Respiratory

Question 1

Describe the pathophysiology behind right ventricular failure in COPD patients

Answer 1

• Chronic hypoxia
• distal airspace’s are under ventilated due to obstruction (V/Q mismatch)
• leads to pulmonary vasoconstriction -> pulmonary hypertension
• ventricular hypertrophy and right sided heart failure (Cor Pulmonale)

Question 2

Describe the pattern of ABG findings in early severe asthma

Answer 2

Type 1 respiratory failure (hypoxaemia)
pH - high/normal
pO2 - low 
pCO2 - low/normal 
HCO3 - normal 

Generally characterised by hyperventilation, hypoxaemia

Question 3

Where does idiopathic pulmonary fibrosis tend to affect?

Answer 3

Lower zones

Question 4

State the paraneoplastic features of squamous cell lung cancer

Answer 4

• PTH-rp causing hypercalacaemia
• Hypertrophic pulmonary osteoarthropathy
• Hyperthyroidism due to ectopic TSH

Question 5

Suggest questions to use when enquiring about the severity/impact of asthma

Answer 5

• Does your asthma cause difficulty sleeping?
• Do you have asthma symptoms throughout the day?
• Is asthma effecting your normal activities?
• How often are you using the blue/salbutamol inhaler?

Question 6

Spirometry results diagnostic of asthma

Answer 6

forced expiratory volume in 1 second/forced vital capacity (FEV1/FVC) ratio of less than 70% as a positive test for obstructive airway disease
Regard an improvement of FEV1 of more than 12%, with bronchodilator, as a positive test