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Right-to-left shunt physiology — FRCA Primary MCQ

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HardPhysiologyRight-to-left shunt physiologyFRCA Primary

A patient with severe pneumonia remains hypoxaemic despite high-flow oxygen. ABG shows PaO2 7.8 kPa on FiO2 0.8 and PaCO2 4.9 kPa. What is the most likely explanation?

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Correct answer: EPerfusion of non-ventilated alveoli

Marked hypoxaemia despite high FiO2 suggests right-to-left shunt, where blood perfuses non-ventilated alveoli and cannot be fully corrected by oxygen. Reduced inspired oxygen tension would be unlikely on high-flow oxygen with correct equipment. Carbon monoxide poisoning affects oxygen content and pulse oximetry more than PaO2. A normal PaCO2 can coexist with severe shunt because CO2 diffuses more readily and ventilation may increase.

Reference: West Respiratory Physiology; Nunn's Applied Respiratory Physiology