Morning Rounds \u00b7 Clinical Numericals \u00b7 Round 01<\/title>\n<link href=\"https:\/\/fonts.googleapis.com\/css2?family=Playfair+Display:ital,wght@0,400;0,600;0,700;1,400;1,600&family=Source+Serif+4:ital,wght@0,300;0,400;0,600;1,400&display=swap\" rel=\"stylesheet\">\n<style>\n#ncl01 *,#ncl01 *::before,#ncl01 *::after{box-sizing:border-box;margin:0;padding:0}\n#ncl01{\n --ob:#1A5F7A;--ob-light:#236E8C;--ob-pale:#E6F3F7;--ob-dark:#114455;\n --correct:#2D6B47;--correct-bg:#EAF6EF;--correct-border:#3A9960;\n --wrong:#B83232;--wrong-bg:#FDF0F0;--wrong-border:#E53935;\n --ink:#0F2A35;--ink-mid:#2A4D5A;--ink-soft:#5A7D8A;\n --line:#B8D8E3;--cream:#F2F8FA;--warm:#F8FCFD;\n font-family:'Source Serif 4',Georgia,serif;\n font-size:16px;color:var(--ink);background:var(--cream);\n line-height:1.7;padding:0 0 64px;\n}\n#ncl01 .mr-header{background:linear-gradient(135deg,var(--ob-dark) 0%,var(--ob) 60%,var(--ob-light) 100%);color:#E4F4F9;padding:36px 24px 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.mr-band-c{background:var(--correct-bg);color:var(--correct)}\n#ncl01 .mr-band-w{background:var(--wrong-bg);color:var(--wrong)}\n#ncl01 .mr-band-s{background:var(--ob-pale);color:var(--ob)}\n#ncl01 .mr-retry{display:block;margin:18px auto 4px;background:transparent;border:2px solid var(--ob);color:var(--ob);border-radius:8px;padding:9px 28px;font-family:'Playfair Display',serif;font-size:0.92rem;font-weight:700;cursor:pointer;}\n#ncl01 .mr-retry:hover{background:var(--ob);color:#E4F4F9}\n@media(max-width:480px){\n #ncl01 .mr-title{font-size:1.4rem}\n #ncl01 .mr-num{font-size:1.7rem}\n #ncl01 .mr-stem{font-size:0.9rem}\n #ncl01 .mr-opt-text{font-size:0.86rem}\n}\n<\/style>\n\n<div id=\"ncl01\">\n\n <div class=\"mr-header\">\n <div class=\"mr-series-tag\">Numerical Series · Clinical Physiology<\/div>\n <div class=\"mr-eyebrow\">Morning Rounds · Round 01 of 07<\/div>\n <div class=\"mr-title\">Physiological<br><em>Calculations<\/em><\/div>\n <div class=\"mr-subtitle\">Five questions · Cardiac output, GFR, dead space, compliance & alveolar ventilation<\/div>\n <div class=\"mr-chips\">\n <span class=\"mr-chip\">5 Questions<\/span>\n <span class=\"mr-chip\">+4 \/ −1 scoring<\/span>\n <span class=\"mr-chip\">Options reshuffled<\/span>\n <\/div>\n <\/div>\n\n <div class=\"mr-sentinel\" id=\"ncl01-sentinel\"><\/div>\n\n <div class=\"mr-progress\" id=\"ncl01-progress\">\n <div class=\"mr-prog-inner\">\n <div class=\"mr-pips\" id=\"ncl01-pips\"><\/div>\n <\/div>\n <\/div>\n\n <div class=\"mr-body\">\n <div id=\"ncl01-cases\"><\/div>\n <div class=\"mr-submit-wrap\">\n <button class=\"mr-btn\" id=\"ncl01-submit\">Submit for Debrief<\/button>\n <\/div>\n <div class=\"mr-score\" id=\"ncl01-score\">\n <div class=\"mr-score-in\">\n <div class=\"mr-score-ey\">Round Complete<\/div>\n <div class=\"mr-ring\" id=\"ncl01-ring\">\n <div class=\"mr-ring-in\">\n <span class=\"mr-ring-pct\" id=\"ncl01-pct\">0%<\/span>\n <span class=\"mr-ring-sub\">net<\/span>\n <\/div>\n <\/div>\n <div class=\"mr-score-title\">Your Debrief<\/div>\n <div class=\"mr-score-net\" id=\"ncl01-net\"><\/div>\n <div class=\"mr-verdict\" id=\"ncl01-verdict\"><\/div>\n <div class=\"mr-bands\">\n <span class=\"mr-band mr-band-c\" id=\"ncl01-ct-c\"><\/span>\n <span class=\"mr-band mr-band-w\" id=\"ncl01-ct-w\"><\/span>\n <span class=\"mr-band mr-band-s\" id=\"ncl01-ct-s\"><\/span>\n <\/div>\n <button class=\"mr-retry\" id=\"ncl01-retry\">↻ New Round<\/button>\n <\/div>\n <\/div>\n <\/div>\n\n<\/div>\n\n<script>\n(function () {\n 'use strict';\n\n var NS = 'ncl01';\n var TOTAL = 5;\n var MAX = 20;\n var LTRS = ['A','B','C','D'];\n\n var QS = [\n\n {\n id: 1,\n tag: 'Cardiac Output — Fick Principle',\n stem: 'A patient has an <strong>oxygen consumption (VO&sub2;) of 250 mL\/min<\/strong>. Arterial oxygen content is <strong>200 mL\/L<\/strong> and mixed venous oxygen content is <strong>150 mL\/L<\/strong>. What is the <strong>cardiac output<\/strong>?',\n correct: '5 L\/min',\n opts: [\n '5 L\/min',\n '1.25 L\/min',\n '50 L\/min',\n '2.5 L\/min'\n ],\n exp: 'The <strong>Fick Principle<\/strong>: Cardiac Output = VO&sub2; ÷ (CaO&sub2; − CvO&sub2;).<span class=\"calc\">CO = 250 mL\/min ÷ (200 − 150) mL\/L<br>= 250 mL\/min ÷ 50 mL\/L<br>= <strong>5 L\/min<\/strong><\/span>Units check: mL\/min ÷ mL\/L = L\/min. The arteriovenous oxygen difference (CaO&sub2; − CvO&sub2;) = 50 mL\/L here — the normal range is 40–60 mL\/L at rest. A narrowing AV difference (e.g. 20 mL\/L) at the same VO&sub2; would demand a higher CO to deliver enough oxygen — this is the haemodynamic logic of high-output states.<br><br>Trap 1.25 L\/min divides 250 by 200 (using only CaO&sub2; as denominator). Trap 50 L\/min multiplies instead of divides. Trap 2.5 L\/min divides by 100 instead of 50 — a subtraction error in the AV difference. Normal cardiac output at rest: <strong>4–8 L\/min<\/strong>; cardiac index (CO ÷ BSA) normal range: 2.5–4 L\/min\/m².'\n },\n\n {\n id: 2,\n tag: 'GFR — Clearance Formula',\n stem: 'Inulin is infused to achieve a steady plasma concentration of <strong>1 mg\/mL<\/strong>. Urine inulin concentration is <strong>120 mg\/mL<\/strong> and urine flow rate is <strong>1 mL\/min<\/strong>. What is the <strong>GFR<\/strong>?',\n correct: '120 mL\/min',\n opts: [\n '120 mL\/min',\n '12 mL\/min',\n '1 mL\/min',\n '240 mL\/min'\n ],\n exp: 'Clearance formula: <strong>C = (U × V) ÷ P<\/strong>, where U = urine concentration, V = urine flow rate, P = plasma concentration.<span class=\"calc\">GFR = (120 mg\/mL × 1 mL\/min) ÷ 1 mg\/mL<br>= 120 mg\/min ÷ 1 mg\/mL<br>= <strong>120 mL\/min<\/strong><\/span>Inulin clearance = GFR because inulin is <strong>freely filtered, not secreted, not reabsorbed, not metabolised<\/strong>. It is the gold standard for GFR measurement. The clearance formula tells you: how many mL of plasma must be completely cleared of inulin per minute to account for the amount appearing in urine.<br><br>Normal GFR: <strong>125 mL\/min<\/strong> (male), slightly lower in females. This is also the basis of creatinine clearance estimation (Cockcroft-Gault) used clinically. Trap 12 mL\/min divides by 10 instead of 1. Trap 240 mL\/min doubles the correct answer. Trap 1 mL\/min uses only urine flow without applying concentrations.'\n },\n\n {\n id: 3,\n tag: 'Dead Space — Bohr Equation',\n stem: 'A patient has a <strong>tidal volume of 500 mL<\/strong>. PaCO&sub2; is <strong>40 mmHg<\/strong> and mixed expired PCO&sub2; (PE′CO&sub2;) is <strong>30 mmHg<\/strong>. What is the <strong>physiological dead space volume<\/strong>?',\n correct: '125 mL',\n opts: [\n '125 mL',\n '375 mL',\n '75 mL',\n '250 mL'\n ],\n exp: 'The <strong>Bohr equation<\/strong>: V<sub>D<\/sub>\/V<sub>T<\/sub> = (PaCO&sub2; − PE′CO&sub2;) ÷ PaCO&sub2;.<span class=\"calc\">V<sub>D<\/sub>\/V<sub>T<\/sub> = (40 − 30) ÷ 40 = 10 ÷ 40 = <strong>0.25<\/strong><br>V<sub>D<\/sub> = 0.25 × 500 mL = <strong>125 mL<\/strong><\/span>Dead space fraction = 0.25 means 25% of each breath goes to dead space and contributes no gas exchange. Normally V<sub>D<\/sub>\/V<sub>T<\/sub> = <strong>0.2–0.35<\/strong> (anatomical dead space ~150 mL in a 70 kg adult). Values >0.6 indicate severe ventilatory inefficiency (e.g. massive PE, ARDS).<br><br>The logic: if all expired CO&sub2; came from alveoli (no dead space), PE′CO&sub2; would equal PaCO&sub2;. The difference between them reflects dilution by dead space gas (which has no CO&sub2;). Trap 375 mL subtracts 125 from 500 (giving alveolar volume rather than dead space). Trap 75 mL uses (30−10)÷40 with wrong numbers. Trap 250 mL applies ratio 0.5 by dividing 30 by 40 incorrectly — missing the subtraction step.'\n },\n\n {\n id: 4,\n tag: 'Lung Compliance — Calculation & Clinical Meaning',\n stem: 'A ventilated patient has a <strong>tidal volume of 600 mL<\/strong>. Plateau pressure is <strong>25 cmH&sub2;O<\/strong> and PEEP is <strong>5 cmH&sub2;O<\/strong>. What is the <strong>static lung compliance<\/strong>, and what does the value suggest?',\n correct: '30 mL\/cmH&sub2;O; reduced compliance indicating stiff lungs, consistent with ARDS or pulmonary fibrosis',\n opts: [\n '30 mL\/cmH&sub2;O; reduced compliance indicating stiff lungs, consistent with ARDS or pulmonary fibrosis',\n '24 mL\/cmH&sub2;O; severely reduced compliance consistent with tension pneumothorax',\n '30 mL\/cmH&sub2;O; normal compliance confirming no significant parenchymal lung disease',\n '120 mL\/cmH&sub2;O; elevated compliance suggesting emphysema or air trapping'\n ],\n exp: 'Static compliance = <strong>Tidal Volume ÷ (Plateau Pressure − PEEP)<\/strong>.<span class=\"calc\">C<sub>st<\/sub> = 600 mL ÷ (25 − 5) cmH&sub2;O<br>= 600 ÷ 20<br>= <strong>30 mL\/cmH&sub2;O<\/strong><\/span>Normal static compliance in a ventilated adult: <strong>60–100 mL\/cmH&sub2;O<\/strong>. A value of 30 is roughly half normal — indicating significantly <strong>stiff lungs<\/strong>. ARDS is the classic cause; pulmonary fibrosis, pulmonary oedema, and pneumonia also reduce compliance.<br><br>PEEP must be subtracted because it represents the baseline pressure against which the lungs are being inflated — only the driving pressure above PEEP creates the tidal volume. Forgetting to subtract PEEP (using 25 instead of 20) gives 24 mL\/cmH&sub2;O and is trap B. Elevated compliance (>100 mL\/cmH&sub2;O) occurs in emphysema where lung tissue is destroyed and elastic recoil is lost — the opposite of stiff lungs. Trap C calls 30 mL\/cmH&sub2;O normal — it is half of normal.'\n },\n\n {\n id: 5,\n tag: 'Alveolar Ventilation — Calculation from Dead Space',\n stem: 'A patient breathes at a <strong>respiratory rate of 16\/min<\/strong> with a <strong>tidal volume of 500 mL<\/strong>. Anatomical dead space is <strong>150 mL<\/strong>. What is the <strong>alveolar ventilation<\/strong>?',\n correct: '5600 mL\/min',\n opts: [\n '5600 mL\/min',\n '8000 mL\/min',\n '2400 mL\/min',\n '4800 mL\/min'\n ],\n exp: 'Alveolar ventilation = <strong>(Tidal Volume − Dead Space) × Respiratory Rate<\/strong>.<span class=\"calc\">Alveolar volume per breath = 500 − 150 = 350 mL<br>V<sub>A<\/sub> = 350 mL × 16\/min = <strong>5600 mL\/min<\/strong><\/span>Minute ventilation = V<sub>T<\/sub> × RR = 500 × 16 = 8000 mL\/min. Alveolar ventilation is always <strong>less than minute ventilation<\/strong> by the amount wasted on dead space: 8000 − (150 × 16) = 8000 − 2400 = 5600 mL\/min. The dead space ventilation (2400 mL\/min) goes nowhere useful.<br><br>This distinction matters clinically: a patient who increases RR from 16 to 32 while halving V<sub>T<\/sub> to 250 mL maintains the same minute ventilation (8000 mL\/min) but alveolar ventilation <em>falls<\/em>:<span class=\"calc\">(250−150) × 32 = 100 × 32 = 3200 mL\/min<\/span>Rapid shallow breathing is ventilatorily inefficient precisely because dead space volume is fixed. Trap 8000 mL\/min is minute ventilation without subtracting dead space. Trap 2400 mL\/min is dead space ventilation alone. Trap 4800 mL\/min uses RR = 16 but dead space = 200 mL by mistake.'\n }\n\n ];\n\n var answers = {}, answered = 0, shuffled = {}, done = false;\n\n function gid(s) { return document.getElementById(NS + '-' + s); }\n function byId(s) { return document.getElementById(s); }\n\n function shuffleArr(arr) {\n var a = arr.slice(), i, j, t;\n for (i = a.length - 1; i > 0; i--) {\n j = Math.floor(Math.random() * (i + 1));\n t = a[i]; a[i] = a[j]; a[j] = t;\n }\n return a;\n }\n\n function countVal(v) {\n var n = 0, k;\n for (k in answers) { if (answers[k] === v) n++; }\n return n;\n }\n\n function buildPips() {\n var cont = gid('pips'), i, q, wLine, wPip, line, pip;\n cont.innerHTML = '';\n for (i = 0; i < QS.length; i++) {\n q = QS[i];\n if (i > 0) {\n wLine = document.createElement('div');\n wLine.className = 'mr-pip-wrap';\n line = document.createElement('div');\n line.className = 'mr-pip-line';\n line.id = NS + '-pl' + q.id;\n wLine.appendChild(line);\n cont.appendChild(wLine);\n }\n wPip = document.createElement('div');\n wPip.className = 'mr-pip-wrap';\n pip = document.createElement('div');\n pip.className = 'mr-pip';\n pip.id = NS + '-pip' + q.id;\n pip.textContent = String(q.id);\n wPip.appendChild(pip);\n cont.appendChild(wPip);\n }\n }\n\n function build() {\n var cont, i, q, opts, card, top, numDiv, meta, tag, stem,\n rule, optsDiv, expDiv, lbl, txt, j, optEl, ltrSpan, txtSpan;\n\n cont = gid('cases');\n cont.innerHTML = '';\n answers = {}; answered = 0; shuffled = {}; done = false;\n gid('score').style.display = 'none';\n buildPips();\n\n for (i = 0; i < QS.length; i++) {\n q = QS[i];\n opts = shuffleArr(q.opts);\n shuffled[q.id] = opts;\n\n card = document.createElement('div');\n card.className = 'mr-case';\n\n top = document.createElement('div');\n top.className = 'mr-case-top';\n\n numDiv = document.createElement('div');\n numDiv.className = 'mr-num';\n numDiv.textContent = q.id < 10 ? 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{"id":37407,"date":"2026-08-25T06:32:09","date_gmt":"2026-08-25T01:02:09","guid":{"rendered":"https:\/\/atsixty.com\/?p=37407"},"modified":"2026-08-25T07:50:40","modified_gmt":"2026-08-25T02:20:40","slug":"physiological-calculations","status":"publish","type":"post","link":"https:\/\/atsixty.com\/index.php\/morning-rounds\/physiological-calculations\/","title":{"rendered":"Physiological Calculations"},"content":{"rendered":"\n\n\n\n\n\n\n\nMorning Rounds \u00b7 Clinical Numericals \u00b7 Round 01<\/title>\n<link href=\"https:\/\/fonts.googleapis.com\/css2?family=Playfair+Display:ital,wght@0,400;0,600;0,700;1,400;1,600&family=Source+Serif+4:ital,wght@0,300;0,400;0,600;1,400&display=swap\" rel=\"stylesheet\">\n<style>\n#ncl01 *,#ncl01 *::before,#ncl01 *::after{box-sizing:border-box;margin:0;padding:0}\n#ncl01{\n --ob:#1A5F7A;--ob-light:#236E8C;--ob-pale:#E6F3F7;--ob-dark:#114455;\n --correct:#2D6B47;--correct-bg:#EAF6EF;--correct-border:#3A9960;\n 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#ncl01 .mr-opt-text{font-size:0.86rem}\n}\n<\/style>\n\n<div id=\"ncl01\">\n\n <div class=\"mr-header\">\n <div class=\"mr-series-tag\">Numerical Series · Clinical Physiology<\/div>\n <div class=\"mr-eyebrow\">Morning Rounds · Round 01 of 07<\/div>\n <div class=\"mr-title\">Physiological<br><em>Calculations<\/em><\/div>\n <div class=\"mr-subtitle\">Five questions · Cardiac output, GFR, dead space, compliance & alveolar ventilation<\/div>\n <div class=\"mr-chips\">\n <span class=\"mr-chip\">5 Questions<\/span>\n <span class=\"mr-chip\">+4 \/ −1 scoring<\/span>\n <span class=\"mr-chip\">Options reshuffled<\/span>\n <\/div>\n <\/div>\n\n <div class=\"mr-sentinel\" id=\"ncl01-sentinel\"><\/div>\n\n <div class=\"mr-progress\" id=\"ncl01-progress\">\n <div class=\"mr-prog-inner\">\n <div class=\"mr-pips\" id=\"ncl01-pips\"><\/div>\n <\/div>\n <\/div>\n\n <div class=\"mr-body\">\n <div id=\"ncl01-cases\"><\/div>\n <div class=\"mr-submit-wrap\">\n <button class=\"mr-btn\" id=\"ncl01-submit\">Submit for Debrief<\/button>\n <\/div>\n <div class=\"mr-score\" id=\"ncl01-score\">\n <div class=\"mr-score-in\">\n <div class=\"mr-score-ey\">Round Complete<\/div>\n <div class=\"mr-ring\" id=\"ncl01-ring\">\n <div class=\"mr-ring-in\">\n <span class=\"mr-ring-pct\" id=\"ncl01-pct\">0%<\/span>\n <span class=\"mr-ring-sub\">net<\/span>\n <\/div>\n <\/div>\n <div class=\"mr-score-title\">Your Debrief<\/div>\n <div class=\"mr-score-net\" id=\"ncl01-net\"><\/div>\n <div class=\"mr-verdict\" id=\"ncl01-verdict\"><\/div>\n <div class=\"mr-bands\">\n <span class=\"mr-band mr-band-c\" id=\"ncl01-ct-c\"><\/span>\n <span class=\"mr-band mr-band-w\" id=\"ncl01-ct-w\"><\/span>\n <span class=\"mr-band mr-band-s\" id=\"ncl01-ct-s\"><\/span>\n <\/div>\n <button class=\"mr-retry\" id=\"ncl01-retry\">↻ New Round<\/button>\n <\/div>\n <\/div>\n <\/div>\n\n<\/div>\n\n<script>\n(function () {\n 'use strict';\n\n var NS = 'ncl01';\n var TOTAL = 5;\n var MAX = 20;\n var LTRS = ['A','B','C','D'];\n\n var QS = [\n\n {\n id: 1,\n tag: 'Cardiac Output — Fick Principle',\n stem: 'A patient has an <strong>oxygen consumption (VO&sub2;) of 250 mL\/min<\/strong>. Arterial oxygen content is <strong>200 mL\/L<\/strong> and mixed venous oxygen content is <strong>150 mL\/L<\/strong>. What is the <strong>cardiac output<\/strong>?',\n correct: '5 L\/min',\n opts: [\n '5 L\/min',\n '1.25 L\/min',\n '50 L\/min',\n '2.5 L\/min'\n ],\n exp: 'The <strong>Fick Principle<\/strong>: Cardiac Output = VO&sub2; ÷ (CaO&sub2; − CvO&sub2;).<span class=\"calc\">CO = 250 mL\/min ÷ (200 − 150) mL\/L<br>= 250 mL\/min ÷ 50 mL\/L<br>= <strong>5 L\/min<\/strong><\/span>Units check: mL\/min ÷ mL\/L = L\/min. The arteriovenous oxygen difference (CaO&sub2; − CvO&sub2;) = 50 mL\/L here — the normal range is 40–60 mL\/L at rest. A narrowing AV difference (e.g. 20 mL\/L) at the same VO&sub2; would demand a higher CO to deliver enough oxygen — this is the haemodynamic logic of high-output states.<br><br>Trap 1.25 L\/min divides 250 by 200 (using only CaO&sub2; as denominator). Trap 50 L\/min multiplies instead of divides. Trap 2.5 L\/min divides by 100 instead of 50 — a subtraction error in the AV difference. Normal cardiac output at rest: <strong>4–8 L\/min<\/strong>; cardiac index (CO ÷ BSA) normal range: 2.5–4 L\/min\/m².'\n },\n\n {\n id: 2,\n tag: 'GFR — Clearance Formula',\n stem: 'Inulin is infused to achieve a steady plasma concentration of <strong>1 mg\/mL<\/strong>. Urine inulin concentration is <strong>120 mg\/mL<\/strong> and urine flow rate is <strong>1 mL\/min<\/strong>. What is the <strong>GFR<\/strong>?',\n correct: '120 mL\/min',\n opts: [\n '120 mL\/min',\n '12 mL\/min',\n '1 mL\/min',\n '240 mL\/min'\n ],\n exp: 'Clearance formula: <strong>C = (U × V) ÷ P<\/strong>, where U = urine concentration, V = urine flow rate, P = plasma concentration.<span class=\"calc\">GFR = (120 mg\/mL × 1 mL\/min) ÷ 1 mg\/mL<br>= 120 mg\/min ÷ 1 mg\/mL<br>= <strong>120 mL\/min<\/strong><\/span>Inulin clearance = GFR because inulin is <strong>freely filtered, not secreted, not reabsorbed, not metabolised<\/strong>. It is the gold standard for GFR measurement. The clearance formula tells you: how many mL of plasma must be completely cleared of inulin per minute to account for the amount appearing in urine.<br><br>Normal GFR: <strong>125 mL\/min<\/strong> (male), slightly lower in females. This is also the basis of creatinine clearance estimation (Cockcroft-Gault) used clinically. Trap 12 mL\/min divides by 10 instead of 1. Trap 240 mL\/min doubles the correct answer. Trap 1 mL\/min uses only urine flow without applying concentrations.'\n },\n\n {\n id: 3,\n tag: 'Dead Space — Bohr Equation',\n stem: 'A patient has a <strong>tidal volume of 500 mL<\/strong>. PaCO&sub2; is <strong>40 mmHg<\/strong> and mixed expired PCO&sub2; (PE′CO&sub2;) is <strong>30 mmHg<\/strong>. What is the <strong>physiological dead space volume<\/strong>?',\n correct: '125 mL',\n opts: [\n '125 mL',\n '375 mL',\n '75 mL',\n '250 mL'\n ],\n exp: 'The <strong>Bohr equation<\/strong>: V<sub>D<\/sub>\/V<sub>T<\/sub> = (PaCO&sub2; − PE′CO&sub2;) ÷ PaCO&sub2;.<span class=\"calc\">V<sub>D<\/sub>\/V<sub>T<\/sub> = (40 − 30) ÷ 40 = 10 ÷ 40 = <strong>0.25<\/strong><br>V<sub>D<\/sub> = 0.25 × 500 mL = <strong>125 mL<\/strong><\/span>Dead space fraction = 0.25 means 25% of each breath goes to dead space and contributes no gas exchange. Normally V<sub>D<\/sub>\/V<sub>T<\/sub> = <strong>0.2–0.35<\/strong> (anatomical dead space ~150 mL in a 70 kg adult). Values >0.6 indicate severe ventilatory inefficiency (e.g. massive PE, ARDS).<br><br>The logic: if all expired CO&sub2; came from alveoli (no dead space), PE′CO&sub2; would equal PaCO&sub2;. The difference between them reflects dilution by dead space gas (which has no CO&sub2;). Trap 375 mL subtracts 125 from 500 (giving alveolar volume rather than dead space). Trap 75 mL uses (30−10)÷40 with wrong numbers. Trap 250 mL applies ratio 0.5 by dividing 30 by 40 incorrectly — missing the subtraction step.'\n },\n\n {\n id: 4,\n tag: 'Lung Compliance — Calculation & Clinical Meaning',\n stem: 'A ventilated patient has a <strong>tidal volume of 600 mL<\/strong>. Plateau pressure is <strong>25 cmH&sub2;O<\/strong> and PEEP is <strong>5 cmH&sub2;O<\/strong>. What is the <strong>static lung compliance<\/strong>, and what does the value suggest?',\n correct: '30 mL\/cmH&sub2;O; reduced compliance indicating stiff lungs, consistent with ARDS or pulmonary fibrosis',\n opts: [\n '30 mL\/cmH&sub2;O; reduced compliance indicating stiff lungs, consistent with ARDS or pulmonary fibrosis',\n '24 mL\/cmH&sub2;O; severely reduced compliance consistent with tension pneumothorax',\n '30 mL\/cmH&sub2;O; normal compliance confirming no significant parenchymal lung disease',\n '120 mL\/cmH&sub2;O; elevated compliance suggesting emphysema or air trapping'\n ],\n exp: 'Static compliance = <strong>Tidal Volume ÷ (Plateau Pressure − PEEP)<\/strong>.<span class=\"calc\">C<sub>st<\/sub> = 600 mL ÷ (25 − 5) cmH&sub2;O<br>= 600 ÷ 20<br>= <strong>30 mL\/cmH&sub2;O<\/strong><\/span>Normal static compliance in a ventilated adult: <strong>60–100 mL\/cmH&sub2;O<\/strong>. A value of 30 is roughly half normal — indicating significantly <strong>stiff lungs<\/strong>. ARDS is the classic cause; pulmonary fibrosis, pulmonary oedema, and pneumonia also reduce compliance.<br><br>PEEP must be subtracted because it represents the baseline pressure against which the lungs are being inflated — only the driving pressure above PEEP creates the tidal volume. Forgetting to subtract PEEP (using 25 instead of 20) gives 24 mL\/cmH&sub2;O and is trap B. Elevated compliance (>100 mL\/cmH&sub2;O) occurs in emphysema where lung tissue is destroyed and elastic recoil is lost — the opposite of stiff lungs. Trap C calls 30 mL\/cmH&sub2;O normal — it is half of normal.'\n },\n\n {\n id: 5,\n tag: 'Alveolar Ventilation — Calculation from Dead Space',\n stem: 'A patient breathes at a <strong>respiratory rate of 16\/min<\/strong> with a <strong>tidal volume of 500 mL<\/strong>. Anatomical dead space is <strong>150 mL<\/strong>. What is the <strong>alveolar ventilation<\/strong>?',\n correct: '5600 mL\/min',\n opts: [\n '5600 mL\/min',\n '8000 mL\/min',\n '2400 mL\/min',\n '4800 mL\/min'\n ],\n exp: 'Alveolar ventilation = <strong>(Tidal Volume − Dead Space) × Respiratory Rate<\/strong>.<span class=\"calc\">Alveolar volume per breath = 500 − 150 = 350 mL<br>V<sub>A<\/sub> = 350 mL × 16\/min = <strong>5600 mL\/min<\/strong><\/span>Minute ventilation = V<sub>T<\/sub> × RR = 500 × 16 = 8000 mL\/min. Alveolar ventilation is always <strong>less than minute ventilation<\/strong> by the amount wasted on dead space: 8000 − (150 × 16) = 8000 − 2400 = 5600 mL\/min. The dead space ventilation (2400 mL\/min) goes nowhere useful.<br><br>This distinction matters clinically: a patient who increases RR from 16 to 32 while halving V<sub>T<\/sub> to 250 mL maintains the same minute ventilation (8000 mL\/min) but alveolar ventilation <em>falls<\/em>:<span class=\"calc\">(250−150) × 32 = 100 × 32 = 3200 mL\/min<\/span>Rapid shallow breathing is ventilatorily inefficient precisely because dead space volume is fixed. Trap 8000 mL\/min is minute ventilation without subtracting dead space. Trap 2400 mL\/min is dead space ventilation alone. Trap 4800 mL\/min uses RR = 16 but dead space = 200 mL by mistake.'\n }\n\n ];\n\n var answers = {}, answered = 0, shuffled = {}, done = false;\n\n function gid(s) { return document.getElementById(NS + '-' + s); }\n function byId(s) { return document.getElementById(s); }\n\n function shuffleArr(arr) {\n var a = arr.slice(), i, j, t;\n for (i = a.length - 1; i > 0; i--) {\n j = Math.floor(Math.random() * (i + 1));\n t = a[i]; a[i] = a[j]; a[j] = t;\n }\n return a;\n }\n\n function countVal(v) {\n var n = 0, k;\n for (k in answers) { if (answers[k] === v) n++; }\n return n;\n }\n\n function buildPips() {\n var cont = gid('pips'), i, q, wLine, wPip, line, pip;\n cont.innerHTML = '';\n for (i = 0; i < QS.length; i++) {\n q = QS[i];\n if (i > 0) {\n wLine = document.createElement('div');\n wLine.className = 'mr-pip-wrap';\n line = document.createElement('div');\n line.className = 'mr-pip-line';\n line.id = NS + '-pl' + q.id;\n wLine.appendChild(line);\n cont.appendChild(wLine);\n }\n wPip = document.createElement('div');\n wPip.className = 'mr-pip-wrap';\n pip = document.createElement('div');\n pip.className = 'mr-pip';\n pip.id = NS + '-pip' + q.id;\n pip.textContent = String(q.id);\n wPip.appendChild(pip);\n cont.appendChild(wPip);\n }\n }\n\n function build() {\n var cont, i, q, opts, card, top, numDiv, meta, tag, stem,\n rule, optsDiv, expDiv, lbl, txt, j, optEl, ltrSpan, txtSpan;\n\n cont = gid('cases');\n cont.innerHTML = '';\n answers = {}; answered = 0; shuffled = {}; done = false;\n gid('score').style.display = 'none';\n buildPips();\n\n for (i = 0; i < QS.length; i++) {\n q = QS[i];\n opts = shuffleArr(q.opts);\n shuffled[q.id] = opts;\n\n card = document.createElement('div');\n card.className = 'mr-case';\n\n top = document.createElement('div');\n top.className = 'mr-case-top';\n\n numDiv = document.createElement('div');\n numDiv.className = 'mr-num';\n numDiv.textContent = q.id < 10 ? 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