Respiratory - Common diseases

Question 1

What test is diagnostic for COPD?

Answer 1

Spirometry

Question 2

How is the response of COPD to therapy assessed?

Answer 2

Pre and post bronchodilator spirometry

Question 3

List some symptoms of COPD:

Answer 3

Breathlessness
Productive Cough 
Wheeze
Minimal diurnal variation
Chest pain
Frequent chest infections

Question 4

What spirometry reading would be suggestive of COPD?

Answer 4

FEV1 <80% of predicted

FEV1/FVC ratio <0.7

Question 5

What finding on CT imaging is an independent risk factor for lung cancer in smokers?

Answer 5

Emphysema

Question 6

What other investigations need to be done (other than spirometry) in an initial diagnosis of COPD and why?

Answer 6

FBC - polycythaemia or anaemia may be seen
CXR - look for sinister pathology
Sputum culture - to rule out infection

Question 7

What illness should be ruled out in patients with symptoms of COPD who haven’t smoked?

Answer 7

Alpha-antitrypsin deficiency

Question 8

What method of inheritance is alpha-antitrypsin deficiency?

Answer 8

Autosomal recessive

Question 9

Define asthma:

Answer 9

Chronic reversible inflammation of the airways caused by increased sensitivity to various stimuli

Question 10

What % of diurnal variation would you expect to see on a spirometry measurements in an asthmatic?

Answer 10

> 20% variation

Question 11

What is samter’s traid?

Answer 11

Aspirin sensitivity
nasal polyps
Asthma

Question 12

What spirometry findings would be seen in asthmatics?

Answer 12

FEV1 - Reduced
FVC - Normal
FEV1 / FVC .k.a. FEV1 % - <70%

Question 13

What type of wheeze would be heard in someone with asthma?

Answer 13

Expiratory polyphonic wheeze

Question 14

At what age can you objectively test a child for asthma?

Answer 14

5 years old

Question 15

What assessment is used to predict the likelihood of someone actually having a PE / DVT when they are potentially symptomatic?

Answer 15

Wells Score

Question 16

List some risk factors for developing a PE:

Answer 16

Immobility for long periods of time
Hormone replacement therapy
Malignancy
FHx
Recent surgery
Pregnancy
Thrombophilia
Polycythaemia
SLE

Question 17

What are some symptoms of a PE?

Answer 17

Shortness of breath
Chest pain pleuritic
Hypoxia
Tachycardia
Low grade fever 
Hypotension / instability 
Cough

Question 18

What is the most appropriate investigation for a PE?

Answer 18

CT Pulmonary angiogram

Question 19

If you are unsure whether to do a CTPA for a PE, what test could be done first?

Answer 19

D dimer

Question 20

In a pulmonary embolism, what is the likely ABG finding?

Answer 20

Respiratory alkalosis