The correct answer is a negative pressure change within the pleural space. When the diaphragm and intercostal muscles contract, they expand the chest cavity creating a higher volume of space within the pleural space. As volume within this space increased, the pressure responds by decreasing. This drop in pressure within the pleural space causes air from outside the body (high pressure) to low pressure (within the chest and the lungs).

Normal blood pH is about 7.4 in most tissues (it is a bit lower in veins since they carry waste products, which are acidic). To get back to the physiological set point of pH = 7.4, we want to remove the acid from the blood. The major blood buffer system is shown in the following equation:

As we know, carbon dioxide is one of the major byproducts of respiration, and is considered waste for our bodies. Combined with water and catalyzed by carbonic anhydrase, it is converted into carbonic acid. Carbonic acid is a weak acid and will partially dissociate into hydrogen ions and bicarbonate ions. Thus, overall, carbon dioxide and water yields acid (hydrogen ions). As a result, excess carbon dioxide in the blood will lower the pH.

In order to increase the pH, we must stop this equation from proceeding in the forward direction; thus, (remember Le Chatelier's principle) we must remove carbon dioxide from the left side. This will push the reaction in the reverse direction, quenching hydrogen ions (acid) and removing them from the blood, increasing blood pH back to normal.

Since we want to get rid of excess carbon dioxide, we breathe faster. Oxygen does not have any effect on blood pH. Furthermore, the atmospheric oxygen level (21%) is plenty for our bodies to utilize, as when we exhale there is about 15% oxygen left over, meaning we only use about 25% of the oxygen we breathe (this is why CPR works!).

The correct answer is a negative pressure change within the pleural space. When the diaphragm and intercostal muscles contract, they expand the chest cavity creating a higher volume of space within the pleural space. As volume within this space increased, the pressure responds by decreasing. This drop in pressure within the pleural space causes air from outside the body (high pressure) to low pressure (within the chest and the lungs).

During the normal inspiratory phase of breathing, in other words, when a human is "breathing in," the physiological mechanism used is called "negative-pressure" breathing. Negative-pressure refers to the pressure in the chest cavity as compared to the surrounding environment. The body generates negative-pressure in the chest cavity during breathing by the contraction of the diaphragm muscle (it pulls downward, expanding the thoracic cavity size and space for the lungs to fill), and the outward expansion of the ribcage (which also expands the thoracic cavity size and provides more space for the lungs to fill). With the increased volume of the thoracic cavity generated, this creates the negative pressure that is needed to draw air into the lungs down its gradient of higher pressure (outside the body/thorax) to lower pressure (into the lungs/thorax). Positive-pressure is an incorrect choice because it is the opposite of what occurs during normal human inspiration.

Positive-pressure is sometimes artificially used in the medical setting with machines in patients with obstructive sleep apnea, or in patients who cannot breathe on their own, but is not a part of standard physiological respiration. The Frank-Starling mechanism describes the mechanism by which the heart pumps blood, but does not describe respiration. Glomerular filtration describes the mechanism by which the glomeruli of the kidneys initially filter blood, but does not describe respiration. Idiopathic pulmonary fibrosis is a disease of the interstitium of lung tissue, but does not describe the physiological mechanism used during inspiration.

During the normal inspiratory phase of breathing, in other words, when a human is "breathing in," the physiological mechanism used is called "negative-pressure" breathing. Negative-pressure refers to the pressure in the chest cavity as compared to the surrounding environment. The body generates negative-pressure in the chest cavity during breathing by the contraction of the diaphragm muscle (it pulls downward, expanding the thoracic cavity size and space for the lungs to fill), and the outward expansion of the ribcage (which also expands the thoracic cavity size and provides more space for the lungs to fill). With the increased volume of the thoracic cavity generated, this creates the negative pressure that is needed to draw air into the lungs down its gradient of higher pressure (outside the body/thorax) to lower pressure (into the lungs/thorax). Positive-pressure is an incorrect choice because it is the opposite of what occurs during normal human inspiration.

Positive-pressure is sometimes artificially used in the medical setting with machines in patients with obstructive sleep apnea, or in patients who cannot breathe on their own, but is not a part of standard physiological respiration. The Frank-Starling mechanism describes the mechanism by which the heart pumps blood, but does not describe respiration. Glomerular filtration describes the mechanism by which the glomeruli of the kidneys initially filter blood, but does not describe respiration. Idiopathic pulmonary fibrosis is a disease of the interstitium of lung tissue, but does not describe the physiological mechanism used during inspiration.

Normal blood pH is about 7.4 in most tissues (it is a bit lower in veins since they carry waste products, which are acidic). To get back to the physiological set point of pH = 7.4, we want to remove the acid from the blood. The major blood buffer system is shown in the following equation:

As we know, carbon dioxide is one of the major byproducts of respiration, and is considered waste for our bodies. Combined with water and catalyzed by carbonic anhydrase, it is converted into carbonic acid. Carbonic acid is a weak acid and will partially dissociate into hydrogen ions and bicarbonate ions. Thus, overall, carbon dioxide and water yields acid (hydrogen ions). As a result, excess carbon dioxide in the blood will lower the pH.

In order to increase the pH, we must stop this equation from proceeding in the forward direction; thus, (remember Le Chatelier's principle) we must remove carbon dioxide from the left side. This will push the reaction in the reverse direction, quenching hydrogen ions (acid) and removing them from the blood, increasing blood pH back to normal.

Since we want to get rid of excess carbon dioxide, we breathe faster. Oxygen does not have any effect on blood pH. Furthermore, the atmospheric oxygen level (21%) is plenty for our bodies to utilize, as when we exhale there is about 15% oxygen left over, meaning we only use about 25% of the oxygen we breathe (this is why CPR works!).

In this patient with Chronic Obstructive Pulmonary Disease (COPD), which is a disease that results in difficulty expiring air (and generally does not affect one's ability to inspire air), we would expect to see an increased level of in the air that he/she expires, as compared to someone without COPD. Although this is a medically-oriented question, this does not require you to know anything about COPD that is not already supplied in the question. By stating that the ability to expire air is impacted but that the ability to inspire is generally not affected, this calls upon your knowledge of pulmonary physiology, telling you that if inspiration is not affected, levels are probably not significantly affected, and that if expiration is affected, levels are probably affected.

Once you identify that levels are affected in COPD, the question now is, how exactly are they affected? In a COPD patient, it is stated in the question stem, that they have a decreased ability to expire air. When a healthy person expires air, they remove from the body. In a COPD patient, who therefore has a decreased ability to remove from the lungs, if we measured the amount of a in a single breath, we would expect it to be elevated as compared to a healthy individual. At first glance, this may seem counter-intuitive, since we are stating that COPD patients have trouble removing from the body. However, the air that they expire is the same air that is coming from their lungs, which contains the elevated levels of . Thus, to answer the question, we expect the reading for the expired breath to be elevated as compared to that of a healthy person.

During forced maximum expiration, the lungs are trying their best to push air out of the lungs with the most force. This cannot be accomplished by the lungs alone, so the additional contraction of the abdominal muscles aid to help push air out of the lungs with maximum force.

This is different from normal (quiet) expiration, where only the elastic recoil of the lungs are needed with no additional muscle contractions. Normal expiration does not require pushing air out of the lungs with force.

In this patient with Chronic Obstructive Pulmonary Disease (COPD), which is a disease that results in difficulty expiring air (and generally does not affect one's ability to inspire air), we would expect to see an increased level of in the air that he/she expires, as compared to someone without COPD. Although this is a medically-oriented question, this does not require you to know anything about COPD that is not already supplied in the question. By stating that the ability to expire air is impacted but that the ability to inspire is generally not affected, this calls upon your knowledge of pulmonary physiology, telling you that if inspiration is not affected, levels are probably not significantly affected, and that if expiration is affected, levels are probably affected.

Once you identify that levels are affected in COPD, the question now is, how exactly are they affected? In a COPD patient, it is stated in the question stem, that they have a decreased ability to expire air. When a healthy person expires air, they remove from the body. In a COPD patient, who therefore has a decreased ability to remove from the lungs, if we measured the amount of a in a single breath, we would expect it to be elevated as compared to a healthy individual. At first glance, this may seem counter-intuitive, since we are stating that COPD patients have trouble removing from the body. However, the air that they expire is the same air that is coming from their lungs, which contains the elevated levels of . Thus, to answer the question, we expect the reading for the expired breath to be elevated as compared to that of a healthy person.

During forced maximum expiration, the lungs are trying their best to push air out of the lungs with the most force. This cannot be accomplished by the lungs alone, so the additional contraction of the abdominal muscles aid to help push air out of the lungs with maximum force.

This is different from normal (quiet) expiration, where only the elastic recoil of the lungs are needed with no additional muscle contractions. Normal expiration does not require pushing air out of the lungs with force.