American Board of Surgery Qualifying Exam (ABS QE) Practice Test

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A left shift in the oxyhemoglobin dissociation curve indicates what change in oxygen affinity?

  1. Decreased affinity and increased offloading

  2. Increased affinity and decreased offloading

  3. No change in affinity

  4. Varied affinity based on CO2 levels

The correct answer is: Increased affinity and decreased offloading

A left shift in the oxyhemoglobin dissociation curve is indicative of increased affinity of hemoglobin for oxygen. This means that under conditions represented by a leftward shift, hemoglobin holds onto oxygen more tightly, which translates into difficulty for oxygen to be released to tissues. This phenomenon can occur under several physiological conditions, such as increased pH (more alkaline), decreased carbon dioxide levels, or reduced temperature. These conditions favor hemoglobin's binding to oxygen while simultaneously impairing its ability to offload oxygen at the tissue level. Consequently, this leads to a decreased offloading of oxygen despite potentially higher levels of oxygen saturation in the blood. Understanding this mechanism is essential, as it highlights how different factors like pH and carbon dioxide levels can manipulate oxygen transport and delivery, which is critical in various clinical scenarios.