Resp Formative Qs

Question 1

What is expiratory reserve volume?

Answer 1

Volume of air that can be forcefully exhaled after normal respiration.

Question 2

What is Functional Residual capacity?

Answer 2

Volume left in lungs after normal expiration.

ERV + RV

Question 3

What is residual volume?

Answer 3

The volume of air that cannot be voluntarily expired.

Question 4

What is vital capacity?

Answer 4

The maximum volume of air that can be voluntarily exhaled following a maximum inspiration

Question 5

Why does air flow into the lungs during inspiration?

Answer 5

The external intercostal and diaphragm muscles contract and thoracic volume increases.

Question 6

What is tidal volume?

Answer 6

The volume of air breathed in and out of the lungs during each breath.

Question 7

How do you calculate alveolar ventilation?

Answer 7

(Tidal Vol - Dead space) x Respiratory rate.

Question 8

What is the partial pressure of oxygen in mixed venous blood?

Answer 8

40mmhg (5.3kPa)

Question 9

Which condition will reduce the Arterial partial pressure of oxygen?

Answer 9

Emphysema - oxygen conc. in solution will be reduced

Question 10

What sedative is not safe to use on individuals with chronic lung disease?

Answer 10

Nitrous oxide - it blunts the peripheral chemoreceptor response to falling oxygen and patients are on hypoxic drive so they have no means of controlling ventilation.

Question 11

What happens to arterial PCO2 levels in individuals with chronic lung disease?

Answer 11

Arterial PCO2 levels are elevated due to poor alveolar ventilation.

Question 12

Why are patients with chronic lung disease said to be on hypoxic drive?

Answer 12

Chronic elevation of PCO2 has blunted central response to CO2. Too they rely on peripheral receptors.

Question 13

What is shunt?

Answer 13

When perfusion exceeds ventilation in L/min.

Question 14

In what direction would an asthma attack shift the haemoglobin oxygen binging curve?

Answer 14

RIGHT

Broncho-constriction will decrease ventilation meaning PCO2 will rise, pH will fall.

Question 15

In what direction will hypothermia shift the haemoglobin oxygen binding curve?

Answer 15

LEFT

Decrease in body temp makes it difficult to offload oxygen to peripheral tissues. Want to keep core ventilated/warm.

Question 16

In what direction will the presence of foetal haemoglobin shift the haemoglobin oxygen binding curve?

Answer 16

LEFT

It has a higher affinity for oxygen than adult haemoglobin so wants to keep it more.

Question 17

In what direction will respiratory alkalosis shift the haemoglobin oxygen binding curve?

Answer 17

LEFT

Decrease in H+ means a decrease in PCO2. Doesn’t need to release oxygen to balance it out.

Question 18

In what direction does voluntary hyperventilation shift the haemoglobin oxygen binding curve?

Answer 18

LEFT

Decreases PCO2

Question 19

Which vertebral bodies does the head of the 9th rib articulate with?

Answer 19

T8 and T9

The one ABOVE and its OWN.

Question 20

Where does the cardiac notch appear?

Answer 20

Left lung anterior border.

Question 21

What pleura do lung fissures contain?

Answer 21

Visceral

Question 22

Which lung has an eparterial broncos in its hilum?

Answer 22

Right - as it has 3 lobes.

Question 23

What would be the most appropriate investigation if a patient with known squamous carcinoma of lung is admitted with abdominal pain, constipation and confusion?

Answer 23

Serum calcium - squamous carcinoma is associated with hypercalcaemia due to parathyroid hormone related protein.

Question 24

What would be the most appropriate investigation if a patient with peripheral spiculated opacity on chest x-ray and enlarged supraclavicular lymph node is admitted?

Answer 24

Fine Needle Aspiration lymph node - sample I needed for pathology to diagnose what type of cancer it is.

Question 25

What is an obese man who has excessive daytime somnolence, snoring and napping as well as 10 desaturations per hour on overnight oximetry classification on the Obstructive Sleep Apnoea scale?

Answer 25

Mild - 5 - 15 desaturations per hour

Question 26

What organism is most likely to cause lobar pneumonia?

Answer 26

Streptococcus pneumoniae

Question 27

What are the blood gas values most likely to be if a patient with exacerbation of asthma is too tired to speak or do a peak flow?

Answer 27

pH will be decreased e.g 7.22 - acidosis PaO2 will be decreased e.g 7.8 - hypoxia PaCO2 will be increased e.g 8.6 - hypercapnia

Question 28

What treatment should a newly diagnosed asthmatic who is waking up at night because of asthma receive?

Answer 28

Inhaled corticosteroids (night time waking) and inhaled beta-2-agonist.

Question 29

What is the most likely diagnosis of a previously fit 19 yr old who has a sudden onset of severe right sided chest paining breathlessness whilst walking up stairs? The symptoms are still present an hour later.

Answer 29

Primary pneumothorax

Question 30

What is the most likely diagnosis of a 32yr old man recovering from a bad attack of pneumonia, who develops riggers, persistently poor appetite and increasing SOB on exertion?

Answer 30

Empyema thoracis- is a collection of pus in pleural space and is a complication of pneumonia. Antibiotics haven't helped so must be a deep seated infection.

Question 31

What is acute interstitial pneumonitis?

Answer 31

Rare, rapidly progressive lung disease presenting with acute breathlessness and dry cough.

Question 32

What is aspiration pneumonia?

Answer 32

Pneumonia caused by inhaling food/liquids into the lungs.

Question 33

What is giant pulmonary bulla?

Answer 33

Seen in chronic emphysema. | Big air pocket within the lung tissue.

Question 34

What is the most likely diagnosis for 62yr old male smoker who has coughed up blood 4 times in the last month, lost his appetite and lost 1 stone in weight?

Answer 34

Lung Cancer

Question 35

What clinical signs would you look for if you suspect lung cancer?

Answer 35

Hands- finger clubbing Abdomen - hepatomegaly Neck- lymphadenopathy, tracheal deviation, SVC obstruction

Question 36

What are the clinical signs in patient with left lower lobe pneumonia/consolidation?

Answer 36

``` Tachypnoea Tachycardia Fever Cyanosis Reduced expansion of affected side of chest Dullness to percussion at base Bronchial breathing at base Crackles Increased vocal resonance. ```

Question 37

What organisms may cause pneumonia in a young previously healthy individual?

Answer 37

``` Chlamydia psittaci Streptococcus pneumoniae Mycoplasma pneumoniae Staph. aureus Haemophilus influenza ```

Question 38

What investigations would aid the diagnosis of pneumonia?

Answer 38

``` CXR Sputum culture Mycoplasma IgM Full Blood Count Blood culture Atypical serology Legionella urinary antigen Pneumoccocal urinary antigen ```