Name: _____________________________________

Tutor/Room: ________________________________
Integrated Human Physiology
Harvard Medical School
February 2009
Respiratory Quiz

1. Charlie is a first year HMS student who is interested in physiology and athletics and
decides to do an experiment. He wants to assess respiratory physiology in three
environments: at the top of Mt Everest, in the middle of the HMS quad, and while
SCUBA diving off Cape Cod at a depth of 50 feet.
In each environment, he takes air into his lung sufficient to produce an alveolar
pressure, under static conditions with his glottis closed, of 15 cm H2O. You predict
the lung volume will be (provide the best answer):
a) the same under all conditions
b) largest on Mt Everest
c) largest in the Quad
d) largest when SCUBA diving
e) smallest on Mt Everest.

2. A patient with severe expiratory airflow obstruction comes to the emergency

department complaining of shortness of breath. His symptoms developed suddenly
when he heard his son was injured in Iraq. He is complaining about a sense of not
being able to get a deep breath, and is breathing at a rate of 24 breaths/min with
shallow breaths. His oxygen saturation is 95%.
A) Briefly explain the physiological mechanisms that lead to increased work of
breathing in this patient.

B) Briefly explain how the patients respiratory pattern will affect his ability to
eliminate carbon dioxide.

Name: _____________________________________
Tutor/Room: ________________________________
3. John is a 25 year-old firefighter who suffered from smoke inhalation. He had been
fighting a fire in a warehouse that stored a series of chemicals that, upon burning,
produced fumes known to stimulate irritant receptors in the lung. Twenty-four hours
later he is complaining of shortness of breath and is brought to the emergency
department. Breathing room air, his oxygen saturation is 97%. An arterial blood gas
shows: PaO2=95 mm Hg, PaCO2= 15 mm Hg, and pH 7.60.
Two days later, the ABG shows: PaO2=40, PaCO2=30, and pH 7.44. He is given
supplemental oxygen (100% by mask) and a repeat ABG is PaO2=45, PaCO2=31,
and pH 7.44.
Part A) At the time of the first blood gas, the patient had evidence of (provide the
best answer):
a) an abnormality in the gas exchanger
b) an abnormal PaCO2 due to increased dead space
c) hypoventilation
d) a chronic respiratory alkalosis
e) a metabolic alkalosis

Part B) At the time of the second blood gas, you note that the patients respiratory
system has a very low compliance; this is a change from two days earlier . Assuming
that the inhalation of smoke did not alter the elastic properties of the lung, i.e., the
collagen and associated connective tissue, the most likely explanation for the change
in compliance is:
a) muscle spasm
b) increased airway resistance
c) damaged or decreased surfactant
d) hypoxemia
e) hypocapnia