Multiple Choice
1. C This is the ventilation-perfusion mismatch phenomenon. Not every alveolus receives perfectly matched ventilation and blood flow. Some areas of the lung have slightly impaired ventilation or slight anatomical variations, blood from these areas is slightly less oxygenated. When all pulmonary blood mixes in the pulmonary veins, the average O₂ is fractionally below the ideal alveolar level.
2. B Emphysema destroys alveolar walls, merging many small alveoli into fewer large spaces. Total surface area falls dramatically (potentially from ~250m² to ~30m²). By Fick's law, rate ∝ SA, a massive reduction in SA causes a proportional drop in diffusion rate. The remaining individual alveoli may function normally, but there are far fewer of them.
3. D Ventilation's role is gradient maintenance. Without ventilation, O₂ would be consumed from alveolar air by diffusion into blood but never replaced, so alveolar pO₂ would fall. CO₂ from blood would accumulate in alveolar air, raising alveolar pCO₂. Both changes collapse the partial pressure gradients that drive diffusion. Ventilation does not mechanically push gases across membranes, diffusion is passive and driven by the gradient ventilation maintains.
4. A During intense exercise, muscles dramatically increase cellular respiration rate, consuming O₂ rapidly from capillary blood. Tissue pO₂ drops to ~15 mmHg. This actually increases the gradient from blood to tissue (~95 − 15 = 80 mmHg vs ~95 − 30 = 65 mmHg at rest), accelerating O₂ delivery, a positive feedback loop that meets increased demand. The low venous pO₂ is a consequence of greater O₂ extraction, not reduced loading at the lungs.
5. B Fick's law: rate ∝ (SA × concentration gradient) / membrane thickness. Large SA ↑ rate, thin membrane ↑ rate, maintained gradient ↑ rate. All three must be simultaneously maximised for highest exchange rate, which is exactly what the alveolus achieves.
Q6, Model Answer
Blood flow maintains the concentration gradient driving O₂ from alveolar air into blood by continuously removing O₂-loaded blood from the pulmonary capillaries and replacing it with deoxygenated blood from the systemic circuit. This keeps the pO₂ of blood entering pulmonary capillaries low (~40 mmHg), maintaining a large gradient relative to alveolar air (~100 mmHg). Simultaneously, blood flow delivers CO₂-rich venous blood to the alveoli, maintaining the CO₂ gradient driving CO₂ from blood into alveolar air for exhalation.
If blood flow stopped, blood in the pulmonary capillaries would rapidly equilibrate with alveolar air, pO₂ in blood would rise until it equalled alveolar pO₂ (~100 mmHg) and pCO₂ would equilibrate at ~40 mmHg. With no partial pressure gradient remaining, diffusion would cease entirely. No further O₂ loading or CO₂ unloading would occur. Cardiac arrest produces exactly this outcome, stopping blood flow collapses both alveolar and tissue gas exchange gradients simultaneously.
Q7, Model Answer
Fick's law states that rate of diffusion is inversely proportional to membrane thickness: Rate ∝ (SA × concentration gradient) / membrane thickness. In pulmonary oedema, fluid accumulates in the interstitial space between the alveolar epithelium and pulmonary capillary endothelium. This effectively increases the diffusion distance (membrane thickness) that O₂ and CO₂ must cross, adding a layer of fluid several micrometres thick to the normal ~0.5 μm barrier.
By Fick's law, an increase in membrane thickness causes a proportional decrease in diffusion rate. Less O₂ crosses per unit time despite normal alveolar O₂ levels and normal blood flow. The patient experiences hypoxaemia (low blood O₂) and breathlessness, their lungs contain normal air but cannot transfer it efficiently into the blood.
Q8, Model Answer
External gas exchange occurs at the alveolar surface, the interface between the internal environment (blood in pulmonary capillaries) and the external environment (alveolar air). O₂ diffuses from alveolar air (pO₂ ~100 mmHg) into pulmonary capillary blood (pO₂ ~40 mmHg arriving), driven by a ~60 mmHg partial pressure gradient. CO₂ simultaneously diffuses from blood (pCO₂ ~45 mmHg) into alveolar air (pCO₂ ~40 mmHg), driven by a ~5 mmHg gradient. Both gradients are maintained by ventilation refreshing alveolar air and blood flow cycling venous blood through the capillaries.
Internal gas exchange occurs at systemic capillaries, the interface between blood and body tissues. O₂ diffuses from capillary blood (pO₂ ~95 mmHg) into tissue cells (pO₂ ~20–30 mmHg), driven by a ~65–75 mmHg gradient maintained by continuous cellular respiration consuming O₂. CO₂ diffuses from tissue cells (pCO₂ ~50+ mmHg) into blood (pCO₂ ~40 mmHg), driven by a ~10 mmHg gradient. Both gradients are maintained by tissue metabolism and continuous blood flow through the systemic circuit.
The key distinction is location and what maintains each gradient: external exchange is maintained by ventilation (refreshing alveolar air) and pulmonary blood flow; internal exchange is maintained by cellular metabolism (consuming O₂, producing CO₂) and systemic blood flow.