Respiratory

Question 1

What is tidal volume?

Answer 1

Volume inspired or expired with each breath at rest

Question 2

What is inspiratory reserve volume?

Answer 2

Maximum volume that can be inspired at the end of tidal inspiration

Question 3

How do you measure inspiratory capacity?

Answer 3

Tidal volume + Inspiratory Reserve Volume

Question 4

What is expiratory reserve volume?

Answer 4

The max volume of air that can be expired at the end of normal tidal expiration

Question 5

What is residual volume?

Answer 5

Volume of air remaining after maximum expiration

Question 6

How do you calculate residual volume?

Answer 6

Functional residual capacity - Expiratory Reserve Volume

Question 7

What is functional residual volume?

Answer 7

Volume in lungs at the end-expiratory position

Question 8

How do you calculate functional residual volume?

Answer 8

Residual volume + Expiratory Reserve volume

Question 9

What is vital capacity?

Answer 9

Max volume of air that can be expired after maximum inspiration

Question 10

How do you calculate vital capacity?

Answer 10

Inspiratory capacity + ERV

Question 11

What is total lung capacity?

Answer 11

VC + RV

Question 12

What is the management guidance of COPD?

Answer 12

1) SABA/SAMA
2) If asthmatic features: LABA + ICS and if still no response LABA + LAMA + ICS (if on a SAMA, switch to SABA)
3) If no asthmatic features: add LABA + LAMA (switch SAMA to SABA)

Question 13

Which conditions cause upper zone fibrosis?

Answer 13

CHARTS

Coal worker’s pneumoconiosis
Histiocytosis/hypersensitivity pneumonitis
Ankylosing spondylitis
Radiation
TB
Silicosis/sarcoidosis

Question 14

Which conditions cause lower zone fibrosis?

Answer 14

IPF
Asbestosis
Drugs
Connective tissue disorders

Question 15

What makes up the triangle of safety for chest drain insertion?

Answer 15

Base of the axilla
Lateral edge of pectoralis major
5th intercostal space
Anterior border of latissimus dorsi

Question 16

What happens in the physiological response to hypoxia?

Answer 16

Vasoconstriction of pulmonary arteries so blood is diverted to better aerated areas of the lung, improving efficiency of gas exchange

Question 17

What high risk characteristics determine the need for a chest drain in a pneumothorax?

Answer 17

Haemodynamic compromise
Significant hypoxia
BL pneumothorax
Underlying lung disease
>50 yo with sig. smoking history
Haemothorax

Question 18

What is the management of a pneumothorax if no pain/SOB and no physiological compromise?

Answer 18

Conservative care, regardless of size

Question 19

If there are no high risk characteristics, when should you intervene in a pneumothorax?

Answer 19

Size >2cm apically or laterally on CXR

Question 20

What are the 3 management options of pneumothorax?

Answer 20

Conservative, ambulatory, needle aspiration

Question 21

What are the conservative management options of pneumothorax?

Answer 21

1) primary spontaneous - review every 2-4 days as OPD
2) Secondary spontaneous- monitor as IP

Question 22

How should you manage persistent/recurrent pneumothorax?

Answer 22

VATS -> pleurodesis +/- bullectomy

Question 23

What is the advice on discharge following pneumothorax?

Answer 23

• Stop smoking
• Can fly after 2 weeks
• No scuba diving ever

Question 24

A patient presents for spirometry. Their FVC is normal. Their FEV1 is sig. reduced. Their FEV1/FVC ratio is 0.4. Their TLC is high. Is this an obstructive or restrictive picture?

Answer 24

Obstructive

Question 25

A patient presents for spirometry. Their FEV1 is low, their FVC is low, their FEV1/FVC ratio is 0.9. Their TLC is low. Is this obstructive or restrictive?

Answer 25

Restrictive

Question 26

A patient presents with a normal fev1/fvc ratio with a reduced fev1 and reduced fvc. Their TLC is normal. What is the cause?

Answer 26

Not restrictive lung disease. More likely air trapping.

Question 27

What is TLC?

Answer 27

Total lung capacity. The max volume of air the lungs can hold after a full inspiration.

Question 28

What is TLCO?

Answer 28

The rate that gas will diffuse from alveoli to blood.

Question 29

What affects TLCO?

Answer 29

Alveolar surface area, membrane thickness, pulmonary capillary blood volume

Question 30

What conditions cause a raised TLCO?

Answer 30

Asthma Pulmonary haemorrhage Polycythaemia Hyperkinetic states Left to right shunts Male gender, exercise

Question 31

What conditions cause a reduced TLCO?

Answer 31

PE Pneumonia Anaemia Pulmonary fibrosis Pulmonary oedema Emphysema Reduced cardiac output

Question 32

What is KCO?

Answer 32

Transfer coefficient

Question 33

What would cause a raised KCO with a normal/low TLCO?

Answer 33

Kyphosis/scoliosis Ankylosis Pneumonectomy/lobectomy Neuromuscular weakness

Question 34

A 56-year-old woman is admitted with shortness of breath and wheeze associated with cough, pleuritic chest pain, and brown sputum. She has a background of asthma that has recently become hard to control with frequent exacerbations and hospital admissions despite optimisation of her medication. She has an eosinophilia. Chest x-ray: parenchymal infiltrates with tram track opacities and ring shadows. What is the diagnosis?

Answer 34

Allergic Bronchopulmonary Aspergillosis

Question 35

What is the management of allergic bronchopulmonary aspergillosis?

Answer 35

Oral glucocorticoids Second line - itraconazole

Question 36

A 35-year-old woman is referred to the respiratory clinic with a 6-month history of progressive dyspnoea. She has never smoked. Her father died of emphysema at age 45. Spirometry shows an FEV1/FVC ratio of 0.65. Alpha-1 antitrypsin level is 0.9 g/L (1.1-2.1). Genetic testing reveals a PiMZ genotype. What is the most appropriate advice regarding her risk of developing emphysema?

Answer 36

Low risk

Question 37

How is alpha-1 antitrypsin deficiency inherited?

Answer 37

Autosomal recessive/co-dominant

Question 38

What chromosome is responsible for alpha-1 antitrypsin deficiency?

Answer 38

Chromosome 14

Question 39

What are the genotypes of alpha-1 antitrypsin deficiency?

Answer 39

Normal: PiMM Heterozygous: PIMZ - low risk in non-smoker Homozygous PiSS - 50% normal levels Homozygous PiZZ - 10% normal levels

Question 40

What are the features of alpha-1 antitrypsin deficiency?

Answer 40

Lung: Mainly lower lobe emphysema Liver: Cirrhosis and HCC

Question 41

What is the management of alpha-1 antitrypsin deficiency?

Answer 41

No smoking Supportive - inhalers and PT Alpha-1 antitrypsin protein concentrate IV Lung volume reduction surgery or transplant

Question 42

What are the features of Kartagener's syndrome?

Answer 42

- Dextrocardia -> quiet heart sounds - Bronchiectasis and recurrent chest infections - Subfertility - Recurrent sinusitis

Question 43

What are the paraneoplastic features of small cell lung cancer?

Answer 43

- ADH - ACTH - Lambert-Eaton syndrome

Question 44

What are the paraneoplastic features of squamous cell lung cancer?

Answer 44

- PTH-rp -> hypercalcaemia - Clubbing - HPOA - Hyperthyroidism secondary to ectopic TSH

Question 45

What are the paraneoplastic features of lung adenocarcinoma?

Answer 45

- Gynaecomastia - HPOA

Question 46

What are the indications for steroids in sarcoidosis?

Answer 46

Stage 2 or 3 disease and symptomatic Hypercalcaemia Eye/heart/neuro involvement

Question 47

What is the management of pulmonary arterial hypertension?

Answer 47

1) Acute vasodilator testing 2) If +ve response - calcium channel blocker 3) If -ve response: - Prostacyclin analogues e.g treprostinil, iloprost - Endothelin receptor antagonists e.g non-selective bosentan, selective ambrisentan - Phosphodiesterase inhibitors e.g sildenafil