Medi Call FCPS – 1 | May 2023 Papers
Medi Call FCPS – 1 | Physiology - Respiration
25. Pressure in cylinder at end of last drop when initial pressure in N2O
cylinder is 750 psi ☛ Pressure will be zero
26. Alveolar pressure of water is determines by ☛ P02
27. If ventilation of alveoli stopped bcz of bronchiolar blockage, PO2 in
blood ☛ Equal to mixed venous blood (No O2 for exchange )
28. Less in fetus than mother ☛ PO2 (50 mm Hg and 30 mm Hg)
29. Major differences between PO2 and PCO2 ☛ Aorta and Pulmonary
Artery
30. Highest PCO2 content is in ☛ Pulmonary Artery (Deoxygenated
blood)
31. Healthy person at sea level doubles alveolar ventilation, assuming
respiratory exchange ratio of 1 and PCO2 of 40 mmhg, alveolar PO2 ☛
Inc by 20 mm hg (PAO2 = (Patm – 47) FiO2 – PACO2 / RQ)
32. In steady rate of CO2 formation, if alveolar ventilation is reduced to
half ☛ PCO2 increases double (Vice versa )
33. PO2 If Atm pressure is 630. PCO2 34 and respiratory quotient 0.8.
☛ 80 (PO2 = FiO2 ( Patm - PH2O ) - PCO2 / RQ)
34. Alveolar PO2 level when alveolar PCO2 rises from 40 to 48 at sea
level ☛ 90 mm hg (PAO2 = (Patm – 47) FiO2 – PACO2 / RQ)
Diffusion
35. Highest diffusing capacity across respiratory
membrane and in body fluids is? (Med 1st Dec 2021 (E) +10 in
past) - ID: 4929
Ⓐ Helium Ⓑ Carbon monoxide
Ⓒ Carbon dioxide Ⓓ Oxygen
Ⓒ more soluble a gas is, faster it will diffuse.
Diffusing capacity : ( ml/min/mm hg )
➊ CO ➜ 17 ml ➋ O2 ➜ 21 ml ➌ CO2 ➜ 400 ml ( 20 times ＞ O2 )
Remember ☛ CO affinity for Hb is 200 times ＞ O2 ... but Diffusion is
Less
✦ Guyton, Pg. 518
36. Increased diffusion of CO2 through alveolar membrane
is Due to? (Gynae 30 Sep 2020 ( M ) +5 in past) - ID: 4959
Ⓐ Increased diffusion coefficient
Ⓑ Increased solubility Ⓒ Increase density of CO2
Ⓓ None of above
Ⓐ ↑ solubility of gas ➜ ↑ number of molecules available to diffuse
↓ Molecular weight ➜ ↑ velocity of molecules ➜ ↑ Diffusion
Coefficient
☛ Hence, both Solubility and Molecular weight determine diffusion
coefficient of gas
✦ Guyton, Pg. 519
37. Diffusing Lung capacity of Pleural membrane is
maximum in which of following condition? (Med 19 Nov 2022
(M) +8 in past) - ID: 22913
Ⓐ Polycythemia Ⓑ CCF
Ⓒ Asthma Ⓓ Fibrosis
Ⓐ DLCO values represent ability of lung to transfer gas from inhaled air
into blood stream and acts as marker of extent of lung damage
✪ Low DLCO ➜ ✔ Anemia ( dec. HB ) ✔ COPD / Emphysema ( due to
Less Surface Area ) ✔ fibrosis ( due to Thickening of Alveolar-Capillary
Membrane ) ✔ CHF ( due to interstitial pulmonary edema ➜ thickening
of alveolar-capillary membrane )
✪ High DLCO ➜ ✔ Asthma ( Normal or high due to hyperinflation ) ✔
obesity ( inc. pulmonary blood volume and flow ) ✔ Polycythemia ( Inc.
Hb ) ✔ pregnancy ( Inc. Lung volume )
✦ Pubmed USA, Pg. ✦ USMLE Review Lectures
38. Exchange through lungs depends upon which of
following ? (Surg 16 Aug 2022 (A.N) +3 in past) - ID: 9040
Ⓐ Partial pressure difference of gases
Ⓑ Surface area available for gas exchange
Ⓒ Solubility and molecular weight of gases
Ⓓ All of Above
View References & Discuss MCQs in MediCall App | www.MediCall.pk/app
Ⓓ Fick Law of Diffusion : Vgas = A / T x D x ( P1 - P2 )
A ☛ Surface Area ➜ Directly proportional to diffusion ➜ ↓ in
emphysema, ↑ in exercise
T ☛ Thickness of memberanes ➜ Inversely proportional ➜ ↑ in
fibrosis
D ☛ Diffusion constant ➜ Solubility of Gas ➜ Directly proportional ➜
CO2 ＞ O2
P1 - P2 ☛ Gradient across memberane ➜ more difference in Partial
pressures of gases , higher will be diffusion
✦ Kaplan Physiology, Pg. 164, 165
39. Alveolar capillaries membrane gas exchange rate
increase with (Med 17 Aug 2022 (A.N) +1 in past) - ID: 82397
Ⓐ Large surface area for diffusion
Ⓑ Reduced coeffecient of gas
Ⓒ Low partial pressure of gas inside membrane
Ⓐ Surface area and thickness of plasma membrane ☛ ↑ surface
area ↑ rate of diffusion, whereas a thicker membrane ↓ it
✦ Guyton, Pg. 19
40. PO2 in arterial blood is less than Alveoli pulmonary
veins pO2 But greater than pulmonary artery pO2 because
(Gynae 24 May 2023 (M) +6 in past) - ID: 31253
Ⓐ Oxygen needs gradient to diffuse
Ⓑ Cardiac veins drains into coronary sinus
Ⓒ Oxygen need pressure gradient for unloading
Ⓓ Oxygen need pressure gradient for osmosis
Ⓐ Greater gas partial pressure difference (P1 – P2) across alveolar
membrane, greater rate of diffusion.
when blood first enters pulmonary capillary, gradient for O2 is ➜ 100
– 40 = 60 mm Hg
✦ Kaplan Physiology, Pg. 165
41. Diffusion of gases is directly related to ? (Surg 24 May
2023 (M) +5 in past) - ID: 21403
Ⓐ Distance Ⓑ Covering
Ⓒ Nature Ⓓ Surface area
Ⓓ rate of diffusion is directly proportional to available surface area
42. Diffusion of gas through lung is increased by ☛ Increased diffusion
capacity
43. Diffusion limited gas is ☛ O2 during exercise (More open
capillaries )
44. Diffusing capacity of O2 through respiratory membrane ☛ Is 18-20
ml/min/mmhg at rest (↑ in excercise)
45. Alveolar diffusion increased in ☛ Decrease thickness of alveolar
membrane
46. During heavy exercise oxygen diffusion ☛ Oxygen diffusion
capacity increased by 10 fold
-----
47. O2 Saturation at Sea level under Normal Atmospheric
Pressure of 760 mm Hg, in a young adult is? (Med 6 Nov 2018
(E) +6 in past) - ID: 14069
Ⓐ 100% Ⓑ 80%
Ⓒ 97%
Ⓒ Oxygen saturation is fraction of oxygen-saturated hemoglobin
relative to total hemoglobin (unsaturated + saturated) in blood.
At Sea Level ( 0 ft ) ➜ ● Atm pressure : 760 mm Hg ● PO2 in Air :
159 mm Hg ● PO2 in Alveoli : 104 mm Hg ● Arterial Oxygen
Saturation : 97% ( 0.97 )
✦ Guyton, Pg. 562
48. Minimum air blood barrier (Anesth 23 May 2023 (M) +1 in
past) - ID: 83347
Ⓐ Alveolar poresl of kohn Ⓑ Epithelial endothelial cells
Ⓒ Basement membrane Ⓓ Interstitial space
Ⓑ Minimum air-blood barrier also known as respiratory membrane,
composed of alveolar epithelial cells, capillary endothelial cells, and
their shared basement membrane. This structure allows efficient
66
Medi Call FCPS – 1 | Physiology - Respiration
exchange of gases between air in alveoli and blood in
capillaries.Alveolar Pores of Kohn ☛ tiny holes in alveolar walls that
allow for movement of air between adjacent alveoli, not directly
involved in air-blood barrier or gas exchange process.
49. Function of nose which optimizes gas exchange in
Alveoli (ENT 15 Nov 2022 (M) +4 in past) - ID: 34145
Ⓐ Filtration Ⓑ Humidification
Ⓒ None of above
Ⓑ Humidification in nose ☛ nose warms and humidifies air before it
reaches lungs for gas exchange ➜ achieved by evaporation of water
from epithelial surface ➜ leads to hyperosmolar environment on
epithelial surface.
50. Size of vapour reaching alveoli? (Anesth 15 Nov 2022 (M)) -
ID: 83125
Ⓐ ＜ 0.5 Ⓑ 0.5 to 1
Ⓒ 10 to 30
Ⓑ 5 μm for particles to reach ➜ bronchioles
＜ 2 μm to reach ➜ alveoli
51. Respiratory exchange ratio value (Med 23 Feb 2023 (M)) -
ID: 83336
Ⓐ 0.825 Ⓑ 0.735
Ⓒ 0.875 Ⓓ 0.525
Ⓐ RER ☛ ratio of amount of CO2 produced in of food to amount of
oxygen (O2) used. RER is usually in range of 0.8 to 1.0. 0.825, is
closest to typical range
52. What is likely mechanism in CO2 exchange in venous
blood . (Radio 21 Feb 2023 (A.N) +4 in past) - ID: 6568
Ⓐ Inc HCO3 exchange to Cl shift into cell
Ⓑ Carbonic acid formation and dissociation
Ⓒ Increase CO2 exchange to Cl shift into cell
Ⓐ CO2 generated in tissues ➜ diffuses freely into venous plasma ➜
then into RBCs ➜ combines with H2O ☟
Inside RBCs ☛ CO2 + H2O (Carbonic anhydrase)➜ H2CO3 ➜
dissociates into HCO3 and H+.➜ ↑ HCO3 leaves RBCs in exchange for
Cl- ( chloride shift ) ➜ HCO3 then transported to lungs in plasma (
Major CO2 transport route 70% )
✦ BRS Physiology, Pg. 250, 251
54. Ventilation-perfusion ratio zero in (Surg 16 Feb 2022 (E) +1
in past) - ID: 55689
Ⓐ Pulmonary embolism Ⓑ Pleural effusion Ⓒ Fibrosis
Ⓒ Pulmonary fibrosis ➜ scarring and hardening of lung ➜ reduced
capacity for gas exchange (ventilation) ➜ Despite this, blood continues
to flow (perfusion) to these areas ➜ As a result, areas of lung are
perfused but poorly ventilated ➜ V/Q ratio may approach to zero.
Pulmonary embolism ☛ blockage in pulmonary arteries ➜ prevents
blood from reaching certain areas of lung (no perfusion), but air can
still reach (ventilation continues) ➜ ventilation divided by zero
perfusion ➜ V/Q = infinite.
55. Blood in obstructed bronchus will have ☛ Higher CO2 than mixed
venous blood
56. Capnography may be defined as ☛ Increase PaC02
57. minimum pressure in gas valves is ☛ 4 barr
58. Membrane potential goes from - 70 till +35 due to ☛ Na+ influx
59. Prevents transmitting of two gases ☛ Hypoxic guard
60. Rate of respiration not changed in ☛ No change in blood oxygen
content
61. Composition of Air in middle ear ☛ N-78%, O2-21%, CO2-near nil
(Resembles venous blood)
62. Oxygen unbinding in tissue does not occur in ☛ Carbon monoxide
63. CO2 is carried as ☛ Carboxyhemoglobin
View References & Discuss MCQs in MediCall App | www.MediCall.pk/app
64. Transfer of gas in lung is directly proportional to ☛ Cross sectional
membrane surface area
65. Pulmonary vascular resistance decreases ☛ Moderate exercise (↑
Cardiac Output )
Transport Of Gases
Binding Proteins
1. Error in reading of pulse oximeter is due to? (Med 17 Nov
2022 (M) +10 in past) - ID: 4949
Ⓐ Dark skin Ⓑ Methemoglobinemia
Ⓒ Ambient light Ⓓ High co2
Ⓑ Methemoglobin ➜ Oxidized form of Hb (ferric, Fe3+) ➜ does not
bind O2 as readily as normal Fe2+ ➜ ↓ O2 saturation + ↓ O2 content
✦ First Aid, Pg. 666
2. 1g of Hb binds with how much oxygen ☛ 1.34ml (O2 binding
capacity)
3. Affinity of 02 for hemoglobin ☛ Decreases with hypoxia (Right shift
of curve)
4. Half life of carboxyhemoglobin is ☛ 6 hr (@ room air )
5. In muscle, oxygen binds to ☛ Myoglobin
6. Pulse oximeters ☛ Can’t differentiate methemoglobin from
oxyhemoglobin (Methemoglobin not detected)
7. HB decrease from 15 to 10 ☛ Oxygen content decrease
8. If a man goes to a high altitude O2 delivery to tissues is maintained
by ☛ Increased Hb concentration (↑ Hypoxemia)
9. Fetal Hb ☛ Higher affinity for content of 02 as compared to adult
(Left shift)
O2 Dissociation Curve
10. What does curve Shift to left is called? (Med 1st Dec 2021
(E) +13 in past) - ID: 4904
Ⓐ Bohr effect Ⓑ Haldane effect
Ⓒ Fick’s law Ⓓ Chloride shift
Ⓑ Haldane Effect ➜ ODC shifts to Left ➜ ↑ O2 affinity of Hb ➜ ↑
Saturation of HbO ➜ ↑ Displacement of CO2 from blood and ↓ O2
unloading to tissue
✦ Left ODC = haLdane effect = Low O2 unloading
✦ Guyton, Pg. 536
11. Which of following causes Right shift of Oxygen
Dissociation Curve and decreased O2 affinity of Hb? (Med 17
May 2022 (M) +23 in past) - ID: 12264
Ⓐ Metabolic Acidosis Ⓑ Decrease in 2,3 BPG
Ⓒ CO Poisoning Ⓓ Cold weather
Ⓔ Low PCO2
Ⓐ Pnemonic : Right T.E.A B.A.C Increase O2 availibility
● T = ↑ Temperature ● E = ↑ Exercise ● A = Acidosis (↑ H+) ● B =
↑ BPG ● A = ↑ Altitude ● C = ↑ CO2
✪ Factors shifting ODC Right ☛ T.E.A B.A.C ➜ Right Shift of O2-Hb
curve ➜ ↓ O2 affinity of Hb ➜ ↑ O2 unloading to tissue ➜ ↑ P50 ＞ 26
✦ Right = bohR effect = Rise in O2 availibility
✪ Factors shifting ODC Left ☛ ● ↓ Temperature ● ↓
BPG ● ↓ CO2 ● ↓ H+ ( Alkalosis ) and ● HbF ● MetHb ● CO ➜ ↑ O2
affinity of Hb ➜ ↓ O2 unloading to tissue ➜ ↓ P50 ＜ 26
✦ Left = haLdane effect = Low O2 unloading
✦ First Aid, Pg. 666, 666
12. During muscular exercise all of following are seen
Except? (Surg 16 May 2022 (M) +2 in past) - ID: 9736
Ⓐ Increase in blood flow to muscles
Ⓑ Stroke volume increases
Ⓒ O2 dissociation curve shifts to left
Ⓓ O2 consumption increases
Ⓒ Exercise➜ Right Shift of O2-Hb curve ➜ ↓ O2 affinity of Hb
➜ ↑ O2 unloading to tissue ➜ ↑ P50 ＞ 26
67