Respiratory Lectures

Question 1

What is bronchoscopy?

Answer 1

A diagnostic procedure used to obtain a small amount of lung tissue and fluid samples

Flexible bronchoscopy visualizes the lumen and mucosa of the trachea and airways.

Question 2

When is bronchoscopy indicated?

Answer 2

Suspected lung cancer, mycobacterial disease, immunocompromised patients, refractory consolidation, significant hemoptysis

Ideally performed within 7 working days after decision.

Question 3

What does a CRB65 score assess?

Answer 3

Mortality risk in patients with pneumonia based on confusion, respiratory rate, blood pressure, and age

Scoring: 0 = low risk, 1-2 = intermediate risk, 3-4 = high risk.

Question 4

What are the indications for sputum culture in primary care?

Answer 4

Moderate- or high-severity community-acquired pneumonia

Blood and sputum cultures should be taken; consider urinary antigen tests.

Question 5

What types of sputum are indicative of infection?

Answer 5

Rusty colored (pneumococcal), purulent (yellow-greenish), white milky (viral), foamy white (heart failure)

Bloody hemoptysis may suggest TB, lung cancer, or pulmonary embolism.

Question 6

What is the significance of Gram staining in sputum analysis?

Answer 6

Differentiates bacteria by cell wall properties

Normal sputum should have >25 leukocytes and <10 epithelial cells per low power field.

Question 7

What are the types of specimens for sputum culture?

Answer 7

Expectorated, transtracheal aspirates, translaryngeal aspirates, bronchoalveolar lavage

Saliva is not considered sputum.

Question 8

What is the definition of asthma?

Answer 8

A heterogeneous disease characterized by chronic airways inflammation and variable respiratory symptoms

Symptoms include wheeze, shortness of breath, chest-tightness, and cough.

Question 9

What is the FEV1/FVC ratio in the diagnosis of COPD?

Answer 9

≤ 0.7 and is incompletely reversible after bronchodilators

Indicates obstructive airway disease.

Question 10

What are the key features of obstructive lung disease?

Answer 10

Narrowed airways, difficulty exhaling, hyperinflation, increased residual volume

Examples include asthma and emphysema.

Question 11

What are the key features of restrictive lung disease?

Answer 11

Reduced lung expansion, difficulty inhaling, normal FEV1/FVC ratio

Examples include interstitial lung disease and obesity hypoventilation syndrome.

Question 12

What is the purpose of lung function tests?

Answer 12

To measure how much air a patient can breathe out and how quickly

Vital for diagnosing obstructive and restrictive lung diseases.

Question 13

What is the role of sputum culture in secondary care?

Answer 13

Used when patients are not responding to treatment or have specific risk factors

Helps manage pneumonia, bronchiectasis, bronchitis, or pulmonary abscess.

Question 14

What is the significance of a positive acid-fast stain?

Answer 14

Indicates the presence of tuberculosis

Requires special media for culture and incubation for at least 6 weeks.

Question 15

What is the expected outcome of a normal sputum culture?

Answer 15

Presence of normal upper respiratory tract flora

Includes Neisseria catarrhalis, Candida albicans, and some staphylococci.

Question 16

What is the importance of follow-up chest X-ray after pneumonia?

Answer 16

To confirm resolution of pneumonia radiologically

Recommended 6 weeks after initial diagnosis.

Question 17

What is the purpose of a flow-volume loop in spirometry?

Answer 17

To assess airflow obstruction and lung function

Helps differentiate between obstructive and restrictive lung diseases.

Question 18

What is the significance of the FEV1 value in grading COPD severity?

Answer 18

FEV1 values categorize severity as mild, moderate, severe, or very severe

FEV1 > 80% is mild; FEV1 < 30% is severe.

Question 19

What is the recommended action for a patient with worsening asthma symptoms?

Answer 19

Order spirometry to assess lung function

Helps in diagnosing and managing asthma.

Question 20

What is the definition of sputum?

Answer 20

Material expelled from the respiratory tract, not saliva

Quality and quantity are crucial for effective analysis.

Question 21

What are the contraindications for spirometry testing?

Answer 21

Active infection, pneumothorax, recent surgery

Ensures patient safety during the procedure.

Question 22

What is asthma?

Answer 22

Asthma is a disease with many variations, usually characterised by chronic airways inflammation.

Question 23

What are the two key defining features of asthma?

Answer 23

• A history of respiratory symptoms such as wheeze, shortness of breath, chest-tightness, and cough that vary over time and intensity
• Variable expiratory airflow limitation

Question 24

What tests are used to investigate asthma?

Answer 24

• Peak flow
• Exhaled Nitric Oxide Testing (FeNO)
• Spirometry
• Bronchodilator reversibility (BDR)

Question 25

What does peak expiratory flow rate (PEFR) measure?

Answer 25

The maximum someone can exhale with a full inspiration and a short maximal expiratory effort.

Question 26

Describe the technique for measuring peak flow.

Answer 26

* Move peak flow meter indicator to zero * Sit or stand up straight * Take a deep breath in * Place peak flow meter into the mouth with a tight seal * Blow out hard and fast using chest and belly muscles for no more than two seconds * Repeat three times and take the highest value

Question 27

How long should a peak flow diary be maintained to help confirm a diagnosis of asthma?

Answer 27

2-4 weeks

Question 28

What does a variable peak expiratory flow (PEF) reading indicate?

Answer 28

It can support an asthma diagnosis if there is diagnostic uncertainty after initial assessment.

Question 29

What is considered a positive result for variability in peak flow readings?

Answer 29

More than 20% variability after monitoring at least twice daily for 2-4 weeks.

Question 30

What does a FeNO level of 40 parts per billion (ppb) or higher indicate in adults?

Answer 30

It is considered a positive result confirming eosinophilic airway inflammation.

Question 31

What is the significance of spirometry in asthma diagnosis?

Answer 31

It is used to detect airway obstruction, with a FEV1/FVC ratio normally greater than 70%.

Question 32

What does a normal spirometry result when asymptomatic indicate?

Answer 32

It does not rule out asthma.

Question 33

What does bronchodilator reversibility (BDR) measure?

Answer 33

The increase in expiratory airflow in response to an inhaled short-acting bronchodilator.

Question 34

What is a positive result for bronchodilator reversibility in adults?

Answer 34

An improvement in FEV1 of 12% or more, and an increase of at least 200 mL in response to beta-2 agonists or corticosteroids.

Question 35

What FEV1/FVC ratio indicates obstructive disease?

Answer 35

A ratio of less than 0.70.

Question 36

What does an FEV1 increase of greater than 400 mL strongly suggest?

Answer 36

Asthma.

Question 37

What is the diagnosis if FEV1/FVC is <0.70 and FEV1 increases <12% and <200 mL after bronchodilator administration?

Answer 37

COPD.

Question 38

Fill in the blank: A FeNO level of _______ is considered a positive result in children.

Answer 38

35 ppb

Question 39

True or False: A normal FVC indicates that the patient does not have asthma.

Answer 39

False

Question 40

What should be considered if FEV1/FVC is <0.70 and FEV1 increases >12% and >200 mL?

Answer 40

Look at history and level of change to differentiate between asthma and COPD.

Question 41

What are the main objectives in investigating infectious respiratory diseases?

Answer 41

Identify and investigate patients with: * Tuberculosis * Malaria * Cystic fibrosis * Whooping cough * Alpha 1 antitrypsin deficiency ## Footnote Recognise the indication for viral respiratory PCR and COVID-19 investigation in secondary care.

Question 42

How many people are estimated to be infected with Mycobacterium tuberculosis globally?

Answer 42

Two billion people ## Footnote This is over a quarter of the global population.

Question 43

Which countries account for two-thirds of global tuberculosis cases?

Answer 43

* India * Indonesia * China * The Philippines * Pakistan * Nigeria * Bangladesh * South Africa

Question 44

What was the global death toll from tuberculosis in 2019?

Answer 44

1.4 million people

Question 45

What are common risk factors for tuberculosis?

Answer 45

* Time spent in a high incidence country * TB contact * Current/history of being unhoused * Imprisonment * Drug or alcohol misuse

Question 46

What are the symptoms of active tuberculosis?

Answer 46

* Fever * Night sweats * Weight loss * Cough (pulmonary) * Headache * Lethargy * Vomiting * Confusion * Seizures * Coma

Question 47

What tests are arranged if active tuberculosis is suspected?

Answer 47

* Chest x-ray * Three respiratory sputum samples ## Footnote For microscopy, culture, or specialist molecular tests.

Question 48

What is the purpose of the Mantoux test?

Answer 48

To screen for latent tuberculosis

Question 49

What does a positive Mantoux test indicate?

Answer 49

Induration ≥5mm

Question 50

What are acid fast bacilli (AFB)?

Answer 50

Rod-shaped bacteria that can be seen under a microscope following a staining procedure

Question 51

What is the stain used to visualize AFBs?

Answer 51

Ziehl-Neelsen (ZN)

Question 52

What is the treatment regimen for active tuberculosis?

Answer 52

* Rifampicin * Isoniazid * Pyrazinamide * Ethambutol (or Moxifloxacin) ## Footnote Monitor LFTs and color vision (Ethambutol).

Question 53

What is the definition of malaria?

Answer 53

A disease caused by Plasmodium parasites transmitted through mosquito bites.

Question 54

What should be suspected in anyone with a fever following travel to an endemic area?

Answer 54

Malaria

Question 55

What is the gold standard investigation for malaria?

Answer 55

Thick and thin blood film microscopy

Question 56

What is the universal newborn screening test for cystic fibrosis in the UK?

Answer 56

Blood spot immunoreactive trypsinogen (IRT) concentration

Question 57

What is the average incidence of cystic fibrosis in the UK?

Answer 57

1 in every 2,500 babies

Question 58

What is the main cause of cystic fibrosis?

Answer 58

Mutations in the CFTR gene on chromosome 7

Question 59

What are the stages of whooping cough?

Answer 59

* Catarrhal stage * Paroxysmal stage * Convalescent stage

Question 60

What is the causative organism of whooping cough?

Answer 60

Bordetella pertussis

Question 61

What is the typical presentation of whooping cough?

Answer 61

Cough that is not improving, whoop, apnoea, post-tussive vomiting, cyanosis

Question 62

What is alpha-1 antitrypsin deficiency?

Answer 62

An inherited autosomal recessive disorder affecting the protein produced in the liver that protects tissues

Question 63

What is a common presenting symptom of alpha-1 antitrypsin deficiency?

Answer 63

Dyspnoea, cough, sputum production

Question 64

What tests are performed to diagnose alpha-1 antitrypsin deficiency?

Answer 64

* Serum level of alpha-1 antitrypsin * Lung function tests * Imaging * Skin biopsy

Question 65

What are the indications for performing a viral respiratory PCR?

Answer 65

Acute history of: * Fever * Headache * Cough * Sore throat * Myalgia * Coryzal symptoms

Question 66

What is the first-line test for SARS-CoV-2 virus?

Answer 66

Reverse transcriptase PCR (RT-PCR)

Question 67

What are common symptoms that may prompt testing for COVID-19?

Answer 67

* New continuous cough * Temperature >37.8°C * Loss of, or change in, sense of smell or taste