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Physiology · Respiratory system: physiological shunt in health
Sample itemIn a healthy person breathing air, arterial PO2 is a few mmHg lower than the calculated ideal alveolar PO2 even with well-matched ventilation and perfusion. What is the main contribution?
Original practice item, not a recalled exam question. Nothing here is recorded.
The answer and the reasoning
C. Venous blood from the bronchial and thebesian veins draining into the left heart
A small proportion of cardiac output, mostly bronchial venous and some coronary (thebesian) blood, reaches the left side without passing through ventilated alveoli. This anatomical shunt mixes desaturated blood with oxygenated blood and produces a small normal alveolar-arterial gradient.
Option by option
A. Absorption of oxygen by alveolar macrophages
Macrophage consumption of oxygen is negligible.
B. Complete diffusion limitation at rest
At rest, diffusion equilibrium is reached long before the end of the capillary, so there is no diffusion limit.
C. Venous blood from the bronchial and thebesian veins draining into the left heart (correct)
Correct. Bronchial and thebesian venous drainage bypasses the alveoli and lowers arterial PO2.
D. Failure of oxygen to dissolve in plasma
Oxygen dissolves normally in plasma and is not the cause of the gradient.
Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.
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