Chest Medicine

Question 1

Obstructive lung defects

Answer 1

Asthma
Bronchiectasis
COPD (chronic bronchitis, emphysema)
Cystic fibrosis

Question 2

Restrictive lung defects

Answer 2

Amyotrophic lateral sclerosis (ALS)/MND
Fibrosis
Interstitial pneumonias
Kyphoscoliosis
Muscular dystrophy
Obesity
Sarcoidosis
Pleural effusion
Pneumoconiosis (coal workers', silicosis, asbestosis)

Question 3

sputum: clear and colourless

Answer 3

chronic bronchitis

Question 4

sputum: yellow-green or brown

Answer 4

pulmonary infection

Question 5

sputum: red

Answer 5

haemoptysis

Question 6

sputum: black

Answer 6

smoke, coal, dust

Question 7

sputum: frothy white-pink

Answer 7

pulmonary oedema

Question 8

sputum examination

Answer 8

microscopy, culture/sensitivity, Zn stain, PCR

Question 9

peak expiratory flow

Answer 9

• maximal forced expiration through peak flow meter
• correlates well with forced expiratory volume in 1 second (FEV1)
• estimate of airway calibre in asthma
• effort-dependent

Question 10

erroneous readings of pulse oximetry

Answer 10

• poor perfusion
• movement
• skin pigmentation
• nail varnish
• dyshaemoglobinaemias
• CO poisoning

Question 11

FEV1/FVC ratio

Answer 11

• estimate of severity of airflow obstruction

- classify COPD

Question 12

spirometry results: normal

Answer 12

• FEV1: >80% predicted
• FVC: >80% predicted
• FEV1/FVC ratio: 75-80%

Question 13

spirometry results: obstructive

Answer 13

• FEV1: <80% predicted
• FVC: normal or low
• FEV1/FVC ratio: <70% predicted

Question 14

spirometry results: restrictive

Answer 14

• FEV1: <80% predicted
• FVC: <80% predicted
• FEV1/FVC ratio: >70% normal

Question 15

TLC and RV increased in

Answer 15

obstructive airways diseases

Question 16

TLC and RV reduced in

Answer 16

restrictive lung diseases and musculoskeletal abnormalities

Question 17

gas transfer coefficient (KCO)

Answer 17

• CO diffusing capacity (DLCO) corrected for alveolar volume
• calculated by measuring CO uptake in 10s and lung volume by helium dilution
• LOW: emphysema and interstitial lung disease
• HIGH: alveolar haemorrhage

Question 18

Flow–volume loop

Answer 18

• measures flow at various lung volumes
• Characteristic patterns are seen with intra-thoracic airways obstruction (asthma, emphysema) and extra-thoracic airways obstruction (tracheal stenosis)

Question 19

ultrasound

Answer 19

diagnosing and guiding drainage of pleural effusions and empyema

Question 20

Ventilation/perfusion (V/Q) scans

Answer 20

occasionally used to diagnose pulmonary embolism (PE), eg in pregnancy (unmatched perfusion defects are seen)

Question 21

CT

Answer 21

• diagnosing and staging lung cancer,
• imaging the hila, mediastinum, and pleura
• guiding biopsies

Question 22

Thin (1–1.5mm) section high-resolution CT (HRCT)

Answer 22

diagnosis of interstitial lung disease, emphysema, and bronchiectasis

Question 23

CTPA

Answer 23

diagnosis of PE

Question 24

Pulmonary angiography

Answer 24

rarely used for diagnosing pulmonary hypertension

Question 25

Fibreoptic bronchoscopy

Answer 25

Performed under local anaesthetic via the nose or mouth

Question 26

Fibreoptic bronchoscopy: Diagnostic indications:

Answer 26

• suspected lung carcinoma
• slowly resolving pneumonia
• pneumonia in the immunosuppressed
• interstitial lung disease

Question 27

Bronchoalveolar lavage fluid

Answer 27

microscopy, culture, and cytology

Question 28

Mucosal abnormalities

Answer 28

• brushed: cytology

- biopsied: histopathology