Resp ICM (passmed)

Question 1

What does it mean when you have “mixed respiratory and metabolic acidosis?”

Answer 1

ROME

Low pH - acidotic
High CO2 - respiratory
Low HCO3 - metabolic

Both resp acidosis and met acidosis is occurring its mixed

Question 2

An ABG shows respiratory acidosis and a raised bicarb, what condition is this normally seen in?

Answer 2

COPD - there is some metabolic compensation due to the chronic respiratory acidosis

This ABG can be seen in patients who have had too much oxygen

Question 3

What is FVC?

Answer 3

Forced vital capacity - deep breath in and then forced deep breath out

Question 4

What is FEV1

Answer 4

Forced expiratory volume in the first second - deep breath in, deep breathe out and this is the measurement during that first second of expiration

Question 5

What percentage indicates a normal spirometry?

Answer 5

> 80%

Question 6

How would FVC and FEV1 look like in an obstructive pattern?

Answer 6

FVC - slightly reduced / normal

FEV1 - significantly reduced

Question 7

How do you diagnose an obstructive lung function?

Answer 7

FEV1 / FVC <70%

Question 8

What is obstructive lung function and name 3 condition that fall under this

Answer 8

Obstructive lung function means it is difficult for the patient to fully exhale

• Asthma
• COPD
• Bronchiectasis

Question 9

How would FVC and FEV1 look in a restrictive lung function?

Answer 9

FVC - significantly reduced

FEV1 - slightly reduced

Question 10

What is restrictive lung function and name 3 conditions

Answer 10

Restrictive lung function is when a patient finds it hard to fully inhale

• Pulmonary fibrosis
• Neuromuscular
• Obesity
• Asbestos

Question 11

What does FEV1/FVC look like in a restrictive lung function?

Answer 11

Can be normal or increased

Question 12

How does lung metastases show on a chest x-ray?

Answer 12

Multiple rounded lesions

Question 13

On an ABG how would hyperventilation present and how would the patient present?

Answer 13

Respiratory alkalosis

Episodes of SOB, tingling, lightheadedness (crowded room)

Question 14

What component of the ABG would you check to see if there has been partial or complete compensation?

Answer 14

pH - check to see if it has returned to normal

Question 15

What would you expect to see on an ABG in a patient with DKA?

Answer 15

Metabolic acidosis

- Kidneys produce bicarbonate to buffer the large level of ketones, but it is used up and the blood becomes acidic

Question 16

To diagnose renal cell carcinoma, what would you see on a patient’s x-ray?

Answer 16

“Cannonball metastases”

- multiple, round well-defined

Question 17

After a CXR, what other investigation would you do for renal cell carcinoma?
A - High resolution CT thorax
B - sputum culture
C- Bronchoscopy 
D - CT Abdomen

Answer 17

D

Question 18

Why is a high bicarbonate level see on an ABG for a COPD patient with acute on chronic respiratory acidosis?

Answer 18

It takes time for metabolic compensation to occur

Question 19

What findings would you see on a CXR indicative of heart failure (ABCDE)

Answer 19

A - Alveolar oedema 
B - Kerley B lines
C - Cardiomegaly 
D - Dilated prominent upper lobe vessels 
E - Effusion

Question 20

When would you see a boot shaped heart on an x-ray?

Answer 20

Tetralogy of fallot

Question 21

When would you see a deviated trachea on a CXR?

Answer 21

Tension pneumothorax