Further investigations in chest medicine

Question 1

How does total lung capacity (TLC) and residual volume (RV) differ in obstructive and restrictive diseases?

Answer 1

•TLC and RV are increased in obstructive airway diseases and reduced in restrictive diseases and musculoskeletal abnormalities.

Question 2

What are respiratory diseases is ultrasound useful?

Answer 2

• It is used in the diagnosis and to guide drainage of pleural effusions and empyema.

Question 3

What can a ventilation/perfusion scan (a radionuclide scan) be used for?

Answer 3

• Occasionally used to diagnose pulmonary embolism.

Question 4

What can a bone scan (a radionuclide scan) be used for?

Answer 4

• To diagnose bone metastases.

Question 5

What is computed tomography (CT) of the thorax used for? (6)

Answer 5

• Diagnosing and staging lung cancer
• Imaging the hila / mediastinum / pleura
• Guiding biopsies
• Diagnosis of interstitial lung disease and bronchiectasis (thin section high resolution CT)

Question 6

What is CT pulmonary angiography (CTPA) used for?

Answer 6

• In the diagnosis of PE

Question 7

What diagnostic indications can be revealed by fiberoptic bronchoscopy? (4)

Answer 7

• Suspected lung carcinoma
• Slowly resolving pneumonia
• Pneumonia in the immunosuppressed
• Interstitial lung disease

Question 8

How is fiberoptic bronchoscopy performed?

Answer 8

•Under local anaesthetic via the nose or mouth.

Question 9

What samples may be assessed and retrieved by fiberoptic bronchoscopy?

Answer 9

• Bronchial lavage fluid – microscopy / culture / cytology

* Mucosal abnormalities – brushed (cytology) / biopsied (histopathology)

Question 10

What therapeutic indications can be done by fiberoptic bronchoscopy?

Answer 10

• Aspiration of mucus plugs causing lobar collapse
• Removal of foreign bodies
• Stenting
• Treating tumours – laser