Physiology

Question 1

FEV1/FVC ratio of _____ is needed to make a diagnosis of COPD

Answer 1

Below 70

Question 2

In emphysema, the elastic recoil of the lungs is lost. This means it is EASY/DIFFICULT for the lungs to expand and EASY/DIFFICULT for the lungs to recoil

Answer 2

Easy to expand lungs

Difficult to recoil lungs

Question 3

What is compliance?

Answer 3

How easy it is to stretch the lungs

Question 4

If lung elasticity is lost, what does this mean?

Answer 4

Easy to stretch the lungs but difficult to recoil

Question 5

Reduced pulmonary compliance means that it’s easier/harder to expand the lungs?

Answer 5

Harder

Question 6

What is the cut off (in kPa) for the oxy-Hb dissociation curve which means that O2 sats will be above 90% saturated?

Answer 6

8 kPa or above

Question 7

What diffuses more readily - oxygen or carbon dioxide?

Answer 7

Carbon dioxide diffuses 20 times more readily than oxygen

Question 8

In a patient with anaemia, PO2 will be normal/reduced/increased?

Answer 8

Normal

Question 9

In a patient with anaemia, the Hb saturation will be normal/abnormal? Why is this?

Answer 9

Normal

- there is less Hb available in anaemic patients however the Hb will be fully saturated so Hb saturation is not affected

Question 10

A patient with anaemia has normal PO2 and normal Hb saturation. True or false?

Answer 10

True

Question 11

62 yo male, who smokes since his teen age, complains of increasing SOB. Barrel shaped chest and hyper-resonant percussion note on both sides. What is the most appropriate pulmonary function test result?

A – decreased TLC, increased lung diffusion capacity, normal or increased FEV1/FVC ratio
B – increased TLD, decreased lung diffusion capacity, normal or increased FEV1/FVC ratio
C – increased TLC, decreased lung diffusion capacity, decreased FEV1/FVC ratio
D – decreased TLC, decreased lung diffusion capacity, normal or increased FEV1/FVC ratio
E – decreased TLC, increased lung diffusion capacity, normal or increased FEV1/FVC ratio

Answer 11

Answer: C

Reasoning:
This is suggesting emphysema
COPD is an obstructive lung disease
Obstructive pattern: Decreased FEV1/FVC ratio

Question 12

48 year old man is admitted with acute anterior MI. He wakes up during the night and suddenly feels SOB. When you arrived he is sitting up and the nurse has started high flow oxygen. On examination he has mild tachycardia and chest crackles posteriorly. What is the one best set of medications to help relieve the acute SOB in this patient
A – IV furosemide + oral digoxin
B – IV furosemide + start nitrate infusion
C – IV furosemide + beta blocker
D – IV furosemide + CCB
E – IV furosemide + ACE inhibitor

Answer 12

Answer: B

Reasoning:
This is acute heart failure
IV furosemide treats pulmonary oedema
Whilst B-blocker and ACE inhibitor are treatments of heart failure, they are for long term use - not acute.
Nitrate infusion will cause vasodilatation. This reduces the preload and by doing this it reduces the back pressure on the lungs.

Question 13

Beta blocker is good to use in acute heart failure. True or false?

Answer 13

False

- only use this short term

Question 14

Which drug used in heart failure improves long term survival?

Answer 14

ACE inhibitor

Question 15

26 yo man is brought to A+E department with unconsciousness. He is noted to have needle puncture marks on both arms. His RR is 8 per minute and he has pinpoint pupils. What is the most likely set of ABGs from these patients:
A – pH – 7.34, pCO2 – 6.5, HCO3 – 38, PO2 – 6.1

B – pH – 7.34, pCO2 – 6.5, HCO3 – 38, PO2, 11.2

C – pH – 7.1, pCO2 , 7.1, HCO3 – 26, PO2 – 6.2

Answer 15

Answer C

Reasoning:
Opioid overdose suspected. Patient is hypoventilating.

Question 16

how would you manage a patient that presents with an opiate overdose?

Answer 16

Administer naloxone

Question 17

If someone presents acutely, they are Very likely / Very unlikely to have metabolic compensation in their ABG? Why is this

Answer 17

Very unlikely

- it takes a while for metabolic compensation

Question 18

Since COPD is a chronic problem, respiratory acidosis with a metabolic compensation is likely or unlikely?

Answer 18

Likely

- chronic, so metabolic compensation will occur

Question 19

64 year old man who has been a smoker for 50 years, coughs up sputum every day and is usually breathless on minor exertion; he has to stop once in climbin one flight of stairs. He is admitted to hospital with symptoms of chest infection, and feeling breathless at rest. What is the most likely set of ABGs
A – pH 7.2 ; pCO2 6.8 ; PO2 8.2 ; HCO3 26

B – pH 7.36 ; pCO2 6.8 ; pO2 ; 12.2 ; HCO3 38

C – pH 7.36 ; pCO2 6.8 ; pO2 6.9 ; HCO3 38

D – pH 7.5 ; pCO2 3.4 ; pO2 6.9 ; HCO3 26

E – pH 7.5 ; pCO2 3.4 ; pO2 12.2 ; HCO3 26

Answer 19

Answer C

Reasoning:
High PCO2
High HCO3- to compensate
pO2 low because patient likely to be hypoxic

Question 20

75 year old man with RLL bronchial carcinoma, who is on the practice palliative care register, is reviewed by his GP because of increasing breathlessness. His wife reports that happens more often when he is on his own and overnight. His pain is well controlled with a low dose of oral morphine twice daily. On examination there are a few course creps in the RLL. Which one of the following is likely to be most effective in treating dyspnoea in this patient. 
A – dexamethasone 
B – furosemide 
C – hyoscine 
D – lorazepam 
E – midazolam

Answer 20

Answer: D

Reasoning:
Happens when alone or overnight - suggests it only happens at certain parts of the day rather than all the time

Question 21

65 yo woman is admitted complaining of SOB. She was well until 2 months before admission, when she developed a sore knee, for which she has been prescribed twice daily painkiller tablets. Her stools have recently been black and tarry. She feels very tired, and breathless on minimal exertion, but not at rest. On examination, her CVS is normal and chest clear. What is the most lieely physiological mechanism for her SOB?
A – reduced pulmonary compliance
B – reduced partial pressure of oxygen in the arterial blood
C – stimulation of central chemoreceptors
D – reduced oxygen carrying capacity of the blood
E – reduced diffusion of oxygen into the blood through the respiratory membrane

Answer 21

Answer D

Reasoning:
The patient is bleeding and doesn’t have as much Hb