, in cases of pulmonary embolism
3. Ans. (b)  Difference in conc. of surfactant during inspiration obstructing blood flow, V/Q becomes infinity. Here there
and expiration is no possibility of diffusion of gases from alveoli to blood
(Ref – Boron, Medical physiology, 2nd ed p.634)
vessels. Inspired air loses no oxygen to the blood and gains
no carbon dioxide from the blood.
C
Important points to be noted in compliance curve are:
•• The curve has inspiratory and expiratory components 6. Ans. (b)  Curve C
R
•• Note that the inspiratory and expiratory compliance curves
do not coincide. This difference is called hysteresis
(Ref: Guyton, 13th ed/p.544) I
•• Points to be understood from this graph:
•• The difference between the inflation and the deflation
paths—hysteresis—exists because a greater transpulmonary •• This graph is about the Composite Effects of PCO2, pH, and S
PO2 on Alveolar Ventilation
P
 •• Red curves - measured at a blood pH of 7.4 •• It is the vital capacity
•• Green curves - measured at a blood pH of 7.3 •• Normal vital capacity is 4700 ml
284 •• Curve displaced to the right at higher pHs
•• Curve displaced to the left at lower pHs 11. Ans. (b)  Maximum expiration
(Ref: Ganong, 25th ed/p.629)
7. Ans. (c)  Pulmonary fibrosis
•• It is residual volume
CHAPTER 7  RESPIRATORY PHYSIOLOGY

(Ref: Ganong, 25th ed/p.631) •• It is the volume of air left in lungs after forced expiration
•• This is the pulmonary compliance curve
•• It is decreased (lower curve) in pulmonary fibrosis 12. Ans. (d)  4.5 liters
•• Normal curve is the middle curve (Ref. Guyton and Hall Physiology Review, 3rd ed/p.127)
•• It is increased in emphysema (upper curve)
•• In the graph, residual volume (RV) is 1 L
8. Ans. (d)  Tidal volume •• Total lung capacity (TLC) is 5.5 L
•• Vital capacity is TLC – RV = 4.5 L
(Ref: Ganong, 25th ed/p.629)
•• Using spirometer one cannot measure residual volume, 13. Ans. (c)  Emphysema
FRC and total lung capacity (Ref: Guyton and Hall Physiology Review, 3rd ed/p.128)
9. Ans. (b)  Decreased carbon dioxide •• Green color curve is caused by an obstructive lung disease
- Emphysema
(Ref: Ganong, 25th ed/p.640) •• The height of the curve (PEF) is much less than predicted
•• In oxygen dissociation curve, right shift is favored by, •• Descending part of expiration (effort independent part)
•• Acidosis is predominantly affected. It is concave due to airflow
•• Increase in, 3 DPG limitation in small airways (Dog leg appearance)
•• Increase in PCO2 •• Width of the curve (FVC) is decreased
•• Increase in temperature •• Decreased FEV1 and FEV1/FVC ratio

10. Ans. (d)  4600 ml

(Ref: Ganong, 25th ed/p.629)

C
R
I
S
P
 Multiple Choice Questions
Pulmonary Surfactant
1. Surfactant is made up of
a. Fibrin b. Mucoprotein
c. Phospholipids d. Fibrinogen
285
13. Pleural pressure at the end of inspiration is
 (Recent Question 2015)
(AI 1997)
a. Zero b. More negative
c. Positive d. Less negative

MULTIPLE CHOICE QUESTIONS

14. The intrapleural pressure is negative both during inspiration
2. Major Surfactant is (Recent Question 2015)
and expiration because  (AIIMS May 2005)
a. Dipalmitoyl lecithine
a. Intrapulmonary pressure is always negative
b. Dipalmitoyl cephaline
b. Thoracic cage and lung are elastic structure
c. Dipalmitoyl serine
c. Transpulmonary pressure determines the negativity
d. Dipalmitoyl inositol
d. Surfactant prevents the lungs to collapse
3. Pulmonary surfactant is secreted by  (AIIMS 2014, Recent
15. Intrapleural pressure is negative because (AI 2012)
Question 2012, Al 2005,2000, comed 2009)
a. Chest wall and lungs recoil in opposite directions to each
a. Type I pneumocytes
other
b. Type II pneumocytes
b. Transplumonary pressure is negative
c. Clara cells
c. intraplumonary pressure is negative
d. Bronchial epithelial cells
d. Pulmonary collapse is prevented by surfactants
4. The mechanism of action of surfactant is  (AIIMS Nov 2007
16. Negative intrapleural pressure is due to
a. Lubricated the flow of CO2 diffusion
 (AIIMS Nov 2010)
b. Binds oxygen
a. Uniform distribution of surfactant over alveoli
c. Makes the capillary surface hydrophilic
b. Negative intra-alveolar pressure
d. Breaks the structure of water in the alveoli
c. Absorption by lymphatics
5. Stability of alveoli is maintained by
d. Presence of cartilage in the uppr airway
a. Compliance of the lungs (AIIMS Nov 2009)
17. Pleural pressure positive in 
b. Residual air in alveoli
a. End of inspiration  (Recent Question 2014)
c. Negative intrapleural pressure
b. End of expiration
d. Reduce surface tension by surfactant
c. End of forced expiration
6. The primary function of surfactant is (AGPGI 2005)
d. Start or beginning of inspiration
a. Prevent overexpansion of alveoli
18. True about normal expiration (PGI May 2015)
b. Decrease the surface tension of the fluid lining the alveoli
a. At the end of normal expiration air in lung is ERV
c. Facilitate diffusion of oxygen
b. Chest wall has a tendency to move outward which is
d. Prevent airway closure
balanced by inward recoil of alveoli
7. Respiratory distress syndrome is due to a defect in the
c. In expiration pleural pressure is equal to alveolar pressure
biosynthesis of (Comed 2007)
d. Muscles that elevate the chest cage are classified as muscles
a. Dipalmitoyl lecithine
of expiration
b. Dipalmitoyl cephaline
19. True about breathing are all except  (Recent Question 2013)
c. Dipalmitoyl serine
a. Normal breathing occurs when transpulmonary pressure
d. Dipalmitoyl inositol
is 8 – 5 cm H2O
8. Surfactant production is accelerated by (UP 2007)
b. Compliance depends only on surfactant
a. Thyroxine b. Glucocorticoids
c. Expiration during quire breathing is passive
c. Carbamazepine d. Iodine
d. Inspiration is an active process
20. A person is having normal lung compliance and increased
Mechanics of Breathing airway resistance. The most economical way of breathing
9. Boyle’s Law states that-  (Recent Question 2013) for him (AIIMS Nov 2K)
a. P/T = constant b. PV = constant a. Rapid and deep b. Rapid and shallow
c. PV = nRT d. V/T= constant c. Slow and deep d. Slow and shallow
10. Which is correct-  (Recent Question 2013) 21. Respiration stops in the last stage of expiration, in forced
a. PV = nRT b. P = VnRT expiration b/c of  (AIIMS June 1998)
c. V = PnRT d. PT = nRV a. Respiration muscle fatigue C
11. What is charle’s law-  (Recent Question 2012) b. Collapse of alveoli
a. PV = constant b. P/T = constant

c. Dynamic compression of airway
d. Breaking effect of inspiratory muscle
R
c. PV = nRT d. None
12. Intrapleural pressure is (Recent Question 2012)

22. Critical closing volume is
a. Volume at the end of forceful expiration
(AIIMS May 2012) I
a. Transpulmonary pressure + Alveolar pressure
b. Transpulmonary pressure - Alveolar pressure

b. Volume at the end of forceful inspiration
c. Volume remaining after Functional Residual capacity is
S
c. Transmural pressure + Alveolar pressure
d. Alveolar pressure - Transpulmonary pressure

measured
d. Close to Residual Volume
P
 23. Small airway have laminar air flow because 34. Residual volume is the volume of air in lung after
a. Reynold’s number > 2000 (AI 2011) a. Maximal inspiration (Recent Question 2013)
286 b. Very small diameter b. Maximal expiration
c. Extremely low velocity c. Normal inspiration
d. Low cross sectional area d. Normal expiration
24. When gases flow through an orifice which factor is least 35. Functional residual capacity of lung is defined as
likely to affect turbulence  (Recent Question 2012)  (PGI June 1997)
CHAPTER 7  RESPIRATORY PHYSIOLOGY

a. Density of gas b. Viscosity of gas a. Volume expired after normal expiration

c. Pressure of gas d. Diameter of orifice b. Volume remaining after forced expiration
25. Compliance of lungs is (Recent Question 2012) c. ERV + RV
a. 200 ml/cm water b. 500 ml/cm water d. Tidal volume + volume inspired forcefully
c. 800 ml/cm water d. 1000 ml/cm water 36. Normal vital capacity in an adult is
26. Pulmonary Compliance is decreased in all of the following  (Recent Question 2013)
condition, Except (AI 2011) a. 1200 ml b. 2500 ml
a. Pulmonary Congestion c. 3000 ml d. 4700 ml
b. COPD 37. Maximum air volume in the lung (Recent Question 2015)
c. Decreased surfactant a. 1200 ml b. 2400 ml
d. Pulmonary fibrosis c. 3000 ml d. 5900 ml
27. Compliance of lung is a measure of (Recent Question 2012) 38. By spirometry, one can measure
a. Elasticity b. Amount of air  (Recent Question 2013)
c. Blood flow d. Presence if fluid a. Residual volume b. FRC
c. TLC d. Tidal volume
Lung Volumes and Capacities 39. Spirometry can demonstrate and measure all of the
following except  (Recent Question 2012)
28. Volume of air taken in and given out during normal
a. Tidal volume
respiration is referred to as (Recent Question 2014)
b. Residual volume
a. IRV b. TV
c. Vital capacity
c. ERV d. VC
d. Inspiratory reserve capacity
29. Tidal volume is calculated by (AI 2001)
40. Nitrogen washout method is used to measure the resistance
a. Inspiratory capacity minus the inspiratory reserve volume
to small airways (Recent Question 2012)
b. Total lung capacity minus the inspiratory reserve volume
a. Dead space volume
c. Functional residual capacity minus residual volume
b. Function residual capacity
d. Vital capacity minus expiratory reserve volume
30. Vital capacity is sum of  (Recent Question 2012) c. Tidal volume
a. Inspiratory reserve volume, Tidal volume and Expiratory d. Diffusion capacity
reserve volume 41. Which of the following is used to measure the resistance to
b. Tidal volume, Inspiratory reserve volume and Residual small airways  (Recent Question 2012)
volume a. Vidal capacity
c. Expiratory reserve volume, Inspiratory reserve volume and b. FEVI
Residual volume c. Max. mid respiratory flow rates
d. Residual volume, Inspiratory reserve volume and d. Closing volume
Expiratory volume 42. A man connected to a body plethysmograph for estimation
31. Air remaining in lung after normal expiration of FRC inspires against a closed glottis. Which of the
 (Recent Question 2013) following statements is true – (AI 2011)
a. TV b. RV a. The pressure in both the lung and the box increase
c. FRC d. VC b. The pressure in both the lung and the box decrease
32. In which of the following conditions the respiratory muscles c. The pressure in the lung decrease, but that in the box
are relaxed (UP 2008) increase
a. Residual volume d. The pressure in the lung increase, but that in the box
b. Functional residual capacity decrease
C

c. Expiratory reserve volume
d. Inspiratory reserve volume
43. What will occur with increase in alveolar ventilation rate
 (Recent Question 2015)
R 33. Relaxation volume of lung is documented as
 (Recent Question 2015)


a. Decreased partial pressure of O2 in alveoli
b. Decreased partial pressure of CO2 in alveoli
I

a. Functional residual capacity
b. Residual volume


c. Decreased CO2 diffusion from blood to alveoli
d. Decreased O2 diffusion from alveoli to blood
S

c. Vital capacity
d. Closing volume
P
 44. Pulmonary function abnormalities in interstitial lung
diseases include all of the following except
a. Reduced vital Capacity (AIIMS Nov 2005)
b. Reduced FEV1/FVC ratio
c. Reduced diffusion capacity
d. Reduced total lung capacity
45. In upper airway obstruction all of the following changes are
seen except  (AI 1999)
a. Decreased maximum breathing capacity
b. RV decreased
c. Decreased FEV
d. Decreased Vital capacity
46. Regarding pulmonary function test all are TRUE, EXCEPT
 (AIIMS June 1999)
a. Total lung volume increases in emphysema
b. Compliance decreases in interstitial lung disease
c. Compliance is total lung distensibility
d. FEV1 is forced expiratory rate at one minute
47. Total lung capacity depends upon (AI 1998)
a. Size of airway
b. Closing volume
c. Lung compliance
d. Residual volume
48. Hyaline membrane disease of lungs is by space
 (AIIMS Nov 2010)
a. FRC is smaller than closing volume
b. FRC is greater than closing volume
c. FRC is equal to closing volume
d. FRC is independent to closing volume
Alveolar Ventilation and Dead Space Ventilation
49. Formula for minute volume?  (JIPMER May 2018)
a. RR* Tidal volume
b. RR/Tidal volume
c. Fio2/PEEP
d. Fio2/PEEP * RR
50. Normal dead space to tidal volume ratio is 
 (JIPMER May 2018)
a. 50–70 b. 10–20
c. 30–40 d. 80–90
51. Total alveolar ventilation volume (in L / min) is c. Partial pressure of CO2 alone becomes zero
 (Recent Question 2014)
a. 1.5 b. 3.5
c. 4.2 d. 5.0
52. Calculate the Alveolar ventilation per minute of a patient
with respiratory rate 14/min, tidal vol. 500 mL with a vital
capacity 7000 mL c. Decreased blood volume during systole
 (AIIMS May 2001)
a. 4900 ml b. 2000 ml
c. 7700 ml d. 7000 ml
53. Maximum voluntary ventilation is
 (Recent Question 2013)
a. 25 L / min b. 50 L/ min
c. 100 L/ min d. 150 L / min
54. Respiratory minute volume of lung is
 (Recent Question 2012)
a. 6 L b. 4 L
c. 500 mL d. 125 L
55. Least amount of co2 is in
a. Anatomical dead space-end inspiration phase
b. Anatomical dead space-end expiration phase 287
c. Alveoli-end inspiration phase
d. Alveoli-end expiration phase
56. Mouth-to-mouth respiration provides an oxygen
concentration of (AI 1994)
MULTIPLE CHOICE QUESTIONS
a. 16% b. 20%
c. 22% d. 24%
57. Arterial carbon dioxide level
 (Recent Question 2014)
a. 40 mm Hg b. 37 mm Hg
c. 45 mm Hg d. 60 mm Hg
58. Difference in the amount of O2 inspired and CO2 expired
 (Recent Question 2012)
a. 20 ml/min b. 50 ml/min
c. 75 ml/min d. 100 ml/min
59. Regarding Dead space volume in a normal individual
 (Recent Question 2012)
a. Anatomical dead space > Physiological dead space
b. Anatomical dead space = Physiological dead space
c. Anatomical dead space < Physiological dead space
d. Anatomical dead space is not related to physiological dead
60. Physiological dead space is calculated by
 (Recent Question 2013)
a. Boyle’s law b. Dalton’s law
c. Bohr equation d. Charles’s law
61. How will you calculate that how much inspired air actually
ventilates the alveoli
 (Recent Question 2015)
a. Single breath N2 method
b. Dalton’s law
c. Bohr equation
d. Boyle’s law
Pulmonary Circulation and VQ Ratio
62. When Va/Q is infinity ?  (Recent Pattern Question 2018)
a. Partial pressure of O2 becomes zero
b. No exchange of O2 and CO2
d. Partial pressure of both O2 and CO2 remain normal
63. Pulmonary circulation differs from systemic circulation
 (AIIMS May 2008, 2006)
a. Pulmonary vasodilation in hypoxia
b. Pulmonary Vasoconstriction in hypoxia
d. Increased basal vasoconstrictor tone
64. Pulmonary Vasoconstriction is caused by
 (Recent Question 2015) C
a. Hypoxia b. Thromboxane A2
c. Histamine d. Angiotensin – II R
65. Pulmonary vasoconstriction is caused by
 (Recent Question 2013)
I
a. Prostacyclin b. α – 2 stimulation
c. Hypoxia d. Histamine
S
P
 66. During heavy exercise the cardiac output (CO) increases
up to five fold while pulmonary arterial pressure rises very
288 little. This physiological ability of the pulmonary circulation
is best explained by (AI 2009)
a. Increase in the number of open capillaries
b. Sympathetically mediated greater distensibility of
pulmonary vessels
CHAPTER 7  RESPIRATORY PHYSIOLOGY
c. Large amount of smooth muscle in pulmonary arterioles
d. Smaller surface area of pulmonary circulation
67. All of the following statements about bronchial circulation
are true, Except  (AI 2010)
a. Contribute 2% of systemic circulation
b. Contribute to gaseous exchange
c. Cause venous admixing of blood
d. Provide nutritive function of lung
68. During standing, In apex of lung- Transport of Gases
 (Recent Question 2013)
a. Blood flow is high
b. Ventilation is high
c. V/Q is high
d. V/Q is low
69. Mismatch of ventilation/perfusion ratio is seen is- c. 45 d. 573
 (Recent Question 2015)
a. Apex b. Base
c. Both d. None
70. True statement regarding pulmonary ventilation is-
a. PaO2 is maximum at the apex
b. V/Q is maximum at the base
c. Ventilation per unit lung volume is maximum at the apex
d. Blood circulation is minimum at base
71. Ventilation perfusion ratio is maximum at-
a. Apex of lung  (Recent Question 2014)
b. Base of lung
c. Posterior lobe of lung
d. Middle of the lung
72. PaO2 is maximum- (Recent Question 2012)
a. Base of lung b. Posterior lobe
c. Apex of lung d. Middle lobe
Diffusion of Gases
73. Transport of carbon monoxide (CO) is diffusion limited
because- (ALLMS Nov 2009)
a. High affinity of CO for hemoglobin
b. Alveolar membrane is less permeable CO
c. CO crosses epithelial barrier slowly
d. ON exposure to air there is sudden increase in partial
pressure
74. Oxygen comes from alveoli to blood by-
a. Diffusion  (Recent Question 2015)
b. Receptor mediated
C c. Active transport
d. Osmosis
R 75. CO2 diffuses more easily through the respiratory membrane
than O2 because it is-  (AIIMS Nov 2010)
I a. Less dense
b. More soluble in plasma
S c. Less molecular weight
d. Less PCO2 in the alveoli
P c. Carbamino-hemoglobin d. Bicarbonate
76. Gas used to measure the diffusion capacity of lung- 
 (AIIMS Nov 2010)
a. CO b. NO
c. CO2 d. Nitrogen
77. Normal diffusion of CO2 at rest-
a. 20-25 mL/min/mm Hg  (Recent Question 2012)
b. 50-100 mL/min/mm Hg
c. 100-200 mL/min/mm Hg
d. 300-400 mL/min/mm Hg
78. DLCO is decreased in all except
a. Pulmonary vascular disease
b. Emphysema
c. ILD
d. Polycythemia
79. What is the expected mixed venous oxygen tension, in mm Hg, in a
normal adult after breathing 100% oxygen for 10 minutes?
 (JIPMER May 2018)
a. 150 b. 740
80. The oxygen carrying capacity of an 18-year-old boy with
hemoglobin of 14 g/dl is  (AIIMS May 2017)
a. 14 b. 16
c. 18 d. 22
81. Which of the following is/are effect of increased 2,3-DPG on
oxygen-hemoglobin dissociation curve  (PGI May 2017)
a. ↑ed affinity of hemoglobin to oxygen
b. ↓ed affinity of hemoglobin to oxygen
c. Left shift of oxygen-hemoglobin dissociation curve
d. Right shift of oxygen-hemoglobin dissociation curve
e. No change in oxygen-hemoglobin dissociation curve
82. Oxygen carrying capacity of blood is largely determined by-
 (Manipal 2008)
a. Hb level
b. Amount of CC2 in blood
c. Acidosis
d. Plasma concentration
83. One intern calculated the concentration of O2 in blood as
0.0025ml/ml blood. Considering atmospheric pressure of
760 mm Hg, how much approximate oxygen tension could
have been in the blood?
a. 40 mm Hg
b. 60 mm Hg
c. 80 mm Hg
d. 100 mm Hg
84. Basic function of hemoglobin is-  (Recent Question 2013)
a. Increased O2 delivery in lung and uptake at tissue
b. Increased O2 delivery at tissue and uptake at lung
c. Increased CO2 delivery at tissue and uptake in lung
d. None of the above
85. Percentage of O2 carried in chemical combination-
a. 97% b. 3%
c. 66% d. 33%
86. CO2 primarily transported in the arterial blood as- 

a. Dissolved CO2
(UP 2008, Comed 2007, AI 2005)
b. Carbonic Acid
 87. Venous blood with high hematocrit is seen in- 98. Which of these is not a cause of rightward shift of Oxygen-
 (Recent Question 2012) Hemoglobin dissociation curve?
a. RBC high chloride b. Plasma high Na  (Recent Question 2013) 289
c. Plasma high HCO3 d. RBC high K a. Increased hydrogen ions
88. Chloride shift is due to- (Recent Question 2012) b. Decreased CO2
a. Generation of HCO3– in RBCs c. Increased temperature
b. Metabolism of glucose in RBCs d. Increased BPG

MULTIPLE CHOICE QUESTIONS

c. Formation of O2 -Hb complex in RBCs 99. Oxygen dissociation curve shifts to right in all except- 
d. Release of K+ in RBCs  (AI 2K)
89. O2 delivery to tissues depends on all/except- a. Diabetic ketoacidosis b. Blood transfusion
a. Cardiac output (AIIMS May 2007) c. High altitude d. Anemia
b. Type of fluid administered 100. During exercise increase in O2 delivery to muscles is because
c. Hemoglobin concentration of all except- (AL 2K)
d. Affinity of hemoglobin for O2 a. Oxygen dissociation curve shift to left
90. What will be hemoglobin saturation, if PO2 is 60mm Hg at b. Increased stroke volume
pH 7.4 and temperature 370 C-  (Recent Question 2015) c. Increased extraction of oxygen from the blood
a. 50% b. 60% d. Increased blood flow to muscle
c. 75% d. 90% 101. False about the O2 dissociation curve
91. O2 delivery to tissues is decreased by- (PGI nov. 2014) a. Sigmoid curve  (Recent Question 2012)
a. Secreased Hemoglobin level b. Combination of the first heme in the Hb molecule with O2
b. Deceased paO2 increases the affinity of the second heme for O2
c. Increased paCO2 c. Increases in pH shift curve to right
d. Increased HCO3 d. Fall in temperature shift curve to left
e. Increased pH 102. True regarding conversion of deoxyhemoglobin to
92. Fetal hemoglobin has more affinity for oxygen than adult oxyhemoglobin is-  (AIIMS May 2002)
hemoglobin because-  (Recent Question 2015) a. Binding of O2 causes release of H
a. Decreased 2, 3 DPG concentration b. One mole of deoxyhemoglobin binds two moles of 2, 3
b. Low affinity for 2, 3 DPG DPG
c. Increase 2, 3 DPG concentration c. pH of blood has no effect on the binding of O2
d. Reduced pH d. Binding of O2 cause increased Binding of 2, 3 DPG
93. 2, 3 DPG is decreased in-  (Recent Question 2015) 103. 2,3 DPG binds to _________ site of Hb and _________
a. Anemia b. Acidosis release of O2-  (AIIMS May 2014)
c. High altitude d. Exercise a. One, increase b. Four, increase
94. Oxygen affinity is increased by all of the following except- c. One, decrease d. Four, decrease
 (Recent Question 2014) 104. Decreased glycolytic activity impairs oxygen transport by
a. Alkalosis hemoglobin due to-  (AI 2003)
b. Hypoxia a. Reduced energy production
c. Increased HbF b. Decreased production of 2-3 bisphosphoglycerate
d. Hypothermia c. Reduced synthesis of hemoglobin
95. The factor responsible for the left shift of Hb-O2 dissociation d. Low levels of oxygen
curve is-  (AIIMS May 2014) 105. Increase in P50 in oxygenation curve is due to decrease in-
a. Increase in 2,3 DPG in RBC  (Recent Question 2012)
b. Fall in temperature a. pH b. Oxygen
c. Fall in pH c. Temperature d. CO2
d. Increase level of CO2 blood 106. In hyperventilation-  (PGI May 2014)
96. All of the following factors influence hemoglobin a. P50 and Hb affinity for O2 increases
dissociation curve, except-  (AIIMS May 2006) b. P50 and Hb affinity for O2 decreases
a. Chloride ion concentration c. P50 increases and O2 affinity decreases
b. CO2 tension d. P50 decreases and O2 affinity increases
c. Temperature e. No change
d. 2-3 DPG levels 107. Haldane effect-  (Recent Question 2012) C
97. O2 dissociation curve is shifted to right in all except- a. Effect of 2, 3-BPG
 (AIIMS Dec. 1998) b. Dissociation of CO2 on oxygenation R
a. Hypercapnea c. Dissociation of CO2 on addition of CO2
b. Rise in temperature d. Chloride shift I
c. Raised 2,3 DPG level 108. Increase oxygen delivery to tissues in response to increased
d. Metabolic alkalosis CO2 is-  (Recent Question 2012) S
a. Bohr effect b. Haldane Effect
c. Hamburger effect d. Chloride shift P
 109. Bohr Effect is? (Recent Question 2012) Neural Regulation of Respiration
a. Facilitates oxygen transport
118. Pacemaker regulating the rate of respiration-
290 b. Facilitates CO2 transport
a. Pneumotaxic centre (AIIMS Nov 2010, Nov 2009)
c. Facilitates Chloride transport
b. Dorsal group of nucleus
d. None
110. In presence of Haldane effect, CO2 uptake is 2 ml/ 100ml c. Apneustic centre
of blood in arteries, what will be CO2 uptake in absence of d. Pre-Botzinger complex
CHAPTER 7  RESPIRATORY PHYSIOLOGY

Haldane effect in veins- 119. Which of the following are inactive during normal
a. 2 ml/100 ml of blood  (Recent Question 2015) respiration – (Recent Question 2015)
b. 4 ml/100 ml of blood a. Pre-Botzinger complex
c. 6 ml/100 ml of blood b. Dorsal group of neurons
d. 8 ml/100 ml of blood c. Ventral VRG group of neurons
111. Hemoglobin unlike myoglobin shows- d. Pneumotaxic centre
 (PGI June 1998) 120. Transection at mid pons level results in-
a. Sigmoid curve of oxygen dissociation a. Asphyxia (AIIMS Nov 2009)
b. Positive cooperativity b. Hyperventilation
c. Hills coefficient of one c. Rapid and shallow breathing
d. None of above d. Apneusis
112. Plateau of oxygen-hemoglobin dissociation curve is 121. Damage to Pneumotaxic centre produces- 
signifies- (Recent Question 2015)  (Recent Question 2015)
a. No oxygen is available for binding to Hb a. Deep and fast respiration
b. No Hb molecule is available to bind with O2 b. Deep and slow respiration
c. All oxygen is released to tissues c. Shallow and fast respiration
d. None of the above d. Shallow and slow respiration
113. The oxygen hemoglobin dissociation curve is sigmoid 122. Apneusis occur when-  (Recent Question 2015)
because-  (AI 2009) a. Lesion is above pons
a. Binding of one oxygen molecule increases the affinity of b. Lesion is midpontine with intact vagus
binding other O2 molecules c. Lesion is midpontine with damaged vagus
b. Binding of one oxygen molecule decrease the affinity of d. Lesion is at pontomedullary juction
binding other O2 molecules 123. What will be the effect on respiration if a transmission is
c. Oxygen affinity of hemoglobin decreases when the pH of made between the pons and medulla-
blood falls  (Recent Question 2014)
d. Binding of oxygen to hemoglobin reduces the affinity of a. Apnoea
Hb for CO2 b. Irregular and gasping
114. The oxygen dissociation curve of myoglobin and hemoglobin c. No effect
is different due to-  (Recent Question 2013) d. Slow and deep
a. Hb can bind to 2 oxygen molecules 124. If a cat apneustic center is destroyed along with cutting of
b. Cooperative binding in Hb vagi. Which of the following statement is correct regarding
c. Myoglobin has little oxygen affinity the breathing pattern seen in cat?
d. Hemoglobin follows a hyperbolic curve a. Prolonged inspiratory spasm
115. True about O2 Binding to myoglobin- b. Prolonged expiratory spasm
a. Sigmoid shaped curve  (Recent Question 2015) c. Slow and shallow respiration
d. Animal will die
b. More affinity than hemoglobin
125. Depth of inspiration controlled by-
c. Binds 4 molecule of O2 to Myoglobin
 (Recent Question 2014)
d. P50 is 26 mmHg
a. Pneumotaxic center b. Posterior medulla
116. Which of the following does not occur as the blood passes
c. Apneustic center d. Pons
through systemic capillaries? (AIIMS N 2007, MH 2007)
126. “Inflation of lungs induces further inflation” is explained
a. Increased protein content
by-  (AIIMS Nov 2003)
b. Shift of hemoglobin dissociation curve to left
a. Hering- Breuer inflation reflex
c. Increased hematocrit
C d. Decreased pH
b. Hering- Breuer deflation reflex
c. Head’s paradoxical reflex
117. The normal value of P50 on the oxyhaemoglobin dissociation
R curve in an adult is-  (AIIMS Nov 2004)
d. J-reflex
127. J receptors are found in which of the following-
I

a. 1.8 kPa
b. 2.7 kPa
 (AIIMS Nov. 2013)
a. Pulmonary interstitium
S

c. 3.6 kPa
d. 4.5 kPa


b. Alveolar capillaries
c. Terminal bronchiole
P d. Respiratory muscles
 128. Not a stimulus for normal/resting ventilation? 141. Peripheral and central Chemoreceptors may both contribute
 (AIIMS Nov 2010) to increased ventilation that occurs as a result of increased-
a. Stretch receptors b. J receptors  (Recent Question 2012) 291
c. PO2 d. PCO2 a. Arterial BP
129. Moderate exercise tachypnea is due to stimulation of which b. Arterial tension
receptor-  (AI 1998, MP 1998) c. Arterial O2 concentration
a. Proprioception b. J receptors d. H+

MULTIPLE CHOICE QUESTIONS

c. Lung receptors d. Baro receptors
130. Hyperinflation of lungs is prevented by- a. Most potent stimulus is high PCO2
 (Recent Question 2013)
a. Hering Breuer reflex b. Irritation reflex
c. Cushing reflex d. Bainbridge reflex
131. Hering Breuer reflex is an increase in-
a. Duration of inspiration (Recent Question 2013)
b. Duration of expiration
c. Depth of inspiration
d. Depth of expiration
Chemical Regulation of Respiration
132. Glomus cells are found in (Recent Question 2015)
a. Bladder b. Brain
c. Chemoreceptors d. Kidney
133. The primary direct stimulus for excitation of central
Chemoreceptors regulating ventilation is d. Convulsions
 (AIIMS May 2011, AI 2009)
a. Increased H+ b. Increased CO2
c. Increased O2 d. Decreased CO2
134. Central Chemoreceptors are most sensitive to following
changes in blood  (AI 2009)
a. ↑PCO2 b. ↓PCO2
c. ↑H+ d. ↑PO2
135. Central Chemoreceptors are stimulated by-
a. Decrease in PO2  (Recent Question 2013)
b. Decrease in pH of CSF
c. Hypoxia
d. Increase in pH of CSF
136. Hypercapnea acts on ventilation through-
a. Apneustic center  (Recent Question 2015)
b. Chemoreceptors in wall of 4th ventricle
c. Type- 1 glomus cells in carotid body
d. Type- 2 glomus cells in carotid body
137. Sensitivity of central chemoreceptor in COPD a. Cyanide poisoning b. CO poisoning
 (Recent Question 2015)
a. Decreased to H+ b. Increased to H+
c. Increased to PCO2 d. Increased to PO2
138. Which of following does NOT stimulate peripheral
Chemoreceptors- (AI 1995)
a. Hypoxia b. Hypocapnia
c. Acidosis d. Low perfusion pressure
139. Peripheral Chemoreceptors are most sensitive to-
 (Recent Question 2012m)
a. PO2
c. H+
b. PCO2
d. HCO3
140. Carotid and aortic bodies are stimulated when-
 (Recent Question 2015)
a. Oxygen saturation decreases below 90%
b. Oxygen saturation decreases below 80%
c. Oxygen saturation decreases below 70%
d. Oxygen saturation decreases below 60%
142. True about carotid receptors- (Recent Question 2015)
b. Dopamine is neurotransmitter
c. Low blood flow
d. Afferent through vagus nerve
143. CO2 increases ventilation by acting mainly on receptors of-
 (Recent Question 2012)
a. Apneustic centre
b. Pneumotaxic centre
c. Ventral surface of medulla
d. DPG
144. Administration of pure O2 to hypoxic patients is dangerous
because- (PGI June 1999)
a. Apnea occurs due to hypostimulation of Peripheral Chem-
oreceptors
b. Pulmonary edema
c. DPG
Hypoxia and Cyanosis
145. Hypoxia due to slowing of circulation is-
 (AIIMS May 2014)
a. Anemic b. Histotoxic
c. Stagnant d. None
146. Stagnant hypoxia is seen in
 (Recent Question 2015)
a. COPD b. Anemia
c. CO poisoning d. Shock
147. Arterial O2 content is reduced in one of the following
a. Stagnant hypoxia
b. Anemic hypoxia
c. Histotoxic hypoxia
d. Ischemic hypoxia
148. Arterial O2 content is decreased in hypoxia due to
 (Recent Question 2014)
c. COPD d. Shock
149. Carbon monoxide poisoning is a type of-
 (Recent Question 2013)
a. Anemic hypoxia b. Histotoxic hypoxia
c. Hypoxic hypoxia d. Stagnant hypoxia
150. Which of the following conditions leads to tissue hypoxia
without alteration of oxygen content of blood?
 (AIIMS May 2005) C
a. CO poisoning b. Met Hb
c. Cyanide poisoning d. Respiratory acidosis R
151. In which of the following a reduction in arterial oxygen
tension occurs? (AI 2005) I
a. Anemia
b. CO poisoning S
c. Moderate exercise
d. Hypoventilation P
 152. Which of the following variants of hypoxia does not 160. Cyanosis does not occur in severe anemia because – 
stimulate peripheral chemoreceptors- (AI 1997)  (AI 2009)
292 a. Hypoxic hypoxia b. Anemic hypoxia a. Hypoxia stimulates erythropoietin production
c. Stagnant hypoxia d. Histotoxic hypoxia b. Oxygen carrying capacity of available Hb is increased
153. Among which hypoxia AV O2 difference is max- c. Critical concentration of Hb required to produce Cyanosis
 (Recent Question 2015) is reduced
a. Histotoxic b. Stagnant d. Oxygen hemoglobin curve shift to the right
CHAPTER 7  RESPIRATORY PHYSIOLOGY

c. Hypoxic d. Anemic 161. Cyanosis is seen in all hypoxia except –

154. Least A-V O2 difference is seen in-  (Recent Question 2015) a. Hypoxic hypoxia  (Recent Question 2013)
a. Hypoxic hypoxia b. Stagnant hypoxia
b. Anemic hypoxia c. Anemic hypoxia
c. Stagnant hypoxia d. Histotoxic hypoxia
d. Histotoxic hypoxia 162. Cyanosis is not seen in – (Recent Question 2012)
155. Hypoxemia independent of-  (AIIMS Nov 2010) a. CHF
a. FiO2 b. Altitude b. COPD
c. Hb d. paCO2 c. CO poisoning
156. Toxic effects of high oxygen tension include all of the d. High altitude
following expect-  (AI 2007) 163. Cyanosis in trauma is interpreted as –
a. Pulmonary edema a. Early sign of hypoxia  (AIIMS Nov 2010)
b. Decreased cerebral blood flow b. Late sign hypoxia
c. Retinal damage c. Absence of cyanosis is means adequate tissue ventilation
d. CNS excitation and convulsion d. Absence of cyanosis is means adequate tissue oxygenation
157. Oxygen therapy is least useful in- 164. Regarding carbon monoxide poisoning, wrong statement –
 (Recent Question 2012)  (AI 2012)
a. Anemia b. ARDS a. Oxygen dissociation curve shifted to right
c. Alveolar damage d. COPD b. Oxygen dissociation curve shifted to left
158. Concentration of methemoglobin to cause cyanosis- c. COHb is formed
 (PGI Nov. 2014) d. Hyperbaric oxygen can be used
a. 5 gm/dl b. 2 gm/dl 165. True about Carbon monoxide poisoning  (PGI May 2016)
c. 1.5 gm/dl d. 12 gm/dl a. CO has 100 times more affinity than O2 for Hb
159. Central cyanosis is seen if- b. Cause right side shifting of O2 dissociation curve
 (PGI June 2001) c. Oxygen-haemoglobin saturation curve becomes
a. Methemoglobin 0.5 gm/dl hyperbolic shape
b. O2 saturation < 85% d. Pulse oximetry can accurately detect level of CO
c. O2 saturation < 95% e. 10-15% level of CO normally may occur in healthy non-
d. Hb – 4gm% smoker

C
R
I
S
P
 Answers with Explanations
293
Pulmonary Surfactant •• Epidermal growth factor (EGF)
•• Cyclic adenosine monophosphate (cAMP)
1. Ans. (c)  Phospholipids
Mechanics of Breathing

ANSWERS WITH EXPLANATIONS

(Ref: Ganong, 25th ed/p.630)
9. Ans. (b)  PV = constant
Composition of surfactant
(Ref: Ganong, 25th ed/p.628)
Surfactant lipids Surfactant proteins
•• An important law, that governs air movement in lung is
• Account for approximately • Account for approximately 10% Boyle’s Law
90% of surfactant of surfactant •• Boyle’s Law
(phospholipids) Major surfactant proteins are, ƒƒ States that “at constant temperature, pressure(P) of a gas is
Major surfactant lipids are, • Surfactant protein-A (SP-A) inversely related to its volume(V)
• Dipalmotoyl • Surfactant protein-B (SP-B) ƒƒ P α 1/V
phosphatidylcholine (DPPC) • Surfactant protein-C (SP-C)
– Lecithin- most abundant • Surfactant protein-D (SP-D) 10. Ans. (a)  PV = nRT
component of surfactant
• Phospthatidylglycerol (Ref: Ganong, 25th ed/p.628)
•• Ideal gas law is PV= nRT
•• P – pressure of gas, V – volume of gas, n = number of moles
2. Ans. (a)  Dipalmitoyl lecithine of gas, R = ideal gas constant, T = temperature
(Ref: Ganong, 25th ed/p.631)
11. Ans. (b)  P/T = constant
3. Ans. (b)  Type II pneumocytes (Ref: Ganong, 25th ed/p.628)
(Ref: Ganong, 25th ed/p.630) •• Charles’s law states that at constant pressure, volume is
proportional to the absolute temperature
•• Surfactant is synthesized, secreted, and recycled by alveolar
type II cells 12. Ans. (d)  Alveolar pressure - Transpulmonary pressure
4. Ans. (d)  Breaks the structure of water in the alveoli (Ref: Ganong, 25th ed/p.628)
(Ref: Ganong, 25th ed/p.629) •• Transpulmonary pressure = Intra-alveolar pressure –
intrapleural pressure
•• Surfactant reduces the surface tension. This action of •• So, intrapleural pressure = Alveolar pressure –
prevent alveolar collapse during expiration (atelectasis) and Transpulmonary pressure
makes alveoli more compliant
13. Ans. (b)  More negative
5. Ans. (d)  Reduce surface tension by surfactant
(Ref: Ganong, 25th ed/p.629)
(Ref: Ganong, 25th ed/p.630)
Intrapleural Pressure
6. Ans. (b)  Decrease the surface tension of the fluid lining the •• It is the pressure in the space between lungs and chest wall
alveoli •• Norma Intrapleural pressure is negative (sub atmospheric)
around –2.5 mm Hg at the start of inspiration
(Ref: Ganong, 25th ed/p.630)
Intrapleural pressure changes
7. Ans. (a)  Dipalmitoyl lecithine At the beginning of normal inspiration –2.5 mm Hg
(Ref: Ganong, 25th ed/p.630) At the end of normal inspiration – 6 mm Hg
At the end of forceful inspiration –30 mm Hg C
8. Ans. (b)  Glucocorticoids At the end of forced expiration +50 mm Hg
(Ref: Ganong, 25th ed/p.631) 14. Ans. (b)  Thoracic cage and lung are elastic structure
R
Surfactant Production is Accelerated by: (Ref: Ganong, 25th ed/p.628) I
•• Glucocorticoids •• Thoracic cage and lung are elastic structure. They tend to
•• Thyroid hormones recoil is opposite direction pulling parietal and visceral
S
•• Thyrotropin releasing hormone (TRH) pleura apart. This creates a vacuum in between parietal and
•• Prolactin visceral pleura – so, the intrapleural pressure is negative
P
 15. Ans. (a)  Chest wall and lungs recoil in opposite directions Reynolds number = ρDV/ η
to each other Where,
294 (Ref: Ganong, 25th ed/p.629)
zz ρ–Density of the gas

zz D–Diameter of the airways

zz V –Velocity of gas
16. Ans. (c)  Absorption by lymphatics
zz η –Viscosity of gas
(Ref: Ganong, 25th ed/p.629)
CHAPTER 7  RESPIRATORY PHYSIOLOGY

•• Pressure of gas is not in the formula for Reynolds number

•• Pumping of fluid from the pleural space by the lymphatics is
an important causes for negative Intrapleural pressure 25. Ans. (a)  200 ml / cm water
17. Ans. (c)  End of forced expiration (Ref: Ganong, 25th ed/p.628)
(Ref: Ganong, 25th ed/p.629)
Normal Compliance Values
•• At the end of forced expiration intrapleural pressure is +50
mm Hg Compliance of lung 0.2 L/cm water
Compliance of chest wall 0.2 L/cm water
18. Ans. (b)  Chest wall has a tendency to move outward which is
balanced by inward recoil of alveoli Compliance of lung and chest L/cm water
wall combined
(Ref: Ganong, 25th ed/p.628)
26. Ans. (b)  COPD
19. Ans. (b)  Compliance depends only on surfactant
(Ref: Ganong, 25th ed/p.629)
(Ref: Ganong, 25th ed/p.629)
•• Conditions causing increase in compliance
•• There are two major forces that oppose lung distensibility
ƒƒ As a part of normal ageing - Compliance of lung increases
(Compliance). They are,
in old age
ƒƒ Elastic forces of the lung tissues
ƒƒ Emphysema (COPD)
ƒƒ Opposing force caused by surface tension
� In emphysema there is loss of elastic recoil of lung
� Emphysematous lung is easy to inflate(overdistension)
20. Ans. (c)  Slow and deep
but because of the loss of elastic recoil, additional
(Ref: Ganong, 25th ed/p.629) effort must be given to force air out of lung
•• Obstructive lung diseases – characterized by increase in ƒƒ Flail chest
airway resistance. Taking slow and deep breaths are effective ƒƒ Sternotomy
•• Restrictive lung diseases – Taking rapid and shallow breaths •• Conditions causing decrease in compliance
are effective “Any condition that cause lung stiffness or that opposes
lung expansion always decreases lung compliance”
21. Ans. (c)  Dynamic compression of airway ƒƒ Pulmonary fibrosis
ƒƒ In pulmonary fibrosis, elastic fibers of lung are replaced
(Ref: Ganong, 25th ed/p.628) by stiff collagen fibers
•• During forced expiration, transpulmonary pressure ƒƒ Consolidation
becomes more negative leading to compression of smaller ƒƒ Pulmonary edema
airways ƒƒ Pneumothorax
ƒƒ Obesity
22. Ans. (d)  Close to Residual Volume ƒƒ Kyphoscoliosis
(Ref: Ganong, 25th ed/p.628) ƒƒ Ankylosing spondylysis

27. Ans. (a)  Elasticity

23. Ans. (c)  Extremely low velocity
(Ref: Ganong, 25th ed/p.629)
(Ref: Ganong, 25th ed/p.629)
•• Compliance of lung is a measure of its elasticity
•• Small airways have laminar air flow because of Extremely
C low velocity of airflow in them
Lung Volumes and Capacities
R 24. Ans. (c)  Pressure of gas
28. Ans. (b)  TV
(Ref: Ganong, 25th ed/p.629)
I Whether the air flow is laminar or turbulent is determined by (Ref: Ganong, 25th ed/p.628)
Reynolds number •• Tidal volume is the volume of air inspired or expired with
S each breath during normal quiet breathing. It is 500– 750 ml
P
29. Ans. (a)  Inspiratory capacity minus the inspiratory reserve ƒƒ Nitrogen washout technique
volume ƒƒ Body plethysmography
(Ref: Ganong, 25th ed/p.628)
295
39. Ans. (b)  Residual volume
•• Inspiratory capacity (IC) = TV + IRV
•• So tidal volume = Inspiratory capacity minus the inspiratory (Ref: Ganong, 25th ed/p.629)
reserve volume
40. Ans. (b)  Function residual capacity

ANSWERS WITH EXPLANATIONS

30. Ans. (a) Inspiratory reserve volume, Tidal volume and
Expiratory reserve volume
(Ref: Ganong, 25th ed/p.629)
•• Vital capacity (VC) = Inspiratory reserve volume + Tidal
volume + Expiratory reserve volume
31. Ans. (c)  FRC
(Ref: Ganong, 25th ed/p.629)
•• Functional residual capacity is the amount of air remaining
in the lungs after a normal tidal expiration
•• It is obtained by adding residual volume + Expiratory
reserve volume
•• FRC is also called as “Equilibrium volume” or “relaxation
volume” because inward elastic recoil of lung balances with
outward recoil of chest wall at Functional residual capacity
32. Ans. (b)  Functional residual capacity
(Ref: Ganong, 25th ed/p.628)
(Ref: Ganong, 25th ed/p.630)
41. Ans. (c)  Max. mid respiratory flow rates
(Ref: Ganong, 25th ed/p.630)
•• Maximal mid-expiratory flow (MMEF 25-75)
ƒƒ It is the average flow during the middle half of the FVC
ƒƒ It is effort independent
ƒƒ It is a sensitive marker for detecting early airway
obstruction
42. Ans. (c)  The pressure in the lung decrease, but that in the
box increase
(Ref: Ganong, 25th ed/p.630)
•• Body plethysmography is based on the principle of
Boyle’s Law which states that volume of a gas is inversely
proportional to the pressure of that gas at constant
temperature

Reciprocal changes in Pressure and volume (Boyle’s law)

33. Ans. (a)  Functional residual capacity
during plethysmography
(Ref: Ganong, 25th ed/p.629)
During inspiration During expiration
34. Ans. (b)  Maximal expiration In subject’s Volume increases Volume decreases
Lung Pressure decreases Pressure increases
(Ref: Ganong, 25th ed/p.628)
In box Volume decreases Volume increases
•• Residual volume (RV) is the volume of air left in lungs after
Pressure increases Pressure decreases
forced expiration
•• It is usually around 20 % of total lung capacity (TLC)
43. Ans. (b)  Decreased partial pressure of CO2 in alveoli
35. Ans. (c)  ERV + RV
(Ref: Ganong, 25th ed/p.628)
(Ref: Ganong, 25th ed/p.629) •• Increase in alveolar ventilation washes out CO2 – So, there is
decreased partial pressure of CO2 in alveoli
36. Ans. (d)  4700 ml
44. Ans. (b)  Reduced FEV1/FVC ratio
(Ref: Ganong, 25th ed/p.629)
•• Normal value of vital capacity is around 4700 ml (Ref: Ganong, 25th ed/p.629)
•• Normally, the FEV1/FVC ratio is greater than 0.7
37. Ans. (d)  5900 ml
(Ref: Ganong, 25th ed/p.628) FEV1/FVC Ratio
•• Normal value of total lung capacity is around 5900 ml Obstructive lung diseases Restrictive lung diseases

38. Ans. (d)  Tidal volume • FEV1/FVC Ratio is low • FEV1/FVC Ratio remains C
because FEV1 drops much normal if the drop in FVC is
(Ref: Ganong, 25th ed/p.629) more significantly than proportional to drop in FEV1 R
•• Lung volumes and capacities that can’t be measured by FVC • FEV1/FVC Ratio may increase if
spirometry the FVC drops more markedly I
ƒƒ Residual volume (RV) than FEV1
ƒƒ Functional residual capacity (FRC) S
ƒƒ Total lung capacity (TLC) 45. Ans. (b)  RV decreased
•• They are usually measured by, P
ƒƒ Helium dilution technique (Ref: Ganong, 25th ed/p.628)
 •• Increase in residual volume denotes “air trapping” which is 53. Ans. (d)  150 L/min
classically seen in obstructive lung diseases
296 (Ref: Ganong, 25th ed/p.)
46. Ans. (d)  FEV1 is forced expiratory rate at one minute
Maximum Voluntary Ventilation (MVV)
(Ref: Ganong, 25th ed/p.628) •• MVV is the largest volume of air an individual breath in and
•• FEV1 is forced expiratory rate in 1st second out of the lungs in 1 minute
CHAPTER 7  RESPIRATORY PHYSIOLOGY

•• It is usually measured for 10 - 15 seconds and extrapolated

47. Ans. (c)  Lung compliance for 1 minute
(Ref: Ganong, 25th ed/p.628) •• Normal MVV is 120 – 170 L/min
•• Lungs are elastic structures. Its ability to expand 54. Ans. (a)  6 L
(stretchability) is quantified in terms of compliance. So,
Total lung capacity depends on the stretchability of lung (Ref: Ganong, 25th ed/p.628)

48. Ans. (a)  FRC is smaller than closing volume Minute Ventilation
•• Also called as pulmonary ventilation
(Ref: Ganong, 25th ed/p.629) •• It is the volume of air inspired or expired per minute
•• Loss of functional residual capacity (FRC) occurs in hyaline •• It is equal to the tidal volume (TV) multiplied by respiratory
membrane disease for the following reasons, rate (RR)
ƒƒ Deficiency of surfactant •• Minute ventilation = TV × RR
ƒƒ Displacement of lung gas volume by edema, vascular •• Normal minute ventilation is 6–7.5 L/min
congestion
55. Ans. (a)  Anatomical dead space-end inspiration phase
Alveolar Ventilation and Dead Space Ventilation (Ref: Ganong, 25th ed/p.630)
•• Anatomical dead space containing atmospheric air at the
49. Ans. (b)  RR/Tidal volume end of inspiration will have the least amount of CO2 –
Ref: Ganong 25th ed P. 632 because atmospheric air has negligible CO2
•• Anatomical dead space-end expiration phase: Here alveolar
Minute ventilation gas rich in CO2 occupies the Anatomical dead space dead
•• Also called as pulmonary ventilation space area
•• It is the volume of air inspired or expired per minute •• Alveolar air contains a mixture of O2 from the inspired air
•• It is equal to the tidal volume (TV) multiplied by respiratory and CO2 which is continuously added to it to exhale out
rate (RR)
•• Minute ventilation = TV × RR 56. Ans. (a)  16%
•• Normal minute ventilation is 6–7.5 L/min
(Ref: Ganong, 25th ed/p.629)
50. Ans. (c)  30–40 •• Mouth-to-mouth respiration provides an oxygen
Ref: Ganong 25 ed P. 632
th concentration of 16%
VD/ VT ratio 57. Ans. (a)  40 mm Hg
•• This ratio is used to find out the proportion of ventilation
remains in dead spaces (Ref: Ganong, 25th ed/p.629)
•• Normally the ratio is 150/500 which equals 0.3
This means that 30% of the ventilation remains in dead spaces. Partial pressures (mm Hg)

51. Ans. (c)  4.2 Gas Arterial blood Venous blood

Oxygen 95 40
(Ref: Ganong, 25th ed/p.629)
•• Alveolar ventilation is 4.2 L/min Carbon dioxide 40 46
•• Alveolar ventilation = respiratory rate * (tidal volume –
C dead space) = 12 (500 – 150) = 4.2L/min 58. Ans. (b)  50ml/min
(Ref: Ganong, 25th ed/p.630)
R 52. Ans. (a)  4900 ml
•• Amount of O2 consumed = 250 ml/min
(Ref: Ganong, 25th ed/p.628) •• Amount of CO2 produced = 200 ml/min
I •• Alveolar ventilation = respiratory rate * (tidal volume – •• So, the difference is 50 ml/min
dead space) = 14 (500 – 150) = 4900 ml/min
S
P
 59. Ans. (b)  Anatomical dead space = Physiological dead space Pulmonary Pulmonary
vasoconstriction vasodilation
(Ref: Ganong, 25th ed/p.630) 297
•• In healthy individuals, Physiologic dead space roughly • Hypoxia • Sympathetic
equals anatomic dead space • Sympathetic stimulation stimulation (β2-
(α-Adrenergic) Adrenergic)
60. Ans. (c)  Bohr equation • Thromboxane • Parasympathetic

ANSWERS WITH EXPLANATIONS

• Endothelin stimulation
(Ref: Ganong, 25th ed/p.629)
• Angiotensin II • Prostacyclin
•• Physiologic dead space is measured with the help of an • Histamine • Nitric oxide
equation termed Bohr’s equation • PGF2α, PGE2 • Bradykinin
Bohr’s Equation •• So, all the options are causes of pulmonary vasoconstric-
PACO –PECO tion. The single best answer if hypoxia
2 2

VD = VT × 65. Ans. (c)  Hypoxia

PACO
2
(Ref: Ganong, 25th ed/p.637)
•• Here in this equation,
ƒƒ VD is the dead space ventilation
ƒƒ VT is the tidal volume 66. Ans. (a)  Increase in the number of open capillaries
ƒƒ PEco2 is the partial pressure of CO2 in mixed expired air (Ref: Ganong, 25th ed/p.636)
ƒƒ PAco2 is the alveolar PaCO2
•• Pulmonary circulation accommodates the increase in cardiac
61. Ans. (a)  Single breath N2 method output by opening of new capillaries which are previously
under perfused. This phenomenon is called “recruitment of
(Ref: Ganong, 25th ed/p.630) capillaries”
•• The technique useful for measuring anatomic dead space is
single-breath Nitrogen method 67. Ans. (b)  Contribute to gaseous exchange
•• This method is also called Fowler’s method (Ref: Ganong, 25th ed/p.637)
•• Bronchial circulation supplies oxygenated blood to the
Pulmonary Circulation and VQ Ratio lungs through bronchial arteries
•• Bronchial circulation constitutes about 2% of the cardiac
62. Ans. (b)  No exchange of O2 and CO2 output
•• Bronchial arteries supply lung till the level of terminal
(Ref: Ganong 25th ed p.636)
bronchioles
•• Bronchial circulation doesn’t contribute to gaseous exchange
Ventilation – Perfusion ratio (V/Q ratio) = ∞ (Infinity)
•• This means that the perfusion is nil (denominator). So, the 68. Ans. (c)  V/Q is high
ratio becomes infinity
(Ref: Ganong, 25th ed/p.636)
•• Physiological cause of non-uniform perfusion is:
ƒƒ Dead spaces – No gas exchange happens •• Ventilation and perfusion are more in the base of lung than
•• Pathological causes of non-uniform perfusion are: at the apex of lung
ƒƒ Pulmonary embolism •• But the fall in perfusion is more at the apex than ventilation
ƒƒ Compression of pulmonary vessels by high alveolar at the apex of lung
pressures •• So, the V/Q ratio is more at apex of lung
ƒƒ Tumor occluding pulmonary vessels
69. Ans. (c)  Both
63. Ans. (b)  Pulmonary Vasoconstriction in hypoxia (Ref: Ganong, 25th ed/p.637)
(Ref: Ganong, 25th ed/p.636) •• Both in apical and basal regions of lung, there is mismatch
•• Most important regulatory factor for pulmonary circulation in ventilation and perfusion
is hypoxia (reduced Po2)
•• Hypoxia causes pulmonary vasoconstriction. This effect 70. Ans. (a)  PaO2 is maximum at the apex
C
is different in systemic circulation where hypoxia causes
vasodilation
(Ref: Ganong, 25th ed/p.638) R
•• PaO2 is maximum at the apex
64. Ans. (a)  Hypoxia •• High P02 of the apical regions of lung favors the growth of I
mycobacterium tuberculosis (Puhl’s Lesion)
(Ref: Ganong, 25th ed/p.637) S
P
 71. Ans. (a)  Apex of lung
298 (Ref: Ganong, 25th ed/p.636)
72. Ans. (c)  Apex of lung
(Ref: Ganong, 25th ed/p.636)
CHAPTER 7  RESPIRATORY PHYSIOLOGY
Diffusion of Gases
73. Ans. (a)  High affinity of CO for hemoglobin
(Ref: Ganong, 25th ed/p.640)
•• The affinity of carbon monoxide for hemoglobin is about
210 times more than that of oxygen for hemoglobin
74. Ans. (a)  Diffusion
(Ref: Ganong, 25th ed/p.640)
•• Diffusion means movement of molecules from area of high
concentration to area of low concentration
•• Gas exchange in lungs happens in the form of diffusion in
lungs
75. Ans. (b)  More soluble in plasma
(Ref: Ganong, 25th ed/p.639)
•• The diffusion coefficient of CO2 is about 20 times that of O2.
So, CO2 diffuses much faster and easily than O2
76. Ans. (a)  CO
(Ref: Ganong, 25th ed/p.639)
•• In clinical practice, carbon monoxide is the gas of choice
for measuring diffusion capacity because it is the diffusion
limited gas
•• The procedure is called diffusing capacity of the lung for
carbon monoxide or DLCO
77. Ans. (d)  300-400 ml/min/mm Hg
(Ref: Ganong, 25th ed/p.640)
•• Normal value of DLCO is 25 mL/min/mm Hg
•• Diffusion coefficient of O2 is about 1.23 times that of CO
•• So, Diffusing capacity for oxygen is 25 * 1.23 = 30 mL/min/
mm Hg
•• Diffusion capacity of CO2 is 400 ml/min/mm Hg
78. Ans. (d)  Polycythemia
(Ref: Ganong, 25th ed/p.639)
•• DLCO is increased in polycythemia
C 84. Ans. (b)  Increased O2 delivery at tissue and uptake at lung
R Transport of Gases
I 79. Ans. (c)  45
Ref: American Board of Anesthesiology American Society of
S Anesthesiologists, Book A 1996 q-67
P (Ref: Ganong, 25th ed/p.)
•• Breathing 100% oxygen will not change the oxygen
saturation much. In arterial blood it is around 97%
saturation which corresponds to a PO2 of 100 mm Hg
•• In venous blood it is 75% saturation which corresponds to
a mixed venous oxygen tension of around 40–45 mm Hg
80. Ans. (c)  18
(Ref: Ganong, 25th ed/p.640)
Oxygen Carrying Capacity of Hemoglobin
•• Each gram of hemoglobin transport 1.34 mL of oxygen
•• So, here in the question, its 14 × 1.34 = 18
81. Ans. (b, d)  ↓ed affinity of hemoglobin to oxygen; d. Right
shift of oxygen-hemoglobin dissociation curve
(Ref: Ganong 25th ed p.641)
Increase in 2,3-diphosphoglycerate (2,3-DPG)- Right
shift of ODC
•• 2,3-DPG is an intermediate product in glycolysis
•• It binds with β chains of deoxyhemoglobin causing more O2
to be released at tissues
•• Most important factors that decreases the 2,3-DPG
concentration is:
ƒƒ Acidosis (low PH) because acidosis inhibits glycolysis
ƒƒ Stored blood (acid citrated buffer used for storage
inhibits glycolysis)
•• Factors that increase 2,3-DPG concentration are:
ƒƒ Thyroid hormones
ƒƒ Growth hormones
ƒƒ Androgens
82. Ans. (a)  Hb level
(Ref: Ganong, 25th ed/p.640))
•• Oxygen is transported in blood in two forms. They are,
ƒƒ Dissolved form (3%)
ƒƒ Combined with hemoglobin (97%)
83. Ans. (c)  80 mm Hg
(Ref: Ganong, 25th ed/p.640)
•• Amount of dissolved O2 in 100 ml of blood = 0.0003 * PaO2
•• Remember that normal arterial blood at PO2 of 100 mm Hg
contains 0.3 ml O2/100 ml of blood
•• 0.0025ml O2/ml blood for 100 ml of blood will become 0.25
ml O2/100 ml
•• 100 mm Hg = 0.3 ml O2/100 ml
•• X = 0.25 ml O2/100 ml
•• So, X = 0.25 * 100/0.3 = 83 mm Hg
(Ref: Ganong, 25th ed/p.640)
•• Hemoglobin is the oxygen carrier protein
•• It takes up oxygen from lungs and deliver it to tissues
85. Ans. (a)  97%
86. Ans. (d)  Bicarbonate 91. Ans. (d, e)  d. Increased HCO3, e. increased pH
(Ref: Ganong, 25th ed/p.640) (Ref: Ganong, 25th ed/p.641) 299
•• Co2 is transported as, •• Remember, right shift of ODC means more oxygen delivery
ƒƒ As bicarbonate form (70% - the major form of Co2 to tissue
transport) •• Left shift of ODC means less oxygen delivery to tissue
ƒƒ As carbamino compound form bound with hemoglobin •• So, this question is about left shift of ODC

ANSWERS WITH EXPLANATIONS

(23%)
ƒƒ In dissolved form (7%)
87. Ans. (a)  RBC high chloride
(Ref: Ganong, 25th ed/p.641)
•• Chloride Shift
ƒƒ Also called as Hamburger phenomenon
ƒƒ The channel responsible for chloride shift is called as
anion exchanger 1 (AE 1). It is also called as Band 3
protein present in RBC membrane
ƒƒ HCO3– leaves the RBCs in exchange for Cl– (chloride
shift) and is transported to the lungs in the plasma
ƒƒ Cl- ion is an osmotically active particle that drags water
along with it into the RBCs
ƒƒ Since RBCs take up water, it increases in size. This is the
reason why hematocrit of venous blood is normally 3%
greater than that of arterial blood
ƒƒ In lungs, chloride shift happen in opposite direction
leading to shrinkage of RBCs
88. Ans. (a)  Generation of HCO3– in RBCs
(Ref: Ganong, 25th ed/p.640)
89. Ans. (b)  Type of fluid administered
(Ref: Ganong, 25th ed/p.642)
90. Ans. (d)  90%
•• Option A – Decreased hb (anemia) – causes right shift
•• Option B – Hypoxia – causes right shift
•• Option C – Increased PaCO2 (Hypercarbia) - causes right
shift
•• Option D - increased HCO3 – alkalosis – causes left shift
•• Option E - increased pH – alkalosis – causes left shift
92. Ans. (b)  Low affinity for 2, 3-DPG
(Ref: Ganong, 25th ed/p.642)
•• Two gamma chains present in HbF has less affinity for 2,
3-DPG when compared to the beta (β) chains of HbA
93. Ans. (b)  Acidosis
(Ref: Ganong, 25th ed/p.641)
•• Most important factors that decreases the 2,3-DPG
concentration is
ƒƒ Acidosis(low PH) because acidosis inhibits glycolysis
ƒƒ Stored blood (acid citrated buffer used for storage
inhibits glycolysis)
94. Ans. (b)  Hypoxia
(Ref: Ganong, 25th ed/p.641)
•• Decreased affinity of oxygen – right shift of ODC
•• Increased affinity of oxygen – left shift of ODC
•• This question is about Increased affinity of oxygen – left
shift of ODC

(Ref: Ganong, 25th ed/p.641) ODC – shift to right

•• Means there is decreased affinity of oxygen to hemoglobin
leading to release of oxygen (unloading of oxygen)
•• Means a higher value of PO2 is required for hemoglobin to
bind a given amount of O2
•• Shift to right commonly occurs in tissues where unloading
of oxygen is very vital
•• Causes of right shift of Oxygen-hemoglobin dissociation
curve
ƒƒ Hypoxia
ƒƒ Increase in PCO2
ƒƒ Decrease in pH of blood (Acidosis)
ƒƒ Increase in the temperature
ƒƒ Increase in 2,3-diphosphoglycerate (2,3-DPG)
ƒƒ High altitude C
ƒƒ Exercise
R
ODC – shift to left
•• Means there is increased affinity of oxygen to hemoglobin
I
•• In the above pic, PO2 of 60 % correspond to Hb saturation
leading to loading of oxygen
of 90%
•• Shift to left commonly occurs in lungs where loading of S
oxygen occurs
P
 •• Left shift simply means that at same PO2, there is more •• P50 - is the partial pressure of oxygen at which hemoglobin
uptake of oxygen saturation with oxygen is 50%.
300 •• Causes of left shift of Oxygen-hemoglobin dissociation •• The value of P50 is around 25 – 27 mm Hg
curve are, •• Hemoglobin affinity for O2 is inversely related to the P50
ƒƒ Decreased pCO2 of blood •• If the oxyhemoglobin dissociation curve is shifted to the
ƒƒ Increased pH of blood (alkalosis) right, the P50 increases
ƒƒ Decreased temperature •• Decrease in pH (acidosis) causes right shift of ODC. So, the
CHAPTER 7  RESPIRATORY PHYSIOLOGY

ƒƒ Fetal hemoglobin answer is pH

ƒƒ Methemoglobin (Iron in ferric form)
106. Ans. (d)  P50 decreases and O2 affinity increases
95. Ans. (b)  Fall in temperature
(Ref: Ganong, 25th ed/p.641)
(Ref: Ganong, 25th ed/p.641)
•• Hyperventilation causes decrease in PCO2 and left shift of
ODC
96. Ans. (a)  Chloride ion concentration •• If the oxyhemoglobin dissociation curve is shifted to the
(Ref: Ganong, 25th ed/p.642) left, the P50 decreases
•• Left shift means there is increased affinity of oxygen to
97. Ans. (d)  Metabolic alkalosis hemoglobin

(Ref: Ganong, 25th ed/p.641) 107. Ans. (b)  Dissociation of CO2 on oxygenation
(Ref: Ganong, 25th ed/p.641)
98. Ans. (b)  Decreased CO2
•• Haldane effect states that “when oxygen binds with
(Ref: Ganong, 25th ed/p.641) hemoglobin, carbon dioxide is released at lungs and when
oxygen is released from hemoglobin, carbon dioxide is
99. Ans. (b)  Blood transfusion loaded at tissues”
(Ref: Ganong, 25th ed/p.641) 108. Ans. (a)  Bohr effect
•• Most important factors that decreases the 2,3-DPG
concentration is (Ref: Ganong, 25th ed/p.641)
ƒƒ Acidosis(low PH) because acidosis inhibits glycolysis •• The decrease in O2 affinity of hemoglobin when pH of
ƒƒ Stored blood (acid citrated buffer used for storage blood falls (PCO2 rises) is called the Bohr effect. This leads
inhibits glycolysis) to release of oxygen at tissues
•• So, blood transfusion of stored blood causes left shift of
ODC because of decreased 2,3-DPG concentration 109. Ans. (a)  Facilitates oxygen transport

100. Ans. (a)  Oxygen dissociation curve shift to left (Ref: Ganong, 25th ed/p.641)

(Ref: Ganong, 25th ed/p.641) 110. Ans. (a)  2 ml/100 ml of blood

101. Ans. (c)  Increases in pH shift curve to right (Ref: Ganong, 25th ed/p.642)

(Ref: Ganong, 25th ed/p.641)

102. Ans. (a)  Binding of O2 causes release of H

(Ref: Ganong, 25th ed/p.641)

103. Ans. (a)  One, increase

(Ref: Ganong, 25th ed/p.641)
•• 2,3-BPG is is produced by RBCs during their normal
glycolysis
C •• One mole of deoxyhemoglobin binds 1 mol of 2,3-DPG.
This increases the release of oxygen
R
104. Ans. (b)  Decreased production of 2-3 bisphosphoglycerate
I (Ref: Ganong, 25th ed/p.641)
•• This picture is carbon dioxide dissociation curve
•• At Po2 100 mm Hg and Pco2 45 mm Hg, CO2 content in blood
S 105. Ans. (a)  pH
changes from 48 ml/dl to 50 ml/dl
•• At Po2 40 mm Hg and Pco2 45 mm Hg, CO2 content in blood
P (Ref: Ganong, 25th ed/p.641) changes from 48 ml/dl to 52 ml/dl
 •• The amount of Co2 taken up at tissues is doubled (Point B to
Point A) due to Haldane effect
•• In the absence of Haldane effect, CO2 content in blood
changes from 48 ml/dl to 50 ml/dl (difference is 2ml/dl)
111. Ans. (a)  Sigmoid curve of oxygen dissociation, b. Positive
cooperativity
(Ref: Ganong, 25th ed/p.641)
112. Ans. (b)  No Hb molecule is available to bind with O2
(Ref: Ganong, 25th ed/p.641)
113. Ans. (a) Binding of one oxygen molecule increases the
affinity of binding other O2 molecules
(Ref: Ganong, 25th ed/p.641)
The Curve is Sigmoid Shaped Because,
•• Once the first molecule of oxygen binds with the first heme
in Hb, it increases the affinity for further oxygen binding
and making it lot easier.
•• There is increasing affinity for oxygen binding so that
affinity for the fourth O2 molecule is the highest
•• This is termed as co-operative binding kinetics and it is the
reason for the sigmoid nature of the curve
114. Ans. (b)  Cooperative binding in Hb
(Ref: Ganong, 25th ed/p.641)
115. Ans. (b)  More affinity than hemoglobin
(Ref: Ganong, 25th ed/p.641)
•• Myoglobin is the iron-containing pigment that stores
oxygen mainly present in skeletal muscle
•• Each molecule of myoglobin can bind with only one
molecule of oxygen
•• myoglobin binds with oxygen with increased affinity
leading to loading of oxygen (left shift)
116. Ans. (b)  Shift of hemoglobin dissociation curve to left
(Ref: Ganong, 25th ed/p.641)
•• Blood reaching systemic capillaries delivers oxygen to the
tissues – Right shift
117. Ans. (c)  3.6 kPa
(Ref: Ganong, 25th ed/p.641)
•• 1 kPa = 7.5 mm Hg
•• The value of P50 is around 25 – 27 mm Hg which
corresponds to 3.6 kPa
Neural Regulation of Respiration
118. Ans. (d)  Pre-Botzinger complex
(Ref: Ganong, 25th ed/p.655)
Pre-Botzinger Complex – “The pacemakers of
respiration”
•• Initiates the respiratory rhythm
301
•• This complex contains six group of neurons that functions
as “central pattern generator” for initiation of respiration
•• Located in the ventrolateral medulla
•• Rhythmically drives the discharge of phrenic motor neurons
ANSWERS WITH EXPLANATIONS
that innervate diaphragm
119. Ans. (c)  Ventral VRG group of neurons
(Ref: Ganong, 25th ed/p.655)
•• At rest, expiration is a passive process
•• Ventral VRG group of neurons controls expiration. So, they
are inactive during normal respiration
120. Ans. (d)  Apneusis
(Ref: Ganong, 25th ed/p.655)
•• In Mid pontine transection – pneumotaxic center separated
from apneustic center
•• If vagus is intact - Breathing becomes slow, deep
•• If vagus is cut - Inspiration is markedly prolonged. This
breathing pattern is called apneusis or inspiratory spasm
121. Ans. (b)  Deep and slow respiration
(Ref: Ganong, 25th ed/p.657)
122. Ans. (c)  Lesion is midpontine with damaged vagus
(Ref: Ganong, 25th ed/p656.)
123. Ans. (b)  Irregular and gasping
(Ref: Ganong, 25th ed/p.656)
•• Lesion between pons and medulla - Irregular respiration is
seen
124. Ans. (a)  Prolonged inspiratory spasm
(Ref: Ganong, 25th ed/p.655)
125. Ans. (a)  Pneumotaxic center
(Ref: Ganong, 25th ed/p.655)
•• Pneumotaxic center limits inspiration by inhibiting
apneustic center
126. Ans. (c)  Head’s paradoxical reflex
(Ref: Ganong, 25th ed/p.659)
•• Hering-Breuer inflation reflex
ƒƒ This reflex is atypical negative feedback reflex where C
“overinflation of lung inhibits further lung inflation”
•• The paradoxical reflex of head R
ƒƒ This reflex is paradoxical to Hering-Breuer inflation
reflex where inflation of lungs causes further inflation
ƒƒ This reflex might me the cause for lung inflation in
I
newborn immediately after birth when the newborn
takes the first breath
S
P
 127. Ans. (a)  Pulmonary interstitium 133. Ans. (a)  Increased H+

302 (Ref: Ganong, 25th ed/p.658) (Ref: Ganong, 25th ed/p.658)

•• J receptors were discovered by an Indian physiologist A. S. •• Central chemoreceptors are mainly stimulated by H+ ions
Paintal
•• These receptors are located very close to the pulmonary 134. Ans. (a)  ↑PCO2
capillaries (Juxtapulmonary receptors) in pulmonary
CHAPTER 7  RESPIRATORY PHYSIOLOGY

(Ref: Ganong, 25th ed/p.658)

interstitium
128. Ans. (b)  J receptors
(Ref: Ganong, 25th ed/p.658)
•• J receptors are activated by,
ƒƒ Pulmonary congestion
ƒƒ increases in the interstitial fluid volume of alveolar wall
ƒƒ hyperinflation of the lung
ƒƒ intravenous injection of chemicals like capsaicin
•• So, J receptors are not a stimulus for normal respiration
129. Ans. (a)  Proprioception
(Ref: Ganong, 25th ed/p.658)
•• Increase in respiratory rate occurs abruptly at the start of
exercise termed as Exercise hyperpnoea. Cause for this
exercise hyperpnoea are,
ƒƒ Psychic stimuli
ƒƒ Afferent impulses from proprioceptors in muscles,
tendons, and joints
130. Ans. (a)  Hering Breuer reflex
(Ref: Ganong, 25th ed/p.658)
•• Role of Hering-Breuer inflation reflex
ƒƒ Protective reflex – It prevents overdistension of lung
alveoli at larger tidal volumes
ƒƒ The threshold for this reflex falls within the normal tidal
volume only in Infants. So, this reflex influences tidal
volume and respiratory rate only in infants
131. Ans. (b)  Duration of expiration
(Ref: Ganong, 25th ed/p.658)
•• Hering-Breuer inflation reflex response consists of,
ƒƒ Slowing of respiratory frequency
ƒƒ Increase in duration of expiration
ƒƒ Bronchodilation
ƒƒ Increased heart rate
ƒƒ Slight vasoconstriction
Chemical Regulation of Respiration
C 132. Ans. (c)  Chemoreceptors
R (Ref: Ganong, 25th ed/p.657)
•• Peripheral chemoreceptors are located in carotid bodies and
I aortic bodies
•• They have two types of cells namely,
S ƒƒ Type I cells or Glomus cells
ƒƒ Type II cells
P (reduced PO2)
•• Central chemoreceptors are present in the brain
•• They are more sensitive to increases in arterial Pco2 but not
PO2 of blood
135. Ans. (b)  Decrease in pH of CSF
(Ref: Ganong, 25th ed/p.658)
•• The CO2 level in blood regulates ventilation chiefly by its
effect on the pH of the CSF
136. Ans. (b)  Chemoreceptors in wall of 4th ventricle
(Ref: Ganong, 25th ed/p.658)
•• Peripheral chemoreceptors are more sensitive to hypoxia
(reduced PO2)
•• Central chemoreceptors are more sensitive to hypercarbia
(increased PCO2)
•• Central chemoreceptors are located in the floor of the
fourth ventricle
137. Ans. (a)  Decreased to H+
(Ref: Ganong, 25th ed/p.657)
•• COPD is characterized by hypercapnia (increased PCO2)
and hypoxia
•• Such increased PCO2 makes CSF acidotic
•• Chemoreceptors lose their sensitivity to (H+) when CSF pH
becomes acidotic
•• So, in COPD, only way to increase ventilation is by hypoxic
stimulation of peripheral chemoreceptors. This phenomenon
is termed as “Hypoxic drive”
•• Administration of oxygen to COPD patients at times
worsens hypercapnia by abolishing this hypoxic drive
138. Ans. (b)  Hypocapnia
(Ref: Ganong, 25th ed/p.657)
•• Peripheral chemoreceptors are mainly stimulated by,
•• Hypoxia (decrease in Po2) – carotid bodies firing rises
rapidly when Po2 falls below 100 mmHg
•• Rise in the Pco2
•• Fall in pH (acidosis)
•• Cyanide
•• Chemicals like nicotine, lobeline
•• Dinitrophenol
•• Increase in plasma K+ levels (play a role in exercise induced
hyperpnea)
139. Ans. (a)  PO2
(Ref: Ganong, 25th ed/p.658)
•• Peripheral chemoreceptors are more sensitive to hypoxia
 •• Central chemoreceptors are more sensitive to hypercarbia •• Anemic hypoxia is seen in Carbon monoxide poisoning and
(increased PCO2) methemoglobinemia
303
140. Ans. (d)  Oxygen saturation decreases below 60% 148. Ans. (b)  CO poisoning
(Ref: Ganong, 25th ed/p.658) (Ref: Ganong, 25th ed/p.646)
•• Threshold for peripheral chemoreceptor activation is •• CO poisoning causes anemic hypoxia where arterial oxygen
Oxygen saturation below 60% content decreases

ANSWERS WITH EXPLANATIONS

141. Ans. (d)  H+ 149. Ans. (a)  Anemic hypoxia
(Ref: Ganong, 25th ed/p.658) (Ref: Ganong, 25th ed/p.647)
•• Peripheral and central chemoreceptors can be stimulated by
increase in H+ 150. Ans. (c)  Cyanide poisoning
(Ref: Ganong, 25th ed/p.646)
142. Ans. (b)  Dopamine is neurotransmitter
•• Histotoxic hypoxia occurs due to blockage of cellular
(Ref: Ganong, 25th ed/p.658) enzymes that utilize oxygen
•• Mechanism of peripheral chemoreceptor stimulation •• Commonly seen in cyanide poisoning
ƒƒ Whenever there is low Po2 (hypoxia), O2-sensitive K+
channels in glomus cells close 151. Ans. (d)  Hypoventilation
ƒƒ Accumulation of K+ inside the glomus cells leads to a (Ref: Ganong, 25th ed/p.646)
state of depolarization
ƒƒ Such depolarization open calcium channels leading to •• Hypoventilation – is a cause for hypoxic hypoxia
calcium influx
152. Ans. (b)  Anemic hypoxia
ƒƒ Influx of calcium causes release of the neurotransmitter
dopamine which stimulates the afferent nerve endings (Ref: Ganong, 25th ed/p.647)
•• Since arterial Po2 is determined by dissolved oxygen, the
143. Ans. (c)  Ventral surface of medulla
value of arterial Po2 is normal in anemic hypoxia
(Ref: Ganong, 25th ed/p.657) •• So, the peripheral chemoreceptors are not stimulated
•• The locations where central chemoreceptors are present are,
153. Ans. (b)  Stagnant
ƒƒ Ventral surface of medulla
ƒƒ Nucleus of tractus solitarius (Ref: Ganong, 25th ed/p.647)
ƒƒ Locus ceruleus •• Arterio venous O2 difference ((a-v-O2 difference) is
ƒƒ Hypothalamus increased in stagnant hypoxia
•• Arterio venous O2 difference ((a-v-O2 difference) is
144. Ans. (a)  Apnea occurs due to hypostimulation of Peripheral
decreased in histotoxic hypoxia
Chemoreceptors
(Ref: Ganong, 25th ed/p.657) 154. Ans. (d)  Histotoxic hypoxia
(Ref: Ganong, 25th ed/p.647)
Hypoxia and Cyanosis
155. Ans. (c)  Hb
145. Ans. (c)  Stagnant (Ref: Ganong, 25th ed/p.647)
(Ref: Ganong, 25th ed/p.647) •• Dissolved oxygen always determine PO2 levels
•• Stagnant hypoxia is also called as ischemic hypoxia or •• Bound oxygen with Hemoglobin doesn’t determine PO2
circulatory hypoxia or Hypoperfusion hypoxia levels
•• Commonly seen in congestive cardiac failure and circulatory
156. Ans. (b)  Decreased cerebral blood flow
shock
(Ref: Ganong, 25th ed/p.647)
146. Ans. (d)  Shock
•• Toxic effects of hyperbaric oxygen includes,
C
(Ref: Ganong, 25th ed/p.646) ƒƒ Pulmonary damage – atelectasis
ƒƒ Retinal damage
R
147. Ans. (b)  Anemic hypoxia ƒƒ Twitching, convulsions I
(Ref: Ganong, 25th ed/p.646) 157. Ans. (a)  Anemia
•• Characterized by reduction in hemoglobin concentration
S
(Ref: Ganong, 25th ed/p.647)
and decline in the O2-carrying capacity of the blood
(reduced arterial O2 content)
P
 •• For anemia, hemoglobin levels have to be increased by 162. Ans. (c)  CO poisoning
blood transfusion
304 (Ref: Ganong, 25th ed/p.647)
158. Ans. (c)  1.5 gm/dl •• CO poisoning causes anemic hypoxia
(Ref: Ganong, 25th ed/p.647) 163. Ans. (b)  Late sign hypoxia
•• The level of methemoglobin producing cyanosis is 1.5 gm/
CHAPTER 7  RESPIRATORY PHYSIOLOGY

(Ref: Ganong, 25th ed/p.646)

dl
•• If deoxyhemoglobin (reduced Hb) is 5.0 g/dL or greater, •• Cyanosis in trauma is an extremely Late sign Hypoxemia or
cyanosis appears it doesn’t occur at all

159. Ans. (b)  O2 saturation < 85% 164. Ans. (a)  Oxygen dissociation curve shifted to right

(Ref: Ganong, 25th ed/p.646) (Ref: Ganong, 25th ed/p.646)

•• Oxygen saturation for patients with central cyanosis is •• CO poisoning causes left shift of Oxygen dissociation curve
usually below 85% and it impairs the unloading of oxygen to tissues
•• CO poisoning is treated with hyperbaric oxygen therapy
160. Ans. (c)  Critical concentration of Hb required to produce because it displaces Carbon monoxide form hemoglobin
Cyanosis is reduced
165. Ans. (c) Oxygen-haemoglobin saturation curve becomes
(Ref: Ganong, 25th ed/p.646) hyperbolic shape
•• Cyanosis is not seen in anemic hypoxia because critical
(Ref: Ganong, 25th ed/p.646)
concentration of Hb required to produce cyanosis is reduced
•• CO has 110 times more affinity than oxygen for hemoglobin
161. Ans. (c)  Anemic hypoxia •• CO poisoning causes left shift of Oxygen dissociation curve
and it impairs the unloading of oxygen to tissues
(Ref: Ganong, 25th ed/p.647)
•• In CO poisoning, arterial blood gas analysis should be done
to detect oxygen saturation
•• Normal level of CO Hb in non-smokers is 0.3 – 0.8 %

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