Respiratory Formative Q&A Flashcards
The volume of gas that enters or leaves the lung with each cycle of respiration
Tidal volume
The additional volume of air that can be inhaled after a normal resting inspiration
Inspiratory reserve volume
The volume of air remaining in the lungs after a normal resting expiration
Functional residual volume
The product of tidal volume and respiratory rate
Minute ventilation
Most of the CO2 transported in the blood is …
In the form of bicarbonate ions
Most of the O2 transported by the blood is
Bound to haemoglobin
Pa O2 and pH are sensed by
Peripheral chemoreceptors
Pa CO2 is sensed by
Central chemoreceptors
A 59 year old man with known squamous carcinoma of the lung, admitted to hospital as an emergency with abdominal pain, constipation and confusion…
Initial investigation?
Serum calcium
A 65 year old woman with a three week history of increasing neck and face swelling, who has a widened superior mediastinum on chest x-ray…
Initial investigation?
CT thorax
A 55 year old cigarette smoker attending his general practitioner with a two month history of troublesome cough…
Initial investigation?
Chest x-ray
A 79 year old woman with a peripheral speculated opacity on chest x-ray and an enlarged superclavicular lymph node. ..
Initial investigation?
FNA lymph node
A 35 year old man with cystic fibrosis…
Likely organism.
Pseudomonas aeruginosa
A 50 year old oil executive with lobar pneumonia…
Likely organism.
Streptococcus pneumoniae
A 65 year old man with lobar pneumonia whose parrot is unwell…
Likely organism.
Chlamydia psittaci
A 19 year old, previously healthy woman experiences sudden onset of severe right-sided chest pain whilst walking upstairs. The pain is associated with breathlessness. Both symptoms are still prominent when she presents to the Accident and Emergency Department one hour later…
Clinical Diagnosis…
Primary Pneumothorax
A 32 year old man is recovering from a bad attack of pneumonia for which he has been off work for several weeks. He goes on to develop night sweats, a persistently poor appetite and increasing shortness of breath on exertion. After a week of oral antibiotic treatment his GP refers him to the local respiratory medicine unit for admission…
Clinical Diagnosis…
Empyema Thoracis
A 62 year old man vomits after a bout of heavy drinking the night before. Immediately afterwards he experiences severe left sided pleuritic chest pain, breathlessness and cough. The pain fails to resolve and is associated with tachypnoea and sweating…
Clinical Diagnosis…
Aspiration pneumonia
A patient with newly diagnosed asthma and waking up at night because of asthma should be commenced on…
Inhaled corticosteroids and inhaled beta-2-agonist
Patients at step 2 therapy with poor control should be commenced on an…
Inhaled long acting beta-2-agonist
A patient at step 5 of the treatment guidelines will require long-term…
Oral corticosteroid
Treatment with an inhaled beta-2-agonist is only recommended for patients at step…
Step 1
What is the clinical term for coughing up blood?
Haemoptysis
A 62 year old male smoker has coughed up blood 4 times during the past 1 month. His appetite has been poor and he has lost 1 stone during this period.
What is the most likely diagnosis?
Lung Cancer
A 62 year old male smoker has coughed up blood 4 times during the past 1 month. His appetite has been poor and he has lost 1 stone during this period.
What clinical signs might you look for?
i. in his hands?
Finger Clubbing
A 62 year old male smoker has coughed up blood 4 times during the past 1 month. His appetite has been poor and he has lost 1 stone during this period.
What clinical signs might you look for?
ii. on palpating his abdomen?
Hepatomegaly
A 62 year old male smoker has coughed up blood 4 times during the past 1 month. His appetite has been poor and he has lost 1 stone during this period.
What clinical signs might you look for?
iii. examining his neck?
Lymphadenopathy
SVC Obstruction
Tracheal Deviation
Lung Cancer:
Give two imaging techniques which would be useful to define the extent of the lesion? (2)
CXR
CT
MRI
Lung Cancer:
Apart from imaging techniques, list two other investigations you would perform at this stage. (2)
Pulmonary Function Test
Biopsy – Percutaneous or Bronchoscopic
Lung Cancer:
What are the four major histological types of this condition? (4)
Small cell carcinoma
Non-small cell carcinoma:
Squamous, Adenocarcinoma, Large Cell undifferentiated carcinoma.
Lung Cancer:
List four organs or tissues to which this condition commonly spreads? (4)
Bone Brain Liver Adrenal Gland Lymph Nodes
An 18 year old student presents to his GP with a 3 day history of left pleuritic chest pain, a productive cough, increasing breathlessness, fever and anorexia.
List six possible clinical signs in a patient with left lower lobe pneumonia/consolidation. (6)
Tachycardia Tachypnoea Hypotension Cyanosis Reduced left-sided chest expansion Dullness to percussion at left base Bronchial Breathing at left base
Name three micro-organisms which are most commonly responsible for pneumonia in a young previously healthy individual. (3)
Streptococcus pneumoniae Mycoplasma pneumoniae Legionella pneumophilia Coxiella burnetti Chlamydia psittaci
Pneumonia:
What four investigations should be performed to make the diagnosis? (4)
CXR Sputum culture FBC ESR/CRP Blood culture
Pneumonia:
What two classes of antibiotics should be used to treat this man before a bacteriological diagnosis is reached? (2)
Beta-lactams
Macrolides
Pneumonia:
In addition to antibiotics what three other measures would you instigate to manage this man in hospital? (3)
Supplemental oxygen
Analgesia
IV fluids.
