Chapter·PhysiologyV/Q mismatch

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1

A 71-year-old man is admitted to the ICU with a history of severe pancreatitis and new onset difficulty breathing. His vital signs are a blood pressure of 100/60 mm Hg, heart rate of 100/min, respirations of 27/min, temperature of 36.7°C (98.1°F), and oxygen saturation of 85% on room air. Physical examination shows a cachectic male in severe respiratory distress. Rales are heard at the base of each lung. The patient is intubated and a Swan-Ganz catheter is inserted. Pulmonary capillary wedge pressure is 8 mm Hg. An arterial blood gas study reveals a PaO2: FiO2 ratio of 180. The patient is diagnosed with acute respiratory distress syndrome. In which of the following segments of the respiratory tract are the cells responsible for the symptoms observed in this patient found?

AAlveolar sacs

BTerminal bronchioles

CBronchi

DRespiratory bronchioles

EBronchioles

2

A 71-year-old man is admitted to the hospital one hour after he was found unconscious. His pulse is 80/min and systolic blood pressure is 98 mm Hg; diastolic blood pressure cannot be measured. He is intubated and mechanically ventilated with supplemental oxygen at a tidal volume of 450 mL and a respiratory rate of 10/min. Arterial blood gas analysis shows: PCO2 43 mm Hg O2 saturation 94% O2 content 169 mL/L Pulmonary artery catheterization shows a pulmonary artery pressure of 15 mm Hg and a pulmonary capillary wedge pressure of 7 mm Hg. Bedside indirect calorimetry shows a rate of O2 tissue consumption of 325 mL/min. Given this information, which of the following additional values is sufficient to calculate the cardiac output in this patient?

ALeft ventricular end-diastolic volume

BPartial pressure of inspired oxygen

CEnd-tidal carbon dioxide pressure

DPulmonary artery oxygen content

ETotal peripheral resistance

3

A 35-year-old man presents to pulmonary function clinic for preoperative evaluation for a right pneumonectomy. His arterial blood gas at room air is as follows: pH: 7.34 PaCO2: 68 mmHg PaO2: 56 mmHg Base excess: +1 O2 saturation: 89% What underlying condition most likely explains these findings?

ACystic fibrosis

BBronchiectasis

CChronic obstructive pulmonary disease

DObesity

EAcute respiratory distress syndrome

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