Respiratory

Question 1

Give the appropriate tests for asthma in over 17s with values

Answer 1

Spirometry with bronchodilator reversibility test (FEV1/FVC ratio <70% positive test)

FeNO test (>40 parts per billion is positive test)

Question 2

Give the appropriate tests for asthma in 5-16s with values

Answer 2

Spirometry with bronchodilator reversibility test (FEV1/FVC ratio <70% positive test)

FeNO test should be requested if there is normal or obstructive spirometry with a negative bronchodilator reversibility (BDR) test (>= 35 parts per billion (ppb) is considered positive)

Question 3

Give the appropriate tests for asthma in <5yo

Answer 3

clinical judgement

Question 4

Give the appropriate tests for suspected COPD

Answer 4

post-bronchodilator spirometry to demonstrate airflow obstruction: FEV1/FVC ratio less than 70%

chest x-ray: hyperinflation, bullae, flat hemidiaphragm. Also important to exclude lung cancer

full blood count: exclude secondary polycythaemia

body mass index (BMI) calculation

Question 5

Spirometry results for suspected COPD shows Post-bronchodilator FEV1/FVC <0.7 and FEV1 >80%. What is the severity?

Answer 5

Stage 1 - mild symptoms

Question 6

Spirometry results for suspected COPD shows Post-bronchodilator FEV1/FVC <0.7 and FEV1 <30%. What is the severity?

Answer 6

Stage 4 - Very severe

Question 7

What is the FVC and FEV1?

Answer 7

FVC: total amount of air exhaled

FEV1: air forced from lungs in one second

Question 8

Indications for D-Dimer

Answer 8

DVT (Deep Vein Thrombosis), PE (Pulmonary Embolism), or DIC (Disseminated Intravascular Coagulation)

Question 9

What does a positive D-Dimer test indicate?

Answer 9

presence of an abnormally high level of cross-linked fibrin degradation products (significant clot formation and breakdown` in the body)

Question 10

Sweat chloride testing indication and physiology

Answer 10

Cystic Fibrosis

Normally chloride travels in and out of cells through the cystic fibrosis transmembrane conductance regulator (CFTR.) In CF, a mutation in CTFR means it cannot work properly so there is a higher concentration of chloride in sweat.

Question 11

Acid-Fast Bacillus (AFB) Testing indication

Answer 11

identify mycobacterial (rod shaped) infection, TB or monitor treatment effectiveness

Question 12

Bordetella pertussis culture

Answer 12

in patients with persistent or fits of coughing (whooping cough)

Question 13

Alpha-1 Antitrypsin indication and physiology

Answer 13

diagnose the cause of early onset emphysema and/or liver disease

A1AT is a protein prduced by the liver and released into the blood. It inactivates elastase in the lungs which is produced by neutrophils in response to inflammation. Elastase breaks down proteins so they can be reused by the body but if not regulated by A1AT it can damage the lung tissue by breaking down itself.
If A1AT doesn’t work it accumulates in liver cells and can cause liver damage.

Question 14

Indications for CXR

Answer 14

Infection

Major trauma ( pneumothorax and haemothorax )

Acute chest pain

Asthma/bronchiolitis

Acute dyspnoea: exclude heart failure, pleural effusion

Chronic dyspnoea: exclude heart failure, effusion and interstitial lung disease

Haemoptysis

Suspected mass, metastasis or lymphadenopathy

Question 15

Indication for CT

Answer 15

Evaluation of an abnormality detected on a chest X-ray

• Pulmonary mass or nodule
• Mediastinal mass

Evaluation of aortic disease

• Aortic aneurysm/dissection
• Trauma

Malignant disease

• Staging
• Lymphadenopathy

Evaluation of pleural disease
- Suspected pulmonary embolus

Question 16

What is a bronchoscopy?

Answer 16

During a bronchoscopy, a bronchoscope is passed through your nose or mouth, past your larynx (voice box), down your trachea (windpipe) and into the bronchi. The images taken by the bronchoscope are projected onto a TV screen and the doctor can look at them to check whether or not any disease is present in your lungs.

Sometimes a biopsy—a sample of tissue—is taken for analysis (testing) in the laboratory. The tissue is removed through the endoscope using tiny forceps

Question 17

Which investigations are likely to take place under a two week rule for suspected lung cancer?

Answer 17

Spirometry , Chest xray and CT scan