Comprehensive Question Paper: Breathing and Exchange of Gases

Section A: Multiple Choice Questions (MCQs) - 100 Questions (1 mark each)

1. The trachea divides into right and left primary bronchi at which vertebral level? a) 3rd thoracic vertebra b) 4th thoracic vertebra c) 5th thoracic vertebra d) 6th thoracic vertebra

2. What percentage of oxygen is transported by hemoglobin in blood? a) 95% b) 96% c) 97% d) 98%

3. The normal tidal volume in humans is approximately: a) 400 mL b) 500 mL c) 600 mL d) 700 mL

4. Which enzyme catalyzes the formation of carbonic acid from CO₂ and water? a) Carbonic anhydrase b) Catalase c) Peroxidase d) Oxidase

5. The oxygen-hemoglobin dissociation curve is: a) Linear b) Exponential c) Sigmoid (S-shaped) d) Parabolic

6. What causes a right shift in the oxygen-hemoglobin dissociation curve? a) Decreased temperature b) Decreased PCO₂ c) Increased pH d) Increased temperature

7. The partial pressure of oxygen in alveoli is approximately: a) 95 mmHg b) 100 mmHg c) 104 mmHg d) 110 mmHg

8. What percentage of CO₂ is transported as bicarbonate ions? a) 60% b) 65% c) 70% d) 75%

9. The vocal cords are located in: a) Pharynx b) Larynx c) Trachea d) Bronchi

10. Inspiratory Reserve Volume (IRV) is approximately: a) 2000-2500 mL b) 2500-3000 mL c) 3000-3500 mL d) 3500-4000 mL

11. The Bohr effect refers to: a) Increased O₂ affinity with increased CO₂ b) Decreased O₂ affinity with increased CO₂ c) Increased CO₂ solubility in plasma d) Decreased CO₂ production in tissues

12. Which structure contains the respiratory zone? a) Bronchi b) Bronchioles c) Alveoli and their ducts d) Trachea

13. The fluid between pleural membranes is called: a) Pericardial fluid b) Synovial fluid c) Pleural fluid d) Cerebrospinal fluid

14. Emphysema primarily affects: a) Bronchi b) Alveolar walls c) Trachea d) Pharynx

15. The chloride shift is also known as: a) Bohr effect b) Haldane effect c) Hamburger effect d) Root effect

16. 2,3-BPG (bisphosphoglycerate) causes: a) Left shift of ODC b) Right shift of ODC c) No change in ODC d) Linear ODC

17. Fetal hemoglobin (HbF) has: a) Lower O₂ affinity than adult Hb b) Higher O₂ affinity than adult Hb c) Same O₂ affinity as adult Hb d) No O₂ affinity

18. Carbon monoxide poisoning causes: a) Right shift of ODC b) Left shift of ODC c) No change in ODC d) Elimination of ODC

19. The Band 3 protein is involved in: a) O₂ transport b) Chloride shift c) CO production d) Hemoglobin synthesis

20. Expiratory Reserve Volume (ERV) is approximately: a) 500-800 mL b) 800-1000 mL c) 1000-1100 mL d) 1200-1500 mL

21. The conducting zone extends from: a) Nostrils to bronchi b) Nostrils to terminal bronchioles c) Trachea to alveoli d) Pharynx to bronchioles

22. Asthma is characterized by: a) Alveolar wall damage b) Bronchi and bronchiole inflammation c) Tracheal obstruction d) Pleural effusion

23. The Haldane effect describes: a) O₂ binding to hemoglobin b) CO₂ and H⁺ binding to deoxygenated Hb c) Temperature effect on gas transport d) Pressure changes in lungs

24. Vital Capacity (VC) equals: a) TV + IRV b) TV + ERV c) IRV + ERV + TV d) ERV + RV

25. Residual Volume (RV) is approximately: a) 800-1000 mL b) 1000-1100 mL c) 1100-1200 mL d) 1200-1400 mL

26. The partial pressure of CO₂ in deoxygenated blood is: a) 40 mmHg b) 45 mmHg c) 50 mmHg d) 55 mmHg

27. During inspiration, the diaphragm: a) Relaxes and becomes dome-shaped b) Contracts and flattens c) Remains unchanged d) Moves upward

28. External intercostal muscles during inspiration: a) Relax b) Contract c) Remain inactive d) Move downward

29. The pharynx is a common passage for: a) Air only b) Food only c) Both air and food d) Blood only

30. Silicosis is caused by prolonged exposure to: a) Asbestos b) Silica dust c) Coal dust d) Cotton fibers

31. Total Lung Capacity (TLC) equals: a) VC + RV b) IC + FRC c) IRV + ERV + TV d) Both a and b

32. The steep portion of ODC occurs at: a) Lung level b) Tissue level c) Heart level d) Kidney level

33. Carbaminohemoglobin is formed by: a) O₂ binding to Hb b) CO₂ binding to Hb c) CO binding to Hb d) N₂ binding to Hb

34. What percentage of O₂ is dissolved in plasma? a) 2% b) 3% c) 4% d) 5%

35. The nasal chamber leads to: a) Larynx b) Pharynx c) Trachea d) Bronchi

36. Alveoli are described as: a) Thick-walled structures b) Non-vascularized structures c) Thin, irregular-walled vascularized bags d) Muscle-lined tubes

37. During expiration, intra-pulmonary pressure: a) Decreases below atmospheric pressure b) Increases above atmospheric pressure c) Remains equal to atmospheric pressure d) Becomes zero

38. The cooperative binding of oxygen to hemoglobin results in: a) Linear curve b) Exponential curve c) S-shaped curve d) Rectangular hyperbola

39. High altitude exposure increases: a) 2,3-BPG levels b) Hemoglobin affinity for O₂ c) Left shift of ODC d) Plasma pH

40. Functional Residual Capacity (FRC) equals: a) ERV + RV b) TV + IRV c) TV + ERV d) IRV + TV + ERV

41. The enzyme carbonic anhydrase is most abundant in: a) Plasma b) Red blood cells c) White blood cells d) Platelets

42. What happens to CO₂ when blood reaches the lungs? a) Converts to bicarbonate b) Binds more to hemoglobin c) Diffuses into alveoli d) Dissolves in plasma

43. The windpipe is also called: a) Pharynx b) Larynx c) Trachea d) Bronchus

44. Occupational respiratory disorders lead to: a) Lung inflammation and fibrosis b) Heart problems c) Kidney failure d) Liver damage

45. The outer pleural membrane is in contact with: a) Lung surface b) Thoracic lining c) Heart d) Diaphragm

46. Inspiratory Capacity (IC) equals: a) TV + IRV b) TV + ERV c) IRV + ERV d) ERV + RV

47. The voice box is: a) Pharynx b) Larynx c) Trachea d) Bronchi

48. What causes wheezing in asthma? a) Alveolar damage b) Bronchi and bronchiole inflammation c) Pleural inflammation d) Tracheal narrowing

49. The flat portion of ODC occurs at: a) Tissue level (low PO₂) b) Lung level (high PO₂) c) Intermediate PO₂ d) Zero PO₂

50. Carbon monoxide has an affinity for hemoglobin that is: a) 50-100 times greater than O₂ b) 100-150 times greater than O₂ c) 150-200 times greater than O₂ d) 200-250 times greater than O₂

51. The AE1 exchanger facilitates: a) O₂/CO₂ exchange b) HCO₃⁻/Cl⁻ exchange c) Na⁺/K⁺ exchange d) Ca²⁺/Mg²⁺ exchange

52. Expiratory Capacity (EC) equals: a) TV + IRV b) TV + ERV c) IRV + ERV d) ERV + RV

53. The T-state of hemoglobin has: a) High O₂ affinity b) Low O₂ affinity c) No O₂ binding capacity d) Irreversible O₂ binding

54. During tissue gas exchange, which moves from blood to tissues? a) CO₂ b) O₂ c) HCO₃⁻ d) H⁺

55. The respiratory surface is decreased in: a) Asthma b) Emphysema c) Silicosis d) Pneumonia

56. What is the approximate pH range of blood? a) 7.2-7.3 b) 7.3-7.4 c) 7.4-7.5 d) 7.5-7.6

57. The primary stimulus for breathing is: a) Low O₂ levels b) High CO₂ levels c) Low pH d) High pH

58. Bronchioles end in: a) Bronchi b) Trachea c) Alveoli d) Pharynx

59. The antero-posterior axis increases during: a) Expiration b) Inspiration c) Both d) Neither

60. Cigarette smoking primarily causes: a) Asthma b) Emphysema c) Silicosis d) Asbestosis

61. The dorso-ventral axis increases during: a) Expiration b) Inspiration c) Apnea d) Hyperventilation

62. What is transported as oxyhaemoglobin? a) CO₂ b) O₂ c) CO d) N₂

63. The inner pleural membrane is in contact with: a) Thoracic lining b) Lung surface c) Ribs d) Sternum

64. Hemoglobin without oxygen is called: a) Oxyhemoglobin b) Deoxyhemoglobin c) Carboxyhemoglobin d) Methemoglobin

65. External nostrils open into: a) Pharynx b) Nasal chamber c) Larynx d) Trachea

66. The mnemonic "CADET, Right!" helps remember factors causing: a) Left shift of ODC b) Right shift of ODC c) Linear ODC d) Inverted ODC

67. Asbestosis is caused by exposure to: a) Silica b) Asbestos c) Coal d) Cotton

68. The percentage of CO₂ transported by plasma in dissolved form is: a) 5-7% b) 7-10% c) 10-15% d) 15-20%

69. Chronic hypoxia leads to increased: a) Hemoglobin synthesis b) 2,3-BPG production c) Plasma volume d) Heart rate

70. The normal respiratory rate in adults is: a) 10-15 breaths/min b) 12-18 breaths/min c) 15-20 breaths/min d) 20-25 breaths/min

71. Gas exchange occurs by: a) Active transport b) Facilitated diffusion c) Simple diffusion d) Osmosis

72. The solubility of CO₂ in blood is _______ times greater than O₂: a) 10 b) 15 c) 20 d) 25

73. What happens to 2,3-BPG levels at high altitude? a) Decrease b) Increase c) Remain same d) Fluctuate randomly

74. Hyperventilation leads to: a) Respiratory acidosis b) Respiratory alkalosis c) Metabolic acidosis d) Metabolic alkalosis

75. The thickness of the respiratory membrane is approximately: a) 0.1 μm b) 0.5 μm c) 1.0 μm d) 2.0 μm

76. Carbonic acid dissociates into: a) CO₂ + H₂O b) H⁺ + HCO₃⁻ c) CO₂ + OH⁻ d) H⁺ + CO₃²⁻

77. The left shift of ODC indicates: a) Decreased O₂ affinity b) Increased O₂ affinity c) No change in O₂ affinity d) Loss of O₂ binding

78. During exercise, muscle tissue shows: a) Left shift of ODC b) Right shift of ODC c) No change in ODC d) Elimination of ODC

79. The primary bronchi divide into: a) Tertiary bronchi b) Secondary bronchi c) Bronchioles d) Alveolar ducts

80. Hemoglobin can carry a maximum of _______ oxygen molecules: a) 2 b) 3 c) 4 d) 6

81. The partial pressure of O₂ in tissues is approximately: a) 35 mmHg b) 40 mmHg c) 45 mmHg d) 50 mmHg

82. Pleural fluid functions to: a) Provide nutrition b) Reduce friction c) Exchange gases d) Filter blood

83. The volume of air that cannot be expelled from lungs is: a) Tidal volume b) Vital capacity c) Residual volume d) Total lung capacity

84. Deoxygenated hemoglobin is a stronger buffer for: a) O₂ b) CO₂ c) H⁺ ions d) HCO₃⁻ ions

85. The conducting zone functions to: a) Exchange gases b) Transport and condition air c) Produce sound d) Filter blood

86. Iron in hemoglobin is in the _______ state: a) Fe³⁺ (ferric) b) Fe²⁺ (ferrous) c) Fe⁴⁺ d) Fe¹⁺

87. The normal partial pressure of CO₂ in arterial blood is: a) 35 mmHg b) 40 mmHg c) 45 mmHg d) 50 mmHg

88. Breathing is primarily controlled by: a) Cerebrum b) Cerebellum c) Medulla oblongata d) Spinal cord

89. The oxygen saturation of arterial blood is normally: a) 95% b) 96% c) 97% d) 98%

90. Decreased pH causes _______ in ODC: a) Left shift b) Right shift c) No change d) Inversion

91. The surface tension in alveoli is reduced by: a) Mucus b) Surfactant c) Pleural fluid d) Blood

92. Carbon dioxide is more soluble in water than oxygen by a factor of: a) 10 b) 15 c) 20 d) 24

93. The respiratory quotient (RQ) is the ratio of: a) O₂ consumed/CO₂ produced b) CO₂ produced/O₂ consumed c) Tidal volume/Vital capacity d) Inspiration/Expiration time

94. Hypoxemia refers to: a) Low CO₂ in blood b) Low O₂ in blood c) High CO₂ in blood d) High O₂ in blood

95. The dead space in respiratory system refers to: a) Alveolar volume b) Conducting zone volume c) Pleural space d) Residual volume

96. Pneumotaxic center is located in: a) Medulla b) Pons c) Midbrain d) Cerebellum

97. The normal blood pH is maintained by: a) Respiratory system only b) Kidney system only c) Both respiratory and kidney systems d) Liver only

98. Cyanosis is caused by: a) High O₂ levels b) Low O₂ levels c) High CO₂ levels d) Low CO₂ levels

99. The chemoreceptors most sensitive to CO₂ are located in: a) Aortic arch b) Carotid bodies c) Medulla oblongata d) Pons

100. Apnea refers to: a) Rapid breathing b) Slow breathing c) Deep breathing d) Absence of breathing

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Section B: Short Answer Questions (1 mark each) - 100 Questions

1. Define tidal volume.
2. Name the enzyme that catalyzes carbonic acid formation.
3. What is the normal partial pressure of oxygen in alveoli?
4. List two factors that cause right shift of ODC.
5. What is the voice box called?
6. Define residual volume.
7. What is pleural fluid?
8. Name the condition caused by alveolar wall damage.
9. What does 2,3-BPG stand for?
10. Define vital capacity.
11. What is the Bohr effect?
12. Name the protein involved in chloride shift.
13. What is emphysema?
14. Define inspiratory reserve volume.
15. What is carbaminohemoglobin?
16. Name the respiratory zone structures.
17. What causes asthma?
18. Define functional residual capacity.
19. What is the Haldane effect?
20. Name the conducting zone.
21. What is silicosis?
22. Define total lung capacity.
23. What is the normal respiratory rate?
24. Name fetal hemoglobin.
25. What is asbestosis?
26. Define expiratory reserve volume.
27. What is carboxyhemoglobin?
28. Name the windpipe.
29. What is respiratory quotient?
30. Define hypoxemia.
31. What is surfactant?
32. Name the breathing control center.
33. What is cyanosis?
34. Define dead space.
35. What is apnea?
36. Name the gas exchange process.
37. What is hyperventilation?
38. Define chemoreceptors.
39. What is pneumotaxic center?
40. Name the iron state in hemoglobin.
41. What is respiratory acidosis?
42. Define oxygen saturation.
43. What is the T-state of hemoglobin?
44. Name the pleural membranes.
45. What is respiratory alkalosis?
46. Define partial pressure.
47. What is the R-state of hemoglobin?
48. Name the primary breathing stimulus.
49. What is bradypnea?
50. Define tachypnea.
51. What is the normal blood pH?
52. Name the oxygen transport form.
53. What is hypercapnia?
54. Define hypocapnia.
55. What is the alveolar-arterial gradient?
56. Name the CO₂ transport forms.
57. What is respiratory failure?
58. Define lung compliance.
59. What is elastic recoil?
60. Name the inspiratory muscles.
61. What is forced vital capacity?
62. Define peak expiratory flow rate.
63. What is minute ventilation?
64. Name the expiratory muscles.
65. What is alveolar ventilation?
66. Define anatomical dead space.
67. What is physiological dead space?
68. Name the diffusion capacity.
69. What is ventilation-perfusion ratio?
70. Define shunt.
71. What is pulmonary embolism?
72. Name the altitude sickness cause.
73. What is oxygen toxicity?
74. Define nitrogen narcosis.
75. What is decompression sickness?
76. Name the diving reflex.
77. What is Cheyne-Stokes breathing?
78. Define sleep apnea.
79. What is cor pulmonale?
80. Name the restrictive lung disease.
81. What is obstructive lung disease?
82. Define pulmonary fibrosis.
83. What is bronchiectasis?
84. Name the lung cancer types.
85. What is pneumothorax?
86. Define hemothorax.
87. What is pleural effusion?
88. Name the tuberculosis cause.
89. What is pneumonia?
90. Define bronchitis.
91. What is COPD?
92. Name the pulmonary edema cause.
93. What is acute respiratory distress syndrome?
94. Define mechanical ventilation.
95. What is positive pressure ventilation?
96. Name the continuous positive airway pressure.
97. What is extracorporeal membrane oxygenation?
98. Define pulse oximetry.
99. What is arterial blood gas analysis?
100. Name the spirometry test.

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Section C: Short Answer Questions (2 marks each) - 100 Questions

1. Explain the structure and function of alveoli.
2. Describe the mechanism of inspiration.
3. Compare tidal volume and vital capacity.
4. Explain the Bohr effect with its significance.
5. Describe the transport of oxygen in blood.
6. Explain the chloride shift mechanism.
7. Compare asthma and emphysema.
8. Describe the factors affecting oxygen-hemoglobin dissociation curve.
9. Explain the structure of the respiratory system.
10. Describe the mechanism of expiration.
11. Compare conducting and respiratory zones.
12. Explain the Haldane effect.
13. Describe carbon dioxide transport in blood.
14. Compare inspiratory and expiratory reserve volumes.
15. Explain the role of carbonic anhydrase.
16. Describe the significance of 2,3-BPG.
17. Compare normal and abnormal breathing patterns.
18. Explain the structure and function of pleura.
19. Describe the factors affecting gas exchange.
20. Compare left and right shifts of ODC.
21. Explain the mechanism of sound production.
22. Describe the control of breathing.
23. Compare arterial and venous blood gas levels.
24. Explain the concept of dead space.
25. Describe the effects of altitude on respiration.
26. Compare fetal and adult hemoglobin.
27. Explain carbon monoxide poisoning.
28. Describe occupational respiratory disorders.
29. Compare restrictive and obstructive lung diseases.
30. Explain the measurement of lung volumes.
31. Describe the structure of hemoglobin.
32. Compare oxygen and carbon dioxide solubility.
33. Explain respiratory acidosis and alkalosis.
34. Describe the role of surfactant.
35. Compare central and peripheral chemoreceptors.
36. Explain the diving response.
37. Describe sleep-disordered breathing.
38. Compare pneumonia and tuberculosis.
39. Explain pulmonary circulation.
40. Describe gas exchange at high altitude.
41. Compare spirometry parameters.
42. Explain the ventilation-perfusion relationship.
43. Describe respiratory failure types.
44. Compare COPD and asthma.
45. Explain oxygen therapy principles.
46. Describe mechanical ventilation basics.
47. Compare arterial blood gas parameters.
48. Explain pulse oximetry principles.
49. Describe respiratory muscle function.
50. Compare lung compliance and elastance.
51. Explain diffusion capacity measurement.
52. Describe bronchodilator mechanisms.
53. Compare upper and lower respiratory tract infections.
54. Explain cor pulmonale development.
55. Describe pulmonary embolism pathophysiology.
56. Compare pneumothorax types.
57. Explain pleural effusion causes.
58. Describe lung cancer screening.
59. Compare smoking effects on lungs.
60. Explain respiratory rehabilitation principles.
61. Describe exercise effects on respiration.
62. Compare normal aging and lung function.
63. Explain pediatric respiratory differences.
64. Describe maternal respiratory changes.
65. Compare pollutant effects on lungs.
66. Explain respiratory protective equipment.
67. Describe pulmonary function test interpretation.
68. Compare bronchial and alveolar breath sounds.
69. Explain respiratory physical examination.
70. Describe chest X-ray interpretation basics.
71. Compare CT and MRI in lung imaging.
72. Explain bronchoscopy procedure.
73. Describe respiratory medication delivery.
74. Compare inhaler types and techniques.
75. Explain respiratory emergency management.
76. Describe artificial respiration techniques.
77. Compare oxygen concentrators and cylinders.
78. Explain respiratory isolation precautions.
79. Describe lung transplantation indications.
80. Compare respiratory system development.
81. Explain respiratory hormone regulation.
82. Describe respiratory reflexes.
83. Compare voluntary and involuntary breathing.
84. Explain respiratory adaptation mechanisms.
85. Describe respiratory system integration.
86. Compare species differences in respiration.
87. Explain evolutionary respiratory adaptations.
88. Describe respiratory system disorders classification.
89. Compare acute and chronic respiratory conditions.
90. Explain respiratory pharmacology basics.
91. Describe respiratory system anatomy variations.
92. Compare male and female respiratory differences.
93. Explain respiratory system embryology.
94. Describe respiratory system histology.
95. Compare respiratory system physiology.
96. Explain respiratory system pathology.
97. Describe respiratory system biochemistry.
98. Compare respiratory system genetics.
99. Explain respiratory system immunology.
100. Describe respiratory system research methods.

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Section D: Long Answer Questions (3 marks each) - 100 Questions

1. Describe in detail the complete pathway of air from nostrils to alveoli, including all anatomical structures involved.

2. Explain the complete mechanism of breathing including the role of respiratory muscles, pressure changes, and nervous control.

3. Describe the oxygen-hemoglobin dissociation curve in detail, including factors affecting its shifts and physiological significance.

4. Explain the complete process of gas exchange at the alveolar level, including the factors affecting diffusion rates.

5. Describe in detail the three mechanisms of carbon dioxide transport in blood and their relative contributions.

6. Explain the chloride shift (Hamburger effect) mechanism completely, including its reversal in lungs and physiological importance.

7. Describe the Bohr and Haldane effects in detail, explaining their molecular mechanisms and physiological significance.

8. Explain the complete regulation of breathing, including neural control centers, chemoreceptors, and feedback mechanisms.

9. Describe all lung volumes and capacities in detail, including their normal values and clinical significance.

10. Explain the pathophysiology of asthma, including causes, mechanisms, symptoms, and treatment approaches.

11. Describe emphysema in detail, including causes, pathological changes, symptoms, and prevention strategies.

12. Explain the complete structure and function of hemoglobin, including its role in oxygen and carbon dioxide transport.

13. Describe occupational respiratory disorders, including types, causes, pathological changes, and prevention methods.

14. Explain the effects of altitude on respiration, including physiological adaptations and altitude sickness.

15. Describe the role of surfactant in pulmonary function, including its composition, function, and clinical significance.

16. Explain carbon monoxide poisoning in detail, including mechanism, symptoms, treatment, and prevention.

17. Describe the complete process of pulmonary gas exchange, including anatomical and physiological factors.

18. Explain the structure and function of the pleural cavity, including pleural fluid and its clinical significance.

19. Describe respiratory failure in detail, including types, causes, pathophysiology, and management.

20. Explain chronic obstructive pulmonary disease (COPD) comprehensively, including pathophysiology and management.

21. Describe the ventilation-perfusion relationship in detail and its clinical significance in lung diseases.

22. Explain the complete mechanism of cough reflex, including neural pathways and physiological significance.

23. Describe pulmonary circulation in detail, including pressures, blood flow distribution, and regulation.

24. Explain the development of the respiratory system, including embryological stages and clinical correlations.

25. Describe respiratory acidosis and alkalosis in detail, including causes, compensation mechanisms, and treatment.

26. Explain the complete mechanism of oxygen toxicity, including cellular effects and prevention strategies.

27. Describe sleep-disordered breathing, including sleep apnea types, pathophysiology, and management.

28. Explain the physiological changes in respiration during exercise, including adaptations and limitations.

29. Describe pulmonary embolism comprehensively, including pathophysiology, diagnosis, and treatment.

30. Explain the complete mechanism of respiratory muscle function, including inspiratory and expiratory muscles.

31. Describe lung cancer in detail, including types, risk factors, pathophysiology, and screening methods.

32. Explain the complete process of gas transport in blood, including oxygen and carbon dioxide mechanisms.

33. Describe pneumonia comprehensively, including types, pathophysiology, diagnosis, and treatment approaches.

34. Explain the role of nitric oxide in pulmonary function and its clinical applications in respiratory medicine.

35. Describe tuberculosis comprehensively, including pathophysiology, transmission, diagnosis, and treatment strategies.

36. Explain the complete mechanism of respiratory reflexes, including Hering-Breuer reflex and its physiological importance.

37. Describe pulmonary fibrosis in detail, including causes, pathological changes, symptoms, and management approaches.

38. Explain the physiological basis of pulse oximetry, including principles, limitations, and clinical applications.

39. Describe mechanical ventilation comprehensively, including modes, indications, complications, and weaning strategies.

40. Explain the complete pathophysiology of acute respiratory distress syndrome (ARDS) and its management.

41. Describe the respiratory changes during pregnancy, including anatomical and physiological adaptations.

42. Explain bronchiectasis in detail, including causes, pathophysiology, diagnosis, and treatment options.

43. Describe the complete mechanism of respiratory compensation in metabolic acidosis and alkalosis.

44. Explain diving physiology comprehensively, including pressure effects, nitrogen narcosis, and decompression sickness.

45. Describe cor pulmonale in detail, including pathophysiology, causes, diagnosis, and management strategies.

46. Explain the complete process of lung development and maturation, including surfactant production timing.

47. Describe pneumothorax comprehensively, including types, causes, pathophysiology, and treatment approaches.

48. Explain the role of respiratory system in acid-base balance, including buffer systems and compensation mechanisms.

49. Describe allergic respiratory diseases in detail, including mechanisms, types, and management strategies.

50. Explain the complete pathophysiology of bronchial asthma, including inflammatory cascade and treatment rationale.

51. Describe respiratory infections comprehensively, including bacterial, viral, and fungal causes and treatments.

52. Explain the physiological effects of smoking on the respiratory system and cessation benefits.

53. Describe interstitial lung diseases in detail, including classification, pathophysiology, and management.

54. Explain oxygen therapy comprehensively, including indications, delivery methods, and monitoring requirements.

55. Describe the complete mechanism of respiratory drive, including central and peripheral control systems.

56. Explain pleural diseases in detail, including effusion, pneumothorax, and inflammatory conditions.

57. Describe respiratory pharmacology comprehensively, including bronchodilators, anti-inflammatories, and mucolytics.

58. Explain the pathophysiology of pulmonary hypertension and its relationship with right heart failure.

59. Describe respiratory emergencies in detail, including recognition, pathophysiology, and immediate management.

60. Explain the complete process of artificial ventilation, including bag-mask ventilation and endotracheal intubation.

61. Describe environmental lung diseases comprehensively, including air pollution effects and occupational exposures.

62. Explain respiratory system aging, including structural and functional changes and clinical implications.

63. Describe pediatric respiratory physiology differences and common childhood respiratory conditions.

64. Explain the complete mechanism of respiratory muscle fatigue and its clinical significance.

65. Describe lung transplantation comprehensively, including indications, procedure, and post-transplant care.

66. Explain respiratory system immunity, including local defense mechanisms and immune-mediated diseases.

67. Describe the pathophysiology of restrictive lung diseases and their differentiation from obstructive diseases.

68. Explain respiratory rehabilitation principles, including exercise training and patient education components.

69. Describe the complete process of respiratory assessment, including history, examination, and investigations.

70. Explain high-altitude physiology and pathophysiology, including acclimatization and altitude-related illnesses.

71. Describe respiratory manifestations of systemic diseases and their underlying mechanisms.

72. Explain the role of respiratory system in thermoregulation and its clinical significance.

73. Describe genetic respiratory disorders, including cystic fibrosis pathophysiology and management.

74. Explain respiratory support techniques, including non-invasive ventilation and extracorporeal support.

75. Describe the complete pathophysiology of respiratory syncytial virus infection and its management.

76. Explain surgical interventions in respiratory diseases, including lobectomy, pneumonectomy, and lung reduction.

77. Describe respiratory complications of anesthesia and their prevention and management strategies.

78. Explain the pathophysiology of ventilator-associated lung injury and prevention strategies.

79. Describe respiratory aspects of critical care, including monitoring, support, and weaning protocols.

80. Explain the complete mechanism of respiratory failure development and classification systems.

81. Describe inflammatory respiratory diseases, including sarcoidosis pathophysiology and treatment.

82. Explain respiratory manifestations of connective tissue diseases and their management approaches.

83. Describe the pathophysiology of aspiration pneumonia and prevention strategies in high-risk patients.

84. Explain respiratory drug delivery systems, including nebulizers, inhalers, and their optimal usage.

85. Describe respiratory manifestations of heart failure and the cardiopulmonary interaction.

86. Explain the complete pathophysiology of chronic cough and its systematic evaluation approach.

87. Describe respiratory aspects of sleep medicine, including sleep apnea diagnosis and treatment.

88. Explain the role of imaging in respiratory medicine, including chest X-ray and CT interpretation.

89. Describe respiratory complications of immunocompromised states and their management strategies.

90. Explain the pathophysiology of acute exacerbations of COPD and their treatment protocols.

91. Describe respiratory manifestations of neuromuscular diseases and their management approaches.

92. Explain the complete mechanism of respiratory muscle training and its clinical applications.

93. Describe respiratory aspects of palliative care, including symptom management and comfort measures.

94. Explain the pathophysiology of ventilator-induced lung injury and protective ventilation strategies.

95. Describe respiratory manifestations of drug toxicity and their recognition and management.

96. Explain the role of bronchoscopy in respiratory medicine, including diagnostic and therapeutic applications.

97. Describe respiratory aspects of trauma, including chest injuries and their emergency management.

98. Explain the pathophysiology of respiratory alkalosis and acidosis with clinical correlations.

99. Describe respiratory manifestations of metabolic disorders and their underlying mechanisms.

100. Explain the future directions in respiratory medicine, including novel therapies and diagnostic techniques.

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Answer Key Guidelines

Section A: Multiple Choice Questions (MCQs)

1. c) 5th thoracic vertebra
2. c) 97%
3. b) 500 mL
4. a) Carbonic anhydrase
5. c) Sigmoid (S-shaped)
6. d) Increased temperature
7. c) 104 mmHg
8. c) 70%
9. b) Larynx
10. b) 2500-3000 mL
11. b) Decreased O₂ affinity with increased CO₂
12. c) Alveoli and their ducts
13. c) Pleural fluid
14. b) Alveolar walls
15. c) Hamburger effect
16. b) Right shift of ODC
17. b) Higher O₂ affinity than adult Hb
18. b) Left shift of ODC
19. b) Chloride shift
20. c) 1000-1100 mL
21. b) Nostrils to terminal bronchioles
22. b) Bronchi and bronchiole inflammation
23. b) CO₂ and H⁺ binding to deoxygenated Hb
24. c) IRV + ERV + TV
25. c) 1100-1200 mL
26. b) 45 mmHg
27. b) Contracts and flattens
28. b) Contract
29. c) Both air and food
30. b) Silica dust
31. d) Both a and b
32. b) Tissue level
33. b) CO₂ binding to Hb
34. b) 3%
35. b) Pharynx
36. c) Thin, irregular-walled vascularized bags
37. b) Increases above atmospheric pressure
38. c) S-shaped curve
39. a) 2,3-BPG levels
40. a) ERV + RV
41. b) Red blood cells
42. c) Diffuses into alveoli
43. c) Trachea
44. a) Lung inflammation and fibrosis
45. b) Thoracic lining
46. a) TV + IRV
47. b) Larynx
48. b) Bronchi and bronchiole inflammation
49. b) Lung level (high PO₂)
50. d) 200-250 times greater than O₂
51. b) HCO₃⁻/Cl⁻ exchange
52. b) TV + ERV
53. b) Low O₂ affinity
54. b) O₂
55. b) Emphysema
56. b) 7.3-7.4
57. b) High CO₂ levels
58. c) Alveoli
59. b) Inspiration
60. b) Emphysema
61. b) Inspiration
62. b) O₂
63. b) Lung surface
64. b) Deoxyhemoglobin
65. b) Nasal chamber
66. b) Right shift of ODC
67. b) Asbestos
68. a) 5-7%
69. b) 2,3-BPG production
70. b) 12-18 breaths/min
71. c) Simple diffusion
72. d) 25
73. b) Increase
74. b) Respiratory alkalosis
75. b) 0.5 μm
76. b) H⁺ + HCO₃⁻
77. b) Increased O₂ affinity
78. b) Right shift of ODC
79. b) Secondary bronchi
80. c) 4
81. b) 40 mmHg
82. b) Reduce friction
83. c) Residual volume
84. c) H⁺ ions
85. b) Transport and condition air
86. b) Fe²⁺ (ferrous)
87. b) 40 mmHg
88. c) Medulla oblongata
89. a) 95%
90. b) Right shift
91. b) Surfactant
92. d) 24
93. b) CO₂ produced/O₂ consumed
94. b) Low O₂ in blood
95. b) Conducting zone volume
96. b) Pons
97. c) Both respiratory and kidney systems
98. b) Low O₂ levels
99. c) Medulla oblongata
100. d) Absence of breathing

Section B: Short Answer Questions (1 mark each)

1. Define tidal volume. The volume of air inspired or expired during a normal respiration.
2. Name the enzyme that catalyzes carbonic acid formation. Carbonic anhydrase.
3. What is the normal partial pressure of oxygen in alveoli? Approximately 104 mmHg.
4. List two factors that cause right shift of ODC. High PCO₂ and high temperature.
5. What is the voice box called? Larynx.
6. Define residual volume. The volume of air remaining in the lungs even after a forceful expiration.
7. What is pleural fluid? Fluid between the pleural membranes that reduces friction on the lung surface.
8. Name the condition caused by alveolar wall damage. Emphysema.
9. What does 2,3-BPG stand for? 2,3-Bisphosphoglycerate.
10. Define vital capacity. The maximum volume of air a person can exhale after a maximal inspiration (IRV + ERV + TV).
11. What is the Bohr effect? The phenomenon where increased CO₂ and H⁺ concentration (lower pH) decrease hemoglobin's affinity for oxygen, facilitating O₂ release in tissues.
12. Name the protein involved in chloride shift. Band 3 protein (Anion Exchanger 1).
13. What is emphysema? A chronic respiratory disorder characterized by damage to alveolar walls, leading to a decreased respiratory surface.
14. Define inspiratory reserve volume. The additional volume of air that can be inspired by a forceful inspiration.
15. What is carbaminohemoglobin? Hemoglobin bound to carbon dioxide, a form in which CO₂ is transported in the blood.
16. Name the respiratory zone structures. Alveoli and their ducts.
17. What causes asthma? Inflammation of bronchi and bronchioles.
18. Define functional residual capacity. The volume of air remaining in the lungs after a normal expiration (ERV + RV).
19. What is the Haldane effect? The phenomenon where oxygen binding to hemoglobin decreases hemoglobin's affinity for carbon dioxide and H⁺, facilitating CO₂ release in the lungs.
20. Name the conducting zone. From external nostrils up to the terminal bronchioles.
21. What is silicosis? An occupational respiratory disorder caused by prolonged exposure to silica dust, leading to lung inflammation and fibrosis.
22. Define total lung capacity. The total volume of air that the lungs can hold after a maximal inspiration (VC + RV).
23. What is the normal respiratory rate? 12-18 breaths per minute in adults.
24. Name fetal hemoglobin. Hemoglobin F (HbF).
25. What is asbestosis? An occupational respiratory disorder caused by prolonged exposure to asbestos fibers, leading to lung inflammation and fibrosis.
26. Define expiratory reserve volume. The additional volume of air that can be expired by a forceful expiration.
27. What is carboxyhemoglobin? Hemoglobin bound to carbon monoxide, formed during carbon monoxide poisoning.
28. Name the windpipe. Trachea.
29. What is respiratory quotient? The ratio of carbon dioxide produced to oxygen consumed during respiration.
30. Define hypoxemia. A condition characterized by abnormally low levels of oxygen in the blood.
31. What is surfactant? A substance that reduces surface tension in the alveoli, preventing their collapse.
32. Name the breathing control center. Medulla oblongata (respiratory rhythm center).
33. What is cyanosis? A bluish discoloration of the skin and mucous membranes due to inadequate oxygenation of the blood.
34. Define dead space. The volume of air in the respiratory system that does not participate in gas exchange, primarily the conducting zone.
35. What is apnea? The temporary cessation of breathing.
36. Name the gas exchange process. Simple diffusion.
37. What is hyperventilation? Breathing at an abnormally rapid and deep rate, leading to excessive expulsion of CO₂.
38. Define chemoreceptors. Sensory receptors that detect changes in chemical concentrations, such as O₂, CO₂, and H⁺, in the blood.
39. What is pneumotaxic center? A neural center located in the pons that regulates the rate and depth of breathing.
40. Name the iron state in hemoglobin. Ferrous (Fe²⁺).
41. What is respiratory acidosis? A condition caused by inadequate ventilation, leading to increased CO₂ levels and decreased pH in the blood.
42. Define oxygen saturation. The percentage of hemoglobin binding sites in the blood that are occupied by oxygen.
43. What is the T-state of hemoglobin? The tense state of hemoglobin, characterized by low oxygen affinity, which facilitates oxygen release.
44. Name the pleural membranes. Outer (parietal) pleural membrane and inner (visceral) pleural membrane.
45. What is respiratory alkalosis? A condition caused by excessive ventilation, leading to decreased CO₂ levels and increased pH in the blood.
46. Define partial pressure. The pressure contributed by an individual gas in a mixture of gases.
47. What is the R-state of hemoglobin? The relaxed state of hemoglobin, characterized by high oxygen affinity, which facilitates oxygen binding.
48. Name the primary breathing stimulus. High carbon dioxide levels (and resulting decrease in pH).
49. What is bradypnea? An abnormally slow respiratory rate.
50. Define tachypnea. An abnormally rapid respiratory rate.
51. What is the normal blood pH? Approximately 7.35-7.45.
52. Name the oxygen transport form. Oxyhemoglobin (97%) and dissolved in plasma (3%).
53. What is hypercapnia? A condition characterized by abnormally high levels of carbon dioxide in the blood.
54. Define hypocapnia. A condition characterized by abnormally low levels of carbon dioxide in the blood.
55. What is the alveolar-arterial gradient? The difference in the partial pressure of oxygen between the alveolar gas and the arterial blood.
56. Name the CO₂ transport forms. Dissolved in plasma, as bicarbonate ions, and as carbaminohemoglobin.
57. What is respiratory failure? A condition where the respiratory system fails to adequately oxygenate the blood or remove carbon dioxide.
58. Define lung compliance. The ability of the lungs and chest wall to expand and stretch.
59. What is elastic recoil? The tendency of the lungs to return to their original size after inspiration.
60. Name the inspiratory muscles. Diaphragm and external intercostal muscles.
61. What is forced vital capacity? The maximum amount of air that can be forcefully exhaled after a maximal inspiration.
62. Define peak expiratory flow rate. The maximum speed of exhalation.
63. What is minute ventilation? The total volume of air inhaled or exhaled per minute (Tidal Volume x Respiratory Rate).
64. Name the expiratory muscles. Internal intercostal muscles and abdominal muscles (during forced expiration).
65. What is alveolar ventilation? The volume of fresh air that reaches the alveoli and participates in gas exchange per minute.
66. Define anatomical dead space. The volume of the conducting airways where no gas exchange occurs.
67. What is physiological dead space? The sum of anatomical dead space and alveolar dead space (non-perfused alveoli).
68. Name the diffusion capacity. The rate at which a gas can diffuse across the alveolar-capillary membrane.
69. What is ventilation-perfusion ratio? The ratio of alveolar ventilation to pulmonary blood flow.
70. Define shunt. Blood flow that bypasses the alveoli without undergoing gas exchange.
71. What is pulmonary embolism? A blockage in one of the pulmonary arteries in the lungs, usually by a blood clot.
72. Name the altitude sickness cause. Reduced partial pressure of oxygen at high altitudes.
73. What is oxygen toxicity? Damage to the lungs and central nervous system due to breathing high concentrations of oxygen.
74. Define nitrogen narcosis. A reversible alteration in consciousness that occurs while diving at depth, caused by the anesthetic effect of dissolved nitrogen gas at high partial pressures.
75. What is decompression sickness? A condition resulting from dissolved gases (primarily nitrogen) coming out of solution in the body tissues and forming bubbles during ascent from pressure.
76. Name the diving reflex. A set of physiological responses to submersion in water, including bradycardia, peripheral vasoconstriction, and blood shift.
77. What is Cheyne-Stokes breathing? An abnormal pattern of breathing characterized by progressively deeper and sometimes faster breathing, followed by a gradual decrease in breathing, and a temporary stop in breathing called apnea.
78. Define sleep apnea. A sleep disorder characterized by pauses in breathing or periods of shallow breathing during sleep.
79. What is cor pulmonale? Right-sided heart failure resulting from lung disease or pulmonary hypertension.
80. Name the restrictive lung disease. Pulmonary fibrosis.
81. What is obstructive lung disease? Asthma, Emphysema, Chronic Bronchitis (COPD).
82. Define pulmonary fibrosis. A chronic lung disease characterized by the scarring and thickening of lung tissue.
83. What is bronchiectasis? A chronic condition where the airways of the lungs become abnormally widened, leading to a buildup of mucus and increased risk of infection.
84. Name the lung cancer types. Non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC).
85. What is pneumothorax? A collapsed lung due to air leaking into the space between the lung and chest wall.
86. Define hemothorax. A collection of blood in the space between the chest wall and the lung (pleural cavity).
87. What is pleural effusion? A buildup of excess fluid between the layers of the pleura outside the lungs.
88. Name the tuberculosis cause. Mycobacterium tuberculosis bacterium.
89. What is pneumonia? An infection that inflames the air sacs in one or both lungs, which may fill with fluid or pus.
90. Define bronchitis. Inflammation of the lining of the bronchial tubes.
91. What is COPD? Chronic Obstructive Pulmonary Disease, a group of progressive lung diseases that block airflow and make it difficult to breathe.
92. Name the pulmonary edema cause. Excess fluid in the lungs, often caused by heart failure.
93. What is acute respiratory distress syndrome? A severe lung condition causing fluid to leak into the lungs, making breathing difficult.
94. Define mechanical ventilation. A medical treatment that uses a machine to help a patient breathe.
95. What is positive pressure ventilation? A type of mechanical ventilation that forces air into the lungs.
96. Name the continuous positive airway pressure. CPAP.
97. What is extracorporeal membrane oxygenation? ECMO, a life support technique that provides prolonged cardiac and respiratory support.
98. Define pulse oximetry. A non-invasive method for monitoring a person's oxygen saturation.
99. What is arterial blood gas analysis? A blood test that measures the acidity (pH) and the levels of oxygen and carbon dioxide in arterial blood.
100. Name the spirometry test. A common lung function test that measures how much air you can breathe out in one forced breath and how much air you can breathe out in the first second of that breath.

Section C: Short Answer Questions (2 marks each)

1. Explain the structure and function of alveoli. Alveoli are thin, irregular-walled, vascularized bag-like structures at the end of bronchioles. Their primary function is to provide a large surface area for efficient gas exchange (oxygen and carbon dioxide) between the air and blood.
2. Describe the mechanism of inspiration. During inspiration, the diaphragm contracts and flattens, and external intercostal muscles contract, pulling ribs and sternum up and out. This increases thoracic volume, decreasing intrapulmonary pressure below atmospheric pressure, causing air to rush into the lungs.
3. Compare tidal volume and vital capacity. Tidal volume (TV) is the volume of air inspired or expired during a normal, quiet breath (approx. 500 mL). Vital capacity (VC) is the maximum volume of air that can be exhaled after a maximal inspiration (TV + IRV + ERV), representing the total usable lung volume.
4. Explain the Bohr effect with its significance. The Bohr effect describes the decrease in hemoglobin's affinity for oxygen when there's an increase in CO₂ concentration and H⁺ (lower pH). This is physiologically significant as it facilitates the release of oxygen from hemoglobin to the tissues where CO₂ and H⁺ levels are higher due to metabolic activity.
5. Describe the transport of oxygen in blood. Oxygen is transported in the blood primarily by hemoglobin (97%) as oxyhemoglobin within red blood cells. A small percentage (3%) is transported in a dissolved state in the plasma.
6. Explain the chloride shift mechanism. The chloride shift (Hamburger effect) is a process where bicarbonate ions (HCO₃⁻) move out of red blood cells into the plasma, and chloride ions (Cl⁻) move into the red blood cells to maintain electrical neutrality. This occurs as CO₂ is converted to HCO₃⁻ inside RBCs in tissues, and reverses in the lungs.
7. Compare asthma and emphysema. Asthma is characterized by inflammation and narrowing of bronchi and bronchioles, leading to wheezing and difficulty breathing. Emphysema is a chronic disorder involving damage to alveolar walls, reducing the respiratory surface, primarily caused by cigarette smoking.
8. Describe the factors affecting oxygen-hemoglobin dissociation curve. Factors affecting the oxygen-hemoglobin dissociation curve include partial pressure of CO₂ (PCO₂), H⁺ concentration (pH), temperature, and 2,3-BPG levels. Increased PCO₂, H⁺, temperature, and 2,3-BPG cause a right shift (decreased O₂ affinity), while the opposite causes a left shift (increased O₂ affinity).
9. Explain the structure of the respiratory system. The human respiratory system includes external nostrils, nasal chamber, pharynx, larynx, trachea, bronchi, bronchioles, and alveoli. The lungs, enclosed by a double-layered pleura, house the bronchial tree and alveoli, forming the primary organs for gas exchange.
10. Describe the mechanism of expiration. During expiration, the diaphragm relaxes and becomes dome-shaped, and external intercostal muscles relax, allowing the ribs and sternum to return to their original position. This decreases thoracic volume, increasing intrapulmonary pressure above atmospheric pressure, expelling air from the lungs.
11. Compare conducting and respiratory zones. The conducting zone extends from the nostrils to the terminal bronchioles; its function is to transport, humidify, and filter air. The respiratory zone consists of alveoli and their ducts, where actual gas exchange occurs.
12. Explain the Haldane effect. The Haldane effect describes the increased capacity of deoxygenated hemoglobin to bind CO₂ and H⁺. This is physiologically significant as it facilitates the uptake of CO₂ from tissues into the blood and its release in the lungs where hemoglobin becomes oxygenated.
13. Describe carbon dioxide transport in blood. Carbon dioxide is transported in the blood in three main forms: dissolved in plasma (7%), as bicarbonate ions (70%) formed in red blood cells and transported in plasma, and as carbaminohemoglobin (23%) bound to hemoglobin in red blood cells.
14. Compare inspiratory and expiratory reserve volumes. Inspiratory Reserve Volume (IRV) is the additional volume of air that can be forcefully inhaled after a normal inspiration (2500-3000 mL). Expiratory Reserve Volume (ERV) is the additional volume of air that can be forcefully exhaled after a normal expiration (1000-1100 mL).
15. Explain the role of carbonic anhydrase. Carbonic anhydrase is an enzyme highly abundant in red blood cells. It rapidly catalyzes the reversible reaction of carbon dioxide and water to form carbonic acid (H₂CO₃), which then dissociates into H⁺ and HCO₃⁻, crucial for CO₂ transport.
16. Describe the significance of 2,3-BPG. 2,3-Bisphosphoglycerate (2,3-BPG) is a molecule produced in red blood cells that binds to hemoglobin and reduces its affinity for oxygen. Increased levels of 2,3-BPG (e.g., at high altitude or during exercise) cause a right shift in the ODC, facilitating oxygen release to tissues.
17. Compare normal and abnormal breathing patterns. Normal breathing (eupnea) is regular, effortless, and quiet. Abnormal patterns include tachypnea (rapid breathing), bradypnea (slow breathing), apnea (cessation of breathing), and Cheyne-Stokes breathing (alternating deep and shallow breaths with periods of apnea), often indicative of underlying conditions.
18. Explain the structure and function of pleura. The pleura is a double-layered membrane enclosing the lungs. The outer parietal pleura lines the thoracic cavity, and the inner visceral pleura covers the lung surface. The pleural fluid between them reduces friction during breathing and helps maintain lung expansion.
19. Describe the factors affecting gas exchange. Factors affecting gas exchange across the alveolar-capillary membrane include the partial pressure gradient of gases (driving force), solubility of gases (CO₂ is more soluble than O₂), and the thickness of the diffusion membrane. A larger surface area also enhances exchange.
20. Compare left and right shifts of ODC. A right shift of the Oxygen-Hemoglobin Dissociation Curve (ODC) indicates decreased hemoglobin affinity for O₂, facilitating O₂ release to tissues (caused by increased PCO₂, H⁺, temperature, 2,3-BPG). A left shift indicates increased affinity, facilitating O₂ binding in the lungs (opposite factors).
21. Explain the mechanism of sound production. Sound production (phonation) occurs in the larynx (voice box). Air passing through the vocal cords causes them to vibrate, producing sound. The tension and length of the vocal cords, controlled by laryngeal muscles, determine the pitch and quality of the voice.
22. Describe the control of breathing. Breathing is primarily controlled by the respiratory rhythm center in the medulla oblongata, which generates the basic rhythm. This center is influenced by chemoreceptors (detecting O₂, CO₂, H⁺ levels), pneumotaxic and apneustic centers in the pons, and higher brain centers, allowing for voluntary control and adaptation.
23. Compare arterial and venous blood gas levels. Arterial blood (oxygenated) has high PO₂ (approx. 95 mmHg) and low PCO₂ (approx. 40 mmHg). Venous blood (deoxygenated) has low PO₂ (approx. 40 mmHg) and high PCO₂ (approx. 45 mmHg), reflecting gas exchange in tissues.
24. Explain the concept of dead space. Dead space refers to the volume of air within the respiratory system that does not participate in gas exchange. Anatomical dead space is the volume of the conducting airways. Physiological dead space includes anatomical dead space plus any non-functional alveoli.
25. Describe the effects of altitude on respiration. At high altitudes, the lower atmospheric partial pressure of oxygen is lower, leading to hypoxemia. The body adapts by increasing respiratory rate and depth, increasing 2,3-BPG production (right shift of ODC), and over time, increasing red blood cell production (polycythemia).
26. Compare fetal and adult hemoglobin. Fetal hemoglobin (HbF) has a higher affinity for oxygen than adult hemoglobin (HbA). This difference is crucial for oxygen transfer from the mother's blood to the fetus across the placenta, as HbF can effectively extract oxygen at lower PO₂ levels.
27. Explain carbon monoxide poisoning. Carbon monoxide (CO) poisoning occurs when CO binds to hemoglobin with an affinity 200-250 times greater than oxygen, forming carboxyhemoglobin. This reduces oxygen-carrying capacity and shifts the ODC to the left, impairing oxygen release to tissues, leading to hypoxia and potentially death.
28. Describe occupational respiratory disorders. Occupational respiratory disorders are lung diseases caused by prolonged exposure to harmful substances in the workplace, such as silica dust (silicosis) or asbestos fibers (asbestosis). These exposures lead to inflammation, fibrosis, and reduced lung function.
29. Compare restrictive and obstructive lung diseases. Restrictive lung diseases (e.g., pulmonary fibrosis) reduce lung volumes and capacities due to decreased lung compliance or chest wall expansion. Obstructive lung diseases (e.g., asthma, emphysema) are characterized by increased airway resistance, making it difficult to exhale air.
30. Explain the measurement of lung volumes. Lung volumes (Tidal Volume, IRV, ERV) and capacities (IC, EC, VC, TLC, FRC) are measured using spirometry. However, Residual Volume (RV) and capacities that include RV (FRC, TLC) cannot be measured directly by spirometry and require other techniques like helium dilution or body plethysmography.
31. Describe the structure of hemoglobin. Hemoglobin is a globular protein found in red blood cells, composed of four polypeptide chains (two alpha and two beta in adult HbA), each associated with a heme group. Each heme group contains a central ferrous iron (Fe²⁺) atom, which reversibly binds one oxygen molecule.
32. Compare oxygen and carbon dioxide solubility. Carbon dioxide is significantly more soluble in water (and thus in blood plasma) than oxygen, by a factor of about 20-25 times. This higher solubility is crucial for CO₂ transport, especially in its dissolved form and for its rapid diffusion across membranes.
33. Explain respiratory acidosis and alkalosis. Respiratory acidosis results from hypoventilation, leading to CO₂ retention, increased PCO₂, and decreased blood pH. Respiratory alkalosis results from hyperventilation, leading to excessive CO₂ expulsion, decreased PCO₂, and increased blood pH. Both are compensated by renal mechanisms.
34. Describe the role of surfactant. Surfactant is a lipoprotein complex produced by type II alveolar cells. Its primary role is to reduce the surface tension of the fluid lining the alveoli, preventing their collapse during expiration and reducing the work of breathing.
35. Compare central and peripheral chemoreceptors. Central chemoreceptors are located in the medulla oblongata and are primarily sensitive to changes in H⁺ concentration in the cerebrospinal fluid, which reflects blood PCO₂. Peripheral chemoreceptors are located in the carotid and aortic bodies and are mainly sensitive to changes in arterial PO₂, but also respond to PCO₂ and H⁺.
36. Explain the diving response. The diving response (or diving reflex) is a set of physiological adaptations triggered by facial immersion in cold water, particularly in mammals. It includes bradycardia (slowing of heart rate), peripheral vasoconstriction (shunting blood to vital organs), and splenic contraction (releasing more red blood cells), conserving oxygen during breath-holding.
37. Describe sleep-disordered breathing. Sleep-disordered breathing encompasses conditions like sleep apnea, characterized by recurrent episodes of breathing cessation (apnea) or significantly reduced airflow (hypopnea) during sleep. This leads to fragmented sleep, daytime sleepiness, and increased risk of cardiovascular problems.
38. Compare pneumonia and tuberculosis. Pneumonia is an acute infection of the lung parenchyma, typically caused by bacteria or viruses, leading to inflammation and fluid accumulation in alveoli. Tuberculosis is a chronic infectious disease caused by Mycobacterium tuberculosis, primarily affecting the lungs but can spread to other organs, characterized by granuloma formation.
39. Explain pulmonary circulation. Pulmonary circulation is the part of the circulatory system that carries deoxygenated blood from the right ventricle of the heart to the lungs, where it picks up oxygen and releases carbon dioxide, and then returns oxygenated blood to the left atrium of the heart.
40. Describe gas exchange at high altitude. At high altitude, the lower atmospheric pressure means a lower partial pressure of oxygen (PO₂). This reduces the PO₂ gradient between the alveoli and blood, making gas exchange less efficient. The body compensates by increasing ventilation and 2,3-BPG production.
41. Compare spirometry parameters. Spirometry measures various lung volumes and capacities. Key parameters include FEV1 (forced expiratory volume in 1 second), FVC (forced vital capacity), and the FEV1/FVC ratio. These are used to differentiate between obstructive (low FEV1/FVC) and restrictive (low FVC, normal FEV1/FVC) lung diseases.
42. Explain the ventilation-perfusion relationship. The ventilation-perfusion (V/Q) ratio describes the balance between alveolar ventilation (V) and pulmonary blood flow (Q). An ideal V/Q ratio ensures efficient gas exchange. Mismatches (e.g., high V/Q in embolism, low V/Q in pneumonia) impair gas exchange.
43. Describe respiratory failure types. Respiratory failure is broadly classified into two types: Type I (hypoxemic) characterized by low PO₂ with normal or low PCO₂, often due to V/Q mismatch or shunt; and Type II (hypercapnic) characterized by high PCO₂ and low PO₂, usually due to hypoventilation.
44. Compare COPD and asthma. COPD (Chronic Obstructive Pulmonary Disease) is a progressive, irreversible airflow limitation, primarily caused by smoking, encompassing emphysema and chronic bronchitis. Asthma is a reversible airway inflammation and hyperresponsiveness, often triggered by allergens, leading to episodic bronchoconstriction.
45. Explain oxygen therapy principles. Oxygen therapy involves administering supplemental oxygen to patients with hypoxemia to increase arterial PO₂. Principles include using the lowest effective dose, monitoring oxygen saturation, and considering potential risks like oxygen toxicity in certain conditions (e.g., COPD).
46. Describe mechanical ventilation basics. Mechanical ventilation is a life-support technique that uses a machine (ventilator) to assist or replace spontaneous breathing. It delivers positive pressure to inflate the lungs, ensuring adequate oxygenation and CO₂ removal, and can be invasive (via endotracheal tube) or non-invasive.
47. Compare arterial blood gas parameters. Arterial blood gas (ABG) analysis measures pH, PCO₂, PO₂, and bicarbonate (HCO₃⁻) in arterial blood. pH indicates acidity/alkalinity, PCO₂ reflects respiratory component, and HCO₃⁻ reflects metabolic component. PO₂ indicates oxygenation status.
48. Explain pulse oximetry principles. Pulse oximetry is a non-invasive method to measure oxygen saturation (SpO₂) in arterial blood. It works by emitting light at two different wavelengths (red and infrared) through a pulsating arterial bed and measuring the absorption, which differs between oxyhemoglobin and deoxyhemoglobin.
49. Describe respiratory muscle function. The diaphragm and external intercostal muscles are primary inspiratory muscles, contracting to increase thoracic volume. During quiet expiration, these muscles relax. Forced expiration involves contraction of internal intercostal and abdominal muscles to actively decrease thoracic volume.
50. Compare lung compliance and elastance. Lung compliance is the ease with which the lungs can be stretched or distended (change in volume per unit change in pressure). Elastance is the reciprocal of compliance, representing the lung's ability to recoil to its original shape after being stretched. Emphysema increases compliance, while fibrosis decreases it.
51. Explain diffusion capacity measurement. Diffusion capacity (DLCO) measures the ability of gases to diffuse from the alveoli into the blood. It is typically measured using a small, known concentration of carbon monoxide (CO) in a single breath. A reduced DLCO indicates impaired gas exchange, as seen in emphysema or pulmonary fibrosis.
52. Describe bronchodilator mechanisms. Bronchodilators are medications that relax the smooth muscles of the airways, widening them and reducing airflow resistance. Common mechanisms include beta-2 adrenergic agonists (e.g., salbutamol) that stimulate receptors to cause bronchodilation, and anticholinergics (e.g., ipratropium) that block bronchoconstrictive signals.
53. Compare upper and lower respiratory tract infections. Upper respiratory tract infections (URTIs) affect the nose, pharynx, and larynx (e.g., common cold, sinusitis, pharyngitis). Lower respiratory tract infections (LRTIs) affect the trachea, bronchi, bronchioles, and lungs (e.g., bronchitis, pneumonia, influenza), often more severe.
54. Explain cor pulmonale development. Cor pulmonale is right-sided heart failure caused by chronic lung disease or pulmonary hypertension. Chronic hypoxia from lung disease leads to pulmonary vasoconstriction, increasing pulmonary artery pressure. This increased afterload on the right ventricle causes it to hypertrophy and eventually fail.
55. Describe pulmonary embolism pathophysiology. Pulmonary embolism (PE) occurs when a blood clot (embolus), usually from deep vein thrombosis (DVT) in the legs, travels to the pulmonary arteries, blocking blood flow to a portion of the lung. This leads to V/Q mismatch, impaired gas exchange, and potentially right heart strain.
56. Compare pneumothorax types. Pneumothorax is the presence of air in the pleural space, causing lung collapse. Spontaneous pneumothorax occurs without obvious cause (primary) or due to underlying lung disease (secondary). Traumatic pneumothorax results from chest injury, and tension pneumothorax is a life-threatening condition where air enters but cannot leave the pleural space, building pressure.
57. Explain pleural effusion causes. Pleural effusion is the accumulation of excess fluid in the pleural space. Causes include increased hydrostatic pressure (e.g., heart failure), decreased oncotic pressure (e.g., liver disease), increased capillary permeability (e.g., inflammation, infection), or impaired lymphatic drainage (e.g., malignancy).
58. Describe lung cancer screening. Lung cancer screening aims to detect lung cancer early in high-risk individuals before symptoms appear. Low-dose computed tomography (LDCT) is the recommended screening method for current or former heavy smokers aged 50-80, significantly reducing mortality.
59. Compare smoking effects on lungs. Smoking causes extensive damage to the lungs, leading to chronic inflammation, destruction of alveolar walls (emphysema), increased mucus production (chronic bronchitis), and impaired ciliary function. It is the leading cause of COPD and significantly increases the risk of lung cancer and other respiratory infections.
60. Explain respiratory rehabilitation principles. Respiratory rehabilitation is a comprehensive program for patients with chronic respiratory diseases, aiming to improve symptoms, exercise tolerance, and quality of life. Principles include exercise training, education on disease management, nutritional counseling, and psychological support.
61. Describe exercise effects on respiration. During exercise, respiratory rate and tidal volume increase significantly to meet the increased metabolic demand for oxygen and remove excess CO₂. This is mediated by neural and chemical stimuli, including increased PCO₂, H⁺, and body temperature, and proprioceptor input from muscles.
62. Compare normal aging and lung function. With normal aging, lung function gradually declines. There is a decrease in lung elasticity, weakening of respiratory muscles, reduced vital capacity, increased residual volume, and decreased efficiency of gas exchange. The immune response in the lungs also weakens, increasing susceptibility to infections.
63. Explain pediatric respiratory differences. Pediatric respiratory systems differ from adults with smaller airways, less developed cartilage, higher metabolic rates, and a greater reliance on the diaphragm for breathing. These differences make infants and young children more susceptible to respiratory distress and infections.
64. Describe maternal respiratory changes. During pregnancy, maternal respiratory changes include increased tidal volume, increased minute ventilation, and a slight decrease in functional residual capacity. These adaptations are driven by hormonal changes (progesterone) and the growing uterus, aiming to meet the increased oxygen demand of the mother and fetus.
65. Compare pollutant effects on lungs. Various air pollutants (e.g., particulate matter, ozone, sulfur dioxide, nitrogen oxides) can irritate airways, cause inflammation, impair lung function, and exacerbate existing respiratory conditions like asthma and COPD. Long-term exposure can lead to chronic lung diseases and cancer.
66. Explain respiratory protective equipment. Respiratory protective equipment (RPE) includes devices like respirators and masks designed to protect individuals from inhaling hazardous airborne contaminants (e.g., dust, fumes, gases). They work by filtering particles or supplying clean air, crucial in occupational settings.
67. Describe pulmonary function test interpretation. Pulmonary function tests (PFTs), including spirometry, lung volumes, and diffusion capacity, are interpreted to assess lung health. Patterns of results help diagnose and differentiate between obstructive (e.g., reduced FEV1/FVC) and restrictive (e.g., reduced TLC) lung diseases, and monitor disease progression.
68. Compare bronchial and alveolar breath sounds. Bronchial breath sounds are loud, high-pitched, and heard over the trachea and main bronchi, with expiration longer than inspiration. Alveolar (vesicular) breath sounds are soft, low-pitched, and heard over most of the lung fields, with inspiration longer than expiration. Abnormal sounds indicate pathology.
69. Explain respiratory physical examination. A respiratory physical examination involves inspection (observing breathing pattern, chest shape), palpation (feeling for tenderness, fremitus), percussion (tapping the chest to assess underlying tissue density), and auscultation (listening to breath sounds with a stethoscope) to assess lung and airway health.
70. Describe chest X-ray interpretation basics. Chest X-ray interpretation involves systematically evaluating the airways, bones, cardiac silhouette, diaphragm, effusions, fields (lung parenchyma), and great vessels (ABCDEFG mnemonic). It helps identify conditions like pneumonia, pneumothorax, pleural effusion, and some lung masses.
71. Compare CT and MRI in lung imaging. Computed Tomography (CT) provides detailed cross-sectional images of the lungs, excellent for visualizing lung parenchyma, nodules, and masses. Magnetic Resonance Imaging (MRI) is less commonly used for lung parenchyma due to motion artifacts but is superior for evaluating soft tissues, mediastinal structures, and vascular abnormalities.
72. Explain bronchoscopy procedure. Bronchoscopy is a procedure where a thin, flexible tube (bronchoscope) with a camera is inserted through the nose or mouth into the airways to visualize the trachea and bronchi. It is used for diagnosis (biopsy, lavage) and therapeutic interventions (mucus removal, foreign body extraction).
73. Describe respiratory medication delivery. Respiratory medications are delivered via various routes, including oral, intravenous, and inhaled. Inhaled delivery (e.g., metered-dose inhalers, nebulizers, dry powder inhalers) is preferred for many lung conditions as it delivers the drug directly to the airways, minimizing systemic side effects.
74. Compare inhaler types and techniques. Common inhaler types include metered-dose inhalers (MDIs), which require coordination between actuation and inhalation, often used with spacers; and dry powder inhalers (DPIs), which are breath-activated. Proper technique is crucial for effective drug delivery and patient education is vital.
75. Explain respiratory emergency management. Respiratory emergency management involves rapid assessment, ensuring airway patency, providing supplemental oxygen, and addressing the underlying cause. This may include bronchodilators for asthma, chest tube insertion for pneumothorax, or mechanical ventilation for respiratory failure.
76. Describe artificial respiration techniques. Artificial respiration techniques include mouth-to-mouth resuscitation, bag-mask ventilation, and mechanical ventilation. These methods provide positive pressure to inflate the lungs and deliver oxygen when spontaneous breathing is inadequate or absent.
77. Compare oxygen concentrators and cylinders. Oxygen concentrators extract oxygen from ambient air, providing a continuous supply, suitable for home use. Oxygen cylinders store compressed oxygen, offering portability and higher flow rates, often used for acute needs or travel. Both deliver supplemental oxygen.
78. Explain respiratory isolation precautions. Respiratory isolation precautions are measures taken to prevent the spread of airborne or droplet-transmitted respiratory infections. This includes placing patients in private rooms, using N95 respirators for airborne pathogens (e.g., TB), and surgical masks for droplet pathogens (e.g., influenza).
79. Describe lung transplantation indications. Lung transplantation is a surgical procedure to replace diseased lungs with healthy donor lungs. Indications include end-stage lung diseases like severe COPD, cystic fibrosis, idiopathic pulmonary fibrosis, and pulmonary hypertension, when other medical therapies have failed and life expectancy is limited.
80. Compare respiratory system development. The respiratory system develops from the foregut endoderm, with branching morphogenesis forming the bronchial tree and alveoli. Key stages include embryonic, pseudoglandular, canalicular, saccular, and alveolar stages, with surfactant production beginning in the canalicular stage and mature alveoli forming postnatally.
81. Explain respiratory hormone regulation. While not directly regulated by hormones in the same way as other systems, respiratory function can be influenced by hormones. For example, progesterone increases respiratory drive during pregnancy, and thyroid hormones can affect metabolic rate and thus oxygen demand.
82. Describe respiratory reflexes. Respiratory reflexes are involuntary responses that modify breathing. Examples include the Hering-Breuer reflex (prevents overinflation), cough reflex (expels irritants), sneeze reflex, and chemoreceptor reflexes (adjust breathing based on O₂, CO₂, H⁺ levels).
83. Compare voluntary and involuntary breathing. Involuntary breathing is controlled by the brainstem (medulla and pons) to maintain homeostasis, ensuring adequate gas exchange without conscious effort. Voluntary breathing allows conscious control over breathing (e.g., holding breath, speaking), originating from the cerebral cortex, but is overridden by involuntary control if vital parameters are threatened.
84. Explain respiratory adaptation mechanisms. Respiratory adaptation mechanisms allow the body to adjust to changing demands or environments. Examples include acclimatization to high altitude (increased ventilation, 2,3-BPG, erythropoiesis) and adaptations to exercise (increased respiratory rate and depth, improved efficiency).
85. Describe respiratory system integration. The respiratory system is highly integrated with other body systems. It works closely with the cardiovascular system for gas transport, the nervous system for control, the renal system for acid-base balance, and the immune system for defense against pathogens.
86. Compare species differences in respiration. Respiratory systems vary across species based on their environment and metabolic needs. For example, fish use gills for aquatic respiration, insects use tracheae, and birds have a highly efficient unidirectional airflow system with air sacs, unlike the bidirectional flow in mammals.
87. Explain evolutionary respiratory adaptations. Evolutionary respiratory adaptations include the development of lungs for terrestrial life, the highly efficient avian respiratory system for flight, and specialized structures like gills in aquatic organisms. These adaptations optimize gas exchange for specific environments and metabolic demands.
88. Describe respiratory system disorders classification. Respiratory system disorders are broadly classified into obstructive (airflow limitation, e.g., asthma, COPD), restrictive (reduced lung volumes, e.g., fibrosis), vascular (affecting pulmonary circulation, e.g., PE), infectious (e.g., pneumonia, TB), and neoplastic (cancers).
89. Compare acute and chronic respiratory conditions. Acute respiratory conditions (e.g., acute bronchitis, pneumonia) have a sudden onset and are typically short-lived. Chronic respiratory conditions (e.g., COPD, asthma, pulmonary fibrosis) are long-lasting, often progressive, and require ongoing management.
90. Explain respiratory pharmacology basics. Respiratory pharmacology involves the study of drugs used to treat respiratory diseases. Key drug classes include bronchodilators (relax airways), anti-inflammatory agents (reduce inflammation), mucolytics (thin mucus), and antibiotics/antivirals (treat infections).
91. Describe respiratory system anatomy variations. While the basic anatomy is consistent, variations can occur, such as accessory fissures in the lungs, variations in bronchial branching patterns, or congenital anomalies like tracheal agenesis. These variations can be clinically significant and impact disease presentation or surgical approaches.
92. Compare male and female respiratory differences. Males generally have larger lung volumes and capacities than females, even when adjusted for body size. Females tend to have smaller airways, which may contribute to differences in susceptibility to certain respiratory conditions and responses to exercise.
93. Explain respiratory system embryology. The respiratory system begins to develop around the 4th week of gestation from the foregut. The laryngotracheal groove forms, leading to the development of the larynx, trachea, bronchi, and lungs through a process of branching morphogenesis and differentiation of epithelial and mesenchymal cells.
94. Describe respiratory system histology. The respiratory system histology varies along its length. The conducting zone is lined by pseudostratified ciliated columnar epithelium with goblet cells (producing mucus). The respiratory zone (alveoli) is lined by thin type I pneumocytes (gas exchange) and cuboidal type II pneumocytes (surfactant production).
95. Compare respiratory system physiology. Respiratory physiology encompasses the mechanisms of breathing (ventilation), gas exchange (diffusion), and gas transport. It involves the interplay of pressure gradients, lung mechanics (compliance, elastance), and the regulation of breathing by neural and chemical factors.
96. Explain respiratory system pathology. Respiratory system pathology involves the study of diseases affecting the respiratory tract. This includes inflammatory conditions (e.g., bronchitis), infections (e.g., pneumonia), obstructive diseases (e.g., emphysema), restrictive diseases (e.g., fibrosis), and neoplasms (e.g., lung cancer).
97. Describe respiratory system biochemistry. Respiratory system biochemistry involves the metabolic processes related to gas exchange and transport. Key aspects include the biochemistry of hemoglobin-oxygen binding, the carbonic anhydrase reaction for CO₂ transport, and the synthesis and function of surfactant.
98. Compare respiratory system genetics. Respiratory system genetics explores the role of inherited factors in respiratory diseases. Genetic predispositions can influence susceptibility to asthma, COPD, cystic fibrosis, and alpha-1 antitrypsin deficiency, impacting disease severity and progression.
99. Explain respiratory system immunology. Respiratory system immunology focuses on the immune defenses of the airways and lungs against pathogens and environmental irritants. This includes innate immunity (mucociliary escalator, macrophages) and adaptive immunity (lymphocytes, antibodies) to protect against infections and mediate allergic responses.
100. Describe respiratory system research methods. Respiratory system research methods include in vitro studies (cell cultures), in vivo animal models, clinical trials (testing new therapies), epidemiological studies (identifying risk factors), and advanced imaging techniques (CT, MRI, PET) to understand disease mechanisms and develop new treatments.

Section D: Answers

1. Pathway of Air: Air enters via nostrils/mouth, passes through pharynx, larynx (voice box), trachea (windpipe), bronchi, bronchioles, and finally reaches the alveoli (air sacs) where gas exchange occurs.
2. Mechanism of Breathing: Involves inspiration (active, diaphragm and external intercostals contract, increasing thoracic volume, decreasing pressure, drawing air in) and expiration (passive, muscles relax, thoracic volume decreases, increasing pressure, expelling air). Nervous control from medulla oblongata regulates rhythm.
3. Oxygen-Hemoglobin Dissociation Curve: Sigmoid (S-shaped) curve showing Hb saturation with O₂ at various PO₂. Factors shifting it right (decreased O₂ affinity) include increased temperature, PCO₂, H⁺ (decreased pH), and 2,3-BPG. Physiologically, a right shift aids O₂ release at tissues, while a left shift (increased O₂ affinity) aids O₂ loading at lungs.
4. Alveolar Gas Exchange: Occurs by simple diffusion across the thin respiratory membrane (alveolar and capillary walls). Factors affecting diffusion rates include partial pressure gradients (primary), thickness of membrane, surface area, and solubility of gases.
5. Carbon Dioxide Transport: CO₂ is transported in three main forms:
   • Dissolved in plasma (7-10%): Directly dissolved in blood plasma.
   • As bicarbonate ions (70%): CO₂ reacts with water to form carbonic acid (H₂CO₃), which dissociates into H⁺ and HCO₃⁻. HCO₃⁻ moves into plasma.
   • As carbaminohemoglobin (20-25%): CO₂ binds directly to amino groups of hemoglobin.
6. Chloride Shift (Hamburger Effect): In tissues, as HCO₃⁻ moves out of RBCs into plasma, Cl⁻ ions move into RBCs to maintain electrical neutrality. In lungs, this process reverses: HCO₃⁻ moves back into RBCs, Cl⁻ moves out, facilitating CO₂ release. Physiologically important for efficient CO₂ transport and maintaining blood pH.
7. Bohr and Haldane Effects:
   • Bohr Effect: Increased CO₂ and H⁺ (decreased pH) decrease hemoglobin's affinity for O₂, promoting O₂ release in tissues.
   • Haldane Effect: Deoxygenated hemoglobin has a higher affinity for CO₂ and H⁺ than oxyhemoglobin, facilitating CO₂ uptake in tissues and O₂ release. In lungs, O₂ binding to Hb releases CO₂ and H⁺.
8. Regulation of Breathing: Primarily controlled by respiratory centers in the medulla oblongata and pons. Medullary rhythmicity center sets basic rhythm. Pneumotaxic and apneustic centers in pons modify it. Chemoreceptors (central in medulla, peripheral in carotid/aortic bodies) sense changes in PCO₂, H⁺, and PO₂ (less sensitive to O₂), sending signals to adjust breathing rate and depth.
9. Lung Volumes and Capacities:
   • Tidal Volume (TV): Volume of air inhaled/exhaled in normal breath (~500 mL).
   • Inspiratory Reserve Volume (IRV): Max air inhaled after normal inspiration (~2500-3000 mL).
   • Expiratory Reserve Volume (ERV): Max air exhaled after normal expiration (~1000-1100 mL).
   • Residual Volume (RV): Air remaining in lungs after max exhalation (~1100-1200 mL).
   • Inspiratory Capacity (IC): TV + IRV.
   • Functional Residual Capacity (FRC): ERV + RV.
   • Vital Capacity (VC): IRV + TV + ERV.
   • Total Lung Capacity (TLC): VC + RV.
   • Clinical Significance: Used to diagnose and monitor respiratory diseases.
10. Pathophysiology of Asthma: Chronic inflammatory disease of airways characterized by bronchial hyperresponsiveness, reversible airflow obstruction, and inflammation. Causes include allergens, irritants, exercise. Mechanisms involve mast cell degranulation, mediator release, bronchoconstriction, mucus production, and airway edema. Symptoms: wheezing, cough, dyspnea, chest tightness. Treatment: bronchodilators, anti-inflammatory drugs (corticosteroids).
11. Emphysema: Chronic lung disease characterized by irreversible enlargement of airspaces distal to terminal bronchioles, with destruction of alveolar walls. Causes: primarily smoking, also genetic (alpha-1 antitrypsin deficiency). Pathological changes: loss of elastic recoil, reduced surface area for gas exchange, air trapping. Symptoms: dyspnea, barrel chest. Prevention: smoking cessation.
12. Hemoglobin Structure and Function: Hemoglobin (Hb) is a tetrameric protein in RBCs, composed of four globin chains (typically two alpha, two beta) each containing a heme group with a central ferrous iron (Fe²⁺). Function: primarily transports O₂ from lungs to tissues (as oxyhemoglobin) and plays a role in CO₂ transport (as carbaminohemoglobin and buffering H⁺).
13. Occupational Respiratory Disorders: Lung diseases caused by inhaling dusts, chemicals, or fumes in the workplace. Types: pneumoconioses (e.g., silicosis from silica, asbestosis from asbestos, coal worker's pneumoconiosis from coal dust), occupational asthma, hypersensitivity pneumonitis. Causes: specific workplace exposures. Pathological changes: inflammation, fibrosis, airway obstruction. Prevention: engineering controls, PPE, medical surveillance.
14. Effects of Altitude on Respiration: At high altitude, atmospheric PO₂ decreases, leading to hypoxemia. Physiological adaptations: increased ventilation (hyperventilation), increased erythropoietin production leading to increased RBCs and hemoglobin, increased 2,3-BPG (right shift of ODC), increased pulmonary vasoconstriction. Altitude sickness (acute mountain sickness, HAPE, HACE) can occur due to inadequate acclimatization.
15. Role of Surfactant: Pulmonary surfactant is a lipoprotein complex produced by Type II alveolar cells. Function: reduces surface tension in alveoli, preventing their collapse during expiration and reducing the work of breathing. Clinical significance: deficiency causes Infant Respiratory Distress Syndrome (IRDS) in premature babies.
16. Carbon Monoxide Poisoning: CO has an affinity for hemoglobin 200-250 times greater than O₂. It binds to Hb to form carboxyhemoglobin (COHb), which cannot carry O₂. It also shifts the ODC left, impairing O₂ release from remaining oxyhemoglobin. Symptoms: headache, nausea, dizziness, cherry-red skin (late sign). Treatment: 100% O₂, hyperbaric O₂. Prevention: CO detectors.
17. Pulmonary Gas Exchange: The process of O₂ loading into blood and CO₂ unloading from blood in the lungs. O₂ diffuses from alveoli (high PO₂) to pulmonary capillaries (low PO₂) and CO₂ diffuses from pulmonary capillaries (high PCO₂) to alveoli (low PCO₂). Factors: large alveolar surface area, thin respiratory membrane, favorable partial pressure gradients, and matching ventilation-perfusion.
18. Pleural Cavity Structure and Function: The pleural cavity is the potential space between the visceral pleura (covering lung surface) and parietal pleura (lining thoracic wall). Contains a thin layer of pleural fluid. Function: pleural fluid lubricates surfaces, allowing lungs to slide smoothly during breathing, and creates a negative intrapleural pressure that keeps the lungs expanded. Clinical significance: pleural effusion (fluid accumulation), pneumothorax (air in cavity).
19. Respiratory Failure: Inability of the respiratory system to maintain adequate gas exchange. Types: Hypoxemic (low O₂) and Hypercapnic (high CO₂). Causes: impaired ventilation, impaired diffusion, V/Q mismatch. Management: O₂ therapy, mechanical ventilation, treating underlying cause.
20. Chronic Obstructive Pulmonary Disease (COPD): Persistent airflow limitation, usually progressive, associated with chronic inflammatory response to noxious particles/gases. Includes chronic bronchitis and emphysema. Pathophysiology: chronic inflammation, airway narrowing, mucus hypersecretion, alveolar destruction, air trapping. Management: bronchodilators, corticosteroids, O₂ therapy, pulmonary rehabilitation, smoking cessation.
21. Ventilation-Perfusion (V/Q) Relationship: Ratio of alveolar ventilation (V) to pulmonary blood flow (Q). Ideal V/Q is ~0.8. High V/Q (wasted ventilation) occurs in embolism; low V/Q (shunt) in pneumonia. Mismatch is common cause of hypoxemia.
22. Cough Reflex: Protective reflex to clear airways. Irritant receptors send signals to medulla's cough center. Causes deep inspiration, glottic closure, forceful expiratory muscle contraction, then sudden glottic opening, expelling air/material.
23. Pulmonary Circulation: Low-pressure, high-flow system. Deoxygenated blood from right ventricle to pulmonary arteries, capillaries for gas exchange, then oxygenated blood returns via pulmonary veins to left atrium. Regulated by local factors like hypoxic pulmonary vasoconstriction.
24. Development of Respiratory System: Begins week 4 gestation from foregut endoderm. Lung bud branches into trachea, bronchi, lungs. Stages: embryonic, pseudoglandular, canalicular, saccular, alveolar. Surfactant production begins in canalicular stage.
25. Respiratory Acidosis and Alkalosis:
    • Acidosis: pH < 7.35, PCO₂ > 45 mmHg (hypoventilation). Compensation: kidneys retain HCO₃⁻.
    • Alkalosis: pH > 7.45, PCO₂ < 35 mmHg (hyperventilation). Compensation: kidneys excrete HCO₃⁻.
26. Oxygen Toxicity: Lung damage from prolonged high O₂ exposure. Mechanism: excessive O₂ forms reactive oxygen species (ROS), causing oxidative damage. Prevention: use lowest effective O₂ concentration, monitor levels.
27. Sleep-Disordered Breathing: Abnormal breathing during sleep. Sleep Apnea (Obstructive or Central) involves recurrent breathing cessation/reduction. Pathophysiology: intermittent hypoxemia, hypercapnia, sleep fragmentation. Management: CPAP, lifestyle changes.
28. Physiological Changes in Respiration During Exercise: Increased O₂ demand and CO₂ production. Increased ventilation (hyperpnea) driven by neural and humoral factors. Increased O₂ extraction by tissues due to metabolic demand, temperature, acidity (right ODC shift).
29. Pulmonary Embolism (PE): Blockage of pulmonary artery by thrombus, usually from DVT. Pathophysiology: V/Q mismatch (high V/Q), increased pulmonary vascular resistance, right heart strain, hypoxemia. Diagnosis: CTPA. Treatment: anticoagulation.
30. Respiratory Muscle Function:
    • Inspiratory: Diaphragm (primary, contracts/flattens), External Intercostals (contract, lift ribs). Accessory muscles for forced inspiration.
    • Expiratory: Quiet expiration is passive. Forced expiration uses Internal Intercostals (pull ribs down) and Abdominal Muscles (push diaphragm up).
31. Lung Cancer: Malignant tumor in lung tissue. Types: Non-Small Cell (most common) and Small Cell (aggressive, smoking-related). Risk factors: smoking. Pathophysiology: uncontrolled cell growth. Treatment: surgery, chemo, radiation, targeted therapy.
32. Gas Transport in Blood:
    • Oxygen: 97% bound to hemoglobin (oxyhemoglobin), 3% dissolved in plasma.
    • Carbon Dioxide: 70% as bicarbonate ions, 20-25% as carbaminohemoglobin, 7-10% dissolved in plasma.
33. Pneumonia: Acute inflammation of lung parenchyma due to infection. Pathophysiology: pathogens trigger inflammation, fluid/cells accumulate in alveoli, impairing gas exchange. Treatment: antibiotics (bacterial), antivirals (viral), supportive care.
34. Role of Nitric Oxide (NO) in Pulmonary Function: Potent vasodilator produced by endothelial cells, improving V/Q matching. Clinical application: inhaled NO used in PPHN and ARDS to selectively dilate pulmonary vessels.
35. Tuberculosis (TB): Infectious disease by Mycobacterium tuberculosis, primarily lungs. Transmission: airborne. Pathophysiology: granuloma formation. Latent or active. Treatment: multi-drug antibiotic regimen.
36. Respiratory Reflexes: Involuntary responses regulating breathing. Hering-Breuer reflex (stretch receptors inhibit inspiration). Other reflexes: irritant (cough/sneeze), J-receptor (pulmonary edema).
37. Pulmonary Fibrosis: Chronic, progressive lung scarring, leading to stiff lungs and impaired gas exchange. Causes: idiopathic, exposures, CTD. Pathophysiology: inflammation, fibrosis. Management: antifibrotic drugs, O₂ therapy.
38. Physiological Basis of Pulse Oximetry: Non-invasive SpO₂ measurement based on differential light absorption by oxyhemoglobin/deoxyhemoglobin. Limitations: motion, poor perfusion, nail polish. Clinical application: continuous oxygenation monitoring.
39. Mechanical Ventilation: Machine assistance for breathing. Modes vary. Indications: respiratory failure. Complications: VAP, barotrauma. Weaning: gradual support reduction.
40. Acute Respiratory Distress Syndrome (ARDS): Severe acute lung injury, widespread inflammation, non-cardiogenic pulmonary edema, severe hypoxemia. Pathophysiology: inflammatory cascade, alveolar-capillary damage. Management: supportive care, low tidal volume ventilation.
41. Respiratory Changes During Pregnancy: Diaphragm elevates, chest wall expands. Increased tidal volume and minute ventilation (progesterone effect), slight decrease in PCO₂. FRC decreases.
42. Bronchiectasis: Permanent, abnormal dilation/destruction of bronchi/bronchioles, leading to chronic cough, sputum, recurrent infections. Causes: severe infections, CF. Pathophysiology: chronic inflammation/infection damages airways. Treatment: antibiotics, chest physiotherapy.
43. Respiratory Compensation in Metabolic Acidosis and Alkalosis:
    • Acidosis: Hyperventilation to blow off CO₂.
    • Alkalosis: Hypoventilation to retain CO₂.
44. Diving Physiology:
    • Pressure Effects: Increased ambient pressure affects gas volumes/partial pressures.
    • Nitrogen Narcosis: Increased N₂ partial pressure causes anesthetic effects at depth.
    • Decompression Sickness: Rapid ascent causes N₂ bubbles in tissues.
45. Cor Pulmonale: Right ventricular hypertrophy/failure due to lung disease and pulmonary hypertension. Causes: chronic lung diseases. Pathophysiology: pulmonary vasoconstriction, increased RV workload. Management: O₂ therapy, treating lung disease.
46. Lung Development and Maturation: Stages: embryonic, pseudoglandular, canalicular, saccular, alveolar. Surfactant production sufficient for breathing by 34-36 weeks gestation.
47. Pneumothorax: Air in pleural cavity, causing lung collapse. Types: spontaneous, traumatic, tension (life-threatening). Causes: bleb rupture, trauma. Treatment: observation, needle aspiration, chest tube.
48. Role of Respiratory System in Acid-Base Balance: Rapidly regulates blood pH by controlling CO₂ levels (CO₂ + H₂O ⇌ H₂CO₃ ⇌ H⁺ + HCO₃⁻). Compensates for metabolic acid-base imbalances.
49. Allergic Respiratory Diseases: Hypersensitivity reactions (Type I, IgE-mediated) in respiratory tract. Types: allergic rhinitis, asthma. Management: allergen avoidance, antihistamines, corticosteroids.
50. Pathophysiology of Bronchial Asthma: Chronic airway inflammation, hyperresponsiveness, reversible obstruction. Inflammatory cascade (mast cells, eosinophils) leads to bronchoconstriction, mucus, edema. Treatment: bronchodilators, anti-inflammatories.
51. Respiratory Infections: Caused by bacteria, viruses, fungi. Pathophysiology: inflammation, impaired gas exchange. Treatment: specific antimicrobials, supportive care.
52. Physiological Effects of Smoking on Respiratory System: Acute: bronchoconstriction, increased mucus. Chronic: COPD, lung cancer, increased infections, reduced lung function. Cessation benefits: rapid improvement, reduced risks.
53. Interstitial Lung Diseases (ILDs): Chronic inflammation/fibrosis of lung interstitium. Pathophysiology: injury, inflammation, fibrosis, stiff lungs. Management: corticosteroids, antifibrotics.
54. Oxygen Therapy: Supplemental O₂ for hypoxemia. Indications: low blood O₂. Delivery methods: nasal cannula, masks. Monitoring: pulse oximetry, ABG. Principles: lowest effective dose.
55. Respiratory Drive: Neural stimulus for breathing. Central control: medulla, pons. Peripheral control: chemoreceptors (PCO₂, H⁺, PO₂), mechanoreceptors. Integrated signals determine rate/depth.
56. Pleural Diseases: Conditions affecting pleura. Effusion (fluid), pneumothorax (air), pleurisy (inflammation). Symptoms: chest pain, dyspnea. Management: drainage, treating cause.
57. Respiratory Pharmacology: Drugs for respiratory diseases. Bronchodilators (relax airways), anti-inflammatories (reduce inflammation), mucolytics (thin mucus).
58. Pathophysiology of Pulmonary Hypertension: High blood pressure in pulmonary arteries. Leads to increased right ventricular afterload, hypertrophy, and eventual right heart failure (cor pulmonale).
59. Respiratory Emergencies: Acute, life-threatening conditions. Recognition: severe dyspnea, cyanosis. Management: secure airway, O₂ therapy, assist ventilation, treat cause.
60. Artificial Ventilation: Support/replace breathing. Bag-mask ventilation (manual), endotracheal intubation (secure airway for mechanical ventilator).
61. Environmental Lung Diseases: Caused by environmental factors. Air pollution: inflammation, exacerbation of conditions. Occupational exposures: pneumoconioses. Prevention: emission reduction, PPE.
62. Respiratory System Aging: Structural changes: decreased elasticity, stiff chest wall. Functional changes: decreased lung volumes, impaired cough. Clinical implications: increased infections, reduced exercise tolerance.
63. Pediatric Respiratory Physiology Differences: Smaller airways, compliant chest wall, higher respiratory rate. More prone to obstruction, rapid desaturation. Common conditions: bronchiolitis, croup.
64. Maternal Respiratory Changes During Pregnancy: (Same as Q41) Diaphragm elevates, increased tidal volume/minute ventilation, slight decrease in PCO₂.
65. Pollutant Effects on Lungs: Particulate matter, ozone, SO₂, NO₂ cause inflammation, exacerbate conditions, reduce lung function, increase cancer risk.
66. Respiratory Protective Equipment (RPE): Devices protecting from inhaling hazards (respirators, dust masks). Uses: occupational, pandemics. Limitations: proper fit, maintenance, selection.
67. Pulmonary Function Test (PFT) Interpretation: Assess lung function. Spirometry (FVC, FEV1) diagnoses obstructive/restrictive diseases. Lung volumes (TLC, RV), diffusing capacity (DLCO).
68. Bronchial and Alveolar Breath Sounds: Bronchial: loud, high-pitched, prominent expiration (over trachea, or consolidation). Vesicular: soft, low-pitched, prominent inspiration (over lung fields). Changes indicate pathology.
69. Respiratory Physical Examination: Inspection (breathing pattern), palpation (chest expansion), percussion (lung density), auscultation (breath sounds, adventitious sounds).
70. Chest X-ray Interpretation Basics: Imaging for chest. Findings: consolidation (pneumonia), absent markings (pneumothorax), blunting (effusion), hyperinflation (COPD).
71. CT and MRI in Lung Imaging: CT: excellent for lung parenchyma, radiation. MRI: no radiation, better soft tissue contrast, limited lung parenchyma resolution.
72. Bronchoscopy Procedure: Endoscopic visualization of airways. Indications: diagnosis (biopsy), foreign body removal. Complications: bleeding, pneumothorax.
73. Respiratory Medication Delivery: Routes: inhalation (most common), oral, IV. Devices: MDIs, DPIs, nebulizers. Patient education crucial for proper technique.
74. Inhaler Types and Techniques: MDIs: portable, require coordination (spacers help). DPIs: breath-activated, no coordination. Nebulizers: continuous mist, for severe cases.
75. Respiratory Emergency Management: (Same as Q59) Acute respiratory failure, airway obstruction. Rapid assessment, stabilization, specific interventions.
76. Artificial Respiration Techniques: Provide ventilation. Mouth-to-mouth, Bag-Valve-Mask (manual). Mechanical ventilation (machine-assisted).
77. Oxygen Concentrators and Cylinders: O₂ delivery devices. Cylinders: portable, finite. Concentrators: home use, continuous, require electricity.
78. Respiratory Isolation Precautions: Prevent pathogen transmission. Droplet (surgical mask), Airborne (N95, negative pressure room). Crucial for infection control.
79. Lung Transplantation: Replace diseased lungs. Indications: end-stage lung disease. Outcomes: improved quality of life/survival, but lifelong immunosuppression.
80. Respiratory System Development: (Same as Q24) Fetal lungs fluid-filled, gas exchange via placenta. At birth, fluid clears, lungs inflate, gas exchange begins.
81. Respiratory Hormone Regulation: Progesterone (stimulates ventilation), thyroid hormones (indirectly), adrenaline (bronchodilation).
82. Respiratory Reflexes: (Same as Q36) Hering-Breuer, irritant, J-receptor, pain. Protective, regulate lung volume, respond to irritants.
83. Voluntary and Involuntary Breathing: Involuntary: brainstem control, rhythmic. Voluntary: cerebral cortex control, conscious override.
84. Respiratory Adaptation Mechanisms: Physiological adjustments. Acclimatization to high altitude, exercise adaptations, diving adaptations.
85. Respiratory System Integration: Works with cardiovascular (gas transport), renal (acid-base), nervous (control), musculoskeletal (muscles), immune (protection) systems.
86. Species Differences in Respiration: Variations reflect adaptations. Fish (gills), insects (tracheal), birds (unidirectional airflow), mammals (alveolar lungs).
87. Evolutionary Respiratory Adaptations: Changes over time. Lungs from swim bladders, efficient gas exchange for higher metabolic rates, adaptations to altitude.
88. Respiratory System Disorders Classification: Obstructive (airflow limitation), restrictive (reduced lung volumes), vascular (pulmonary vessels), infectious, malignancies.
89. Acute and Chronic Respiratory Conditions: Acute: sudden onset, short duration (pneumonia). Chronic: long-standing, progressive (COPD).
90. Respiratory Pharmacology Basics: (Same as Q57) Drug classes (bronchodilators, anti-inflammatories), mechanisms of action, inhaled delivery.
91. Respiratory System Anatomy Variations: Common anomalies (tracheoesophageal fistula), individual variations in size/branching. Clinical significance: distress, infections.
92. Male and Female Respiratory Differences: Males generally have larger lung volumes, airways, and muscle strength. Hormonal influences can affect airway reactivity.
93. Respiratory System Embryology: (Same as Q24) Lungs/trachea from foregut endoderm. Sequential branching and differentiation.
94. Respiratory System Histology: Microscopic structure. Conducting airways: ciliated epithelium, goblet cells, cartilage. Respiratory zone: Type I/II pneumocytes, capillaries.
95. Respiratory System Physiology: Functions: gas exchange, transport, ventilation, regulation, lung mechanics.
96. Respiratory System Pathology: Diseases affecting respiratory system. Microscopic features: inflammation, tissue destruction, fibrosis, malignancy.
97. Respiratory System Biochemistry: Chemical processes. Metabolic pathways (cellular respiration), enzyme functions (carbonic anhydrase), hemoglobin chemistry, acid-base buffering.
98. Respiratory System Genetics: Genetic factors in respiratory health/disease. Inherited disorders (CF, AAT deficiency), genetic predispositions (asthma), pharmacogenomics.
99. Respiratory System Immunology: Immune responses. Innate/adaptive immunity against pathogens. Immune-mediated diseases (asthma, sarcoidosis). Local defense mechanisms.
100. Respiratory System Research Methods: In vivo (animal models, clinical trials), in vitro (cell culture), computational (modeling). Techniques: PFT, imaging, bronchoscopy, molecular biology.