practise questions Flashcards
Define spirometry and discuss its use in clinical practice.
Spirometry is a method of assessing lung function by measuring the volume of air that a patient is able to expel from the lungs after maximal inspiration (1).
Spirometry is a vital screening procedure employed in clinical practice to indicate the presence or absence of lung disease (1).
Determine the origin of ventilatory limitation and/or monitor the effectiveness of a specific treatment intervention (1).
Dyspnoea is a common symptom of heart failure. Briefly explain the physiological mechanism for this.
Dyspnea describes breathlessness as a result of increased physiological dead space
The physiological mechanism is (3):
- ↑ CO2 & H+ Chemoreceptors (metabolic acidosis)
- ↑ Rate & depth of respiration in attempt to restore pH (increased minute ventilation,
breathlessness, dyspnea) - Inadequate perfusion of the tissues with oxygen, which leads to ventilation-perfusion mismatching
What is the main cause, the key characteristic and symptoms of systolic heart failure?
Cause – previous MI or CAD (1).
Thin and weak ventricular walls reducing pumping capacity – reducing stroke volume and cardiac output (1).
Symptoms: Pulmonary oedema, fatigue, dyspnea (1)
How would you recognise atrial fibrillation (AF) on the ECG trace?
No visible P waves (1).
Tiny, irregular fibrillation waves between heartbeats (1).
Irregularly irregular rhythm (1).
Describe the normal ECG changes during exercise (based on Hill and Timmis, 2002).
P wave increases in height (0.5).
R Wave decreases in height (0.5).
J point becomes depressed (0.5).
ST segment becomes sharply up-sloping (0.5).
QT interval shortens (0.5).
T wave decreases in height (0.5).
Which findings (during a CPET) are suggestive of a high probability of ischaemic heart disease? (Hill and Timmis, 2002)
ST depression >2mm (0.5).
Downsloping ST depression (0.5).
Early positive response (6min or low workload) (0.5).
Persistence of ST depression for more than 6min into recovery (0.5).
ST depression in 5 or more leads (0.5).
Exertional hypotension (0.5)
How can the assessment of the O2 pulse progression during a CPET inform decisions about the cause of unexplained dyspnoea?
O2 pulse measures stroke volume (1).
Abnormal values or trajectory (early plateau or double slope) during the CPET (1) indicate myocardial ischaemia (1).
What is the main utility of assessing the PETCO2 values during a CPET?
PETCO2 assesses matching of ventilation to perfusion in the lungs (1).
Abnormal values reflect disease severity in a number of conditions; e.g. heart failure and COPD
(2)
What is the aerobic exercise prescription for a 72-year old male cardiac patient with a resting heart rate of 80bpm (include calculated HR training zones)?
Frequency - 5-7 days per week (0.5).
Intensity - 40-80% Heart Rate Reserve (HRR) (0.5):
- Max HR: 220-72 = 148bpm
- HRR: 148-80 = 68bpm
- 40% HRR: (0.4 x 68) + 80 = 107bm (0.5).
- 80% HRR: (0.8 x 68) + 80 = 134bpm (0.5).
Describe the difference between direct and indirect bronchoprovocation challenges.
Describe the application and difference between direct and indirect bronchoprovocation challenges (3 marks)
Bronchoprovocation challenges are used in clinical practice for the diagnosis of asthma and exercise-induced bronchoconstriction (EIB) (1 mark)
Direct challenges act directly on airway smooth muscle independent of inflammation (1 mark)
Indirect challenges cause inflammatory cells to release mediators to provoke airway smooth muscle constriction (1 mark)
Explain why elite endurance athletes may be susceptible to the development of exercise-induced bronchoconstriction (EIB) (3 marks)
Chronic high ventilation in noxious environments (1 mark)
Airway injury-recycling, airway inflammation and structural airway remodelling (1 mark)
Concept supported by higher prevalence in elite swimmers and cold-air athletes (1 mark)
