These can occur because of an obstruction in the airway, like a mucous plug, a peanut, or a tumor (cannot ventilate distal to the mucus plug) or more distal at the level of alveoli, from edema/blood/pus in an alveolus (cannot get air/oxygen to the alveoli/capillary interface), or a collapsed airway. There is no ventilation no air is moving in and out of alveoli. Let’s start with extremes which will best illustrate the example: V/Q Mismatch vs. Pathological conditions create extreme amounts of V/Q mismatching which are not consistent with proper oxygenation. At the lung bases, there’s more ventilation, but much more blood flow, so V
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