ESA 3 - Respiratory - Session 6 - Spirometry and Pneumonia Flashcards
2018 Respiration New session 6 Spirometry and pneumonia
A 48 year old woman has breathlessness for the last six months. She is an ex-smoker with a 20 pack year smoking history. Her spirometry results are as follows:
FVC: 2.8 (Expected FVC for age and height = 3.25),
FEV1: 2.2 (Expected FEV1 for age and height = 2.79)
What is the most likely pathology causing these results?
A. Anaemia B. Pulmonary fibrosis C. COPD D. Asthma E. Cardiac failure
B. Pulmonary fibrosis
Both FVC and FEV1 are reduced with a FEV1:FVC ratio of 78% . This is a restrictive pattern and pulmonary fibrosis causes a restrictive pattern on spirometry.
Other responses wrong because: Asthma and COPD would show an obstructive pattern with a FEV1:FVC ratio of < 70%. Anaemia and heart failure do not cause abnormal spirometry findings.
A 69-year-old man has had breathlessness and a chronic cough productive of small amounts of white sputum for the last 2 years. He is an ex-smoker with a 20 pack year history and is a retired accountant. He is referred for lung function tests. The spirometry results are as follows:
Pre bronchodilator: FVC: 3.58 (predicted: 3.76 litres); FEV1: 1.9 (predicted: 2.94 litres)
Pre bronchodilator: FVC: 3.6 (predicted: 3.76 litres); FEV1: 2.0 (predicted: 2.94 litres)
What is the most likely diagnosis?
A. Acute bronchitis B. Pulmonary fibrosis C. COPD D. Asthma E. Heart failure
C. COPD
Spirometry shows an obstructive defect - both FVC and FEV1 are reduced, with a FEV1:FVC ratio of 53% (<70% indicates an obstructive defect). There is no significant improvement with bronchodilators (less than 12% increase in FEV1 on post bronchodilator testing), indicating that there is no significant reversibility of the airway obstruction. Hence this is COPD, not asthma.
Other responses are incorrect because:
A: Acute bronchitis is an acute illness with a short history,
B: Lung fibrosis would cause a restrictive defect
E: Heart failure does not cause abnormal spirometry findings
A 72yr old man with COPD is seen in his annual review at the respiratory clinic. He undergoes spirometry testing. The predicted values for his age and height are as follows:
Predicted FVC = 4.23 liters Predicted FEV1 = 3.25 litres
Which set of spirometry results is mostly likely to be seen in this patient?
A. FVC = 4.24 L, FEV1 = 3.25 L
B. FVC = 3.40 L, FEV1 = 1.54 L
C. FVC = 3.40 L, FEV1 = 2.51 L
D. FVC = 3.80 L FEV1 = 3.10 L
B. FVC = 3.40 L, FEV1 = 1.54 L
Obstructive pattern on spirometry - reduced FVC and FEV1; FEV1:FVC ratio = 45% (<70%)
Other responses are wrong because:
A. normal lung function; normal FVC and FEV1; FEV1:FVC ratio = 76%
C. restrictive pattern: reduced FVC and FEV1; FEV1:FVC ratio = 73%
D. restrictive pattern: reduced FVC and FEV1; FEV1:FVC ratio = 81%
A 70yr old lady who presents to the GP with a 6-month history of progressive breathlessness and dry cough. She is an ex-smoker. The GP requests lung function tests.
FVC: 1.6 (predicted value 2.4); FEV1: 1.3 (predicted value 2.0)
What is the most likely diagnosis?
A. Normal lung function
B. Lung fibrosis
C. COPD
D. Asthma
B. Lung fibrosis
Both FVC and FEV1 are reduced with a FEV1: FVC ratio of 78% indicating a restrictive pattern. Pulmonary fibrosis causes a restrictive pattern on spirometry.
Asthma and COPD would both show an obstructive pattern with a FEV1: FVC ratio < 70%.
A patient undergoes spirometry for investigation of breathlessness. The image shows the pre and post bronchodilator flow volume and time-volume graphs.
Purple line – pre bronchodilator; Green line -post bronchodilator
[2018 New Session 6 spirometry and pneumonia quiz - question 5]
What is the most likely diagnosis? A. Pulmonary fibrosis B. COPD C. Asthma D. Bronchial carcinoma
C. Asthma
The pre-bronchodilator (purple line) flow volume curve shows a reduced peak expiratory flow rate and scooping; the volume time graph shows reduced FVC of about 3 Litres and a FEV1 of about 1.7 Litres giving a FEV1/FVC ratio of 56%. These findings are characteristic of an obstructive pattern.
The post-bronchodilator (green line) flow volume curve shows reversal of the scooping and improved PEFR; the volume time graph shows improved FVC of about 4 litres and FEV1 of about 3.2 litres with FEV:FVC ratio of 80% indicating significant reversibility.
Other responses are incorrect because:
A: pulmonary fibrosis would give a restrictive pattern
B: COPD would not show significant reversibility
D: Even if bronchial carcinoma causes an upper airway obstruction it would not give this appearance of scooping on the expiratory flow volume curve. (Instead it would show a fixed upper airway obstruction pattern – you are not required to learn the details of this pattern).
A medical student volunteers for spirometry at a respiratory physiology practical. The image shows his flow volume loop.
Which letter indicates the peak expiratory flow rate?
[2018 New Session 6 spirometry and pneumonia quiz - question 6]
A. K B. L C. M D. N E. None of the above
A. K
K indicates the highest flow rate achieved during expiration (peak expiratory flow rate)
M: indicates the volume of air expired – i.e. forced vital capacity (FVC)
L: indicates start of inspiration (maximal inspiration),
N: indicates start of expiration (maximal expiration as hard and fast as possible)
A medical student volunteers for spirometry at a respiratory physiology practical. The image shows his flow volume loop.
Which letter indicates FEV1?
[2018 New Session 6 spirometry and pneumonia quiz - question 7]
A. K B. L C. M D. N E. None of the above
E. None of the above
The FEV1 cannot be identified on a flow volume loop (although the FEV1 can be identified on a time volume graph).
K indicates the highest flow rate achieved during expiration (peak expiratory flow rate)
M: indicates the volume of air expired – i.e. forced vital capacity (FVC)
L: indicates start of inspiration (maximal inspiration),
N: indicates start of expiration (maximal expiration as hard and fast as possible)
A 70-year-old man is seen in the emergency department with fever, a cough productive of greenish sputum and left sided pleuritic chest pain. On examination he is confused and restless, the temperature is 390C, heart rate is 110/ minute, BP is 85/60, and the respiratory rate is 25 /minute and on auscultation there are signs of a left lower lobar consolidation.
Which of the clinical features mentioned above are NOT USED in the estimation of the CURB – 65 score?
A. Confusion B. Temperature C. Respiration rate D. Blood pressure E. Age
B. Temperature
C= confusion, U= urea concentration, R= respiratory rate, B= blood pressure and Age > 65 are used to assess severity of pneumonia using CURB-65
The table below gives five (5) clinical settings of pneumonia and the likely causative organism/s respectively.
Which of the combinations is INCORRECT?
(Clinical setting - Likely causative organism/s)
A. Community acquired pneumonia - Steptococcus pneumoniae
B. Hospital acquired pneumonia - Staphylococcus aureus
C. Community acquired pneumonia - Haemophilus influenzae
D. Hospital acquired pneumonia - Chlamydia psitacci
E. Aspiration pneumonia - Anaerobic organisms
D. Hospital acquired pneumonia - Chlamydia psitacci
Chlamydia psitacci is associated with exposure to birds, and is not a causative organism of hospital acquired pneumonia
Which of the following organisms causes an ATYPICAL community acquired pneumonia?
A. Streptococcus pneumoniae B. Haemophilus pneumoniae C. Mycoplasma pneumoniae D. Moraxella catarrhalis E. Staphylococcus aureus
C. Mycoplasma pneumoniae
While all of the organisms cause community acquired pneumonia, Mycoplasma pneumoniae is the only atypical organism in the list
