MCQ - General Medicine (Respiratory)

Question 1

Which breath sounds would be present in a patient with COPD?

a. increased vocal resonance, increased vocal fremitus, increased breath sounds, dull to percussion
b. decreased vocal resonance, decreased vocal fremitus, reduced breath sounds, resonant to percussion
c. decreased vocal resonance, decreased vocal fremitus, increased breath sounds, dull to percussion
d. increased vocal resonance, increased vocal fremitus, reduced breath sounds, resonant to percussion

Answer 1

Answer:

b. decreased vocal resonance, decreased vocal fremitus, reduced breath sounds, resonant to percussion

Explanation

COPD is characterised by excessive air in the lungs.

• Air doesn’t transmit sound well compared to normal lumg or consolidation, so vocal resonance and fremitus (transmission of sound) are reduced.
• Breath sounds are reduced in most lung conditions, so this is a safe bet.
• Hyperinflation causes increased resonance to percussion.

Question 2

A patient with asthma (and no other medical conditions) is most likely to have which of the following findings?

a. high FER, decreased total lung capacity
b. high FER, normal total lung capacity
c. low FER, decreased total lung capacity
d. low FER, normal total lung capacity
e. normal FER, decreased total lung capacity

Answer 2

Answer: d. low FER, normal total lung capacity

Explanation:

Asthma is an obstructive condition

• FER measures proportion of oxygen that is exhaled within the first second of exhalation (FEV1) compared with total oxygen that is exhaled (FVC).
• FER = FEV1/FCV
• Asthma’s obstructive nature reduces rate of air exhalation, without reducing the total amount of air exhaled. I.e. FEV1 is reduced but not FVC. This causes FER to be reduced.
• Obstructive conditions do not alter the capacity of the lungs themselves, so normal lung capacity will be expected in asthmatic patients without any other medical conditions.