Explain the causes of the differences between measured end tidal and arterial partial pressures of carbon dioxide (CO2).
The answer required an explanation of the causes of the difference between the PaCO2 and ETCO2. This required recognising how the end point of phase 3 of the capnograph trace corresponds with end tidal CO2. The difference is caused by the alveolar dead space. The difference is normally very small in healthy adults with the ETCO2 being lower than the PaCO2. It is increased with increasing alveolar dead space. Many incorrectly attributed anatomical dead space as a contributor to the PaCO2-ETCO2 gradient. Discussion of the various types of dead space did not score marks. Marks were awarded for the processes that cause an increased gradient e.g. low cardiac output and pulmonary embolism. Recognising physiological factors such as increasing gradient with increasing age scored marks. Marks were not awarded for descriptions on how dead space is measured.
This question is virtually identical to Question 9 from the first paper of 2009 and Question 21 from the first paper of 2017, although looking at the latter would be rather pointless, as the examiners remarks were limited to "many candidates didn’t distinguish between the different types of dead space"and "in general this topic was not well understood".
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