Respiratory Formative Q&A

Question 1

The volume of gas that enters or leaves the lung with each cycle of respiration

Answer 1

Tidal volume

Question 2

The additional volume of air that can be inhaled after a normal resting inspiration

Answer 2

Inspiratory reserve volume

Question 3

The volume of air remaining in the lungs after a normal resting expiration

Answer 3

Functional residual volume

Question 4

The product of tidal volume and respiratory rate

Answer 4

Minute ventilation

Question 5

Most of the CO2 transported in the blood is …

Answer 5

In the form of bicarbonate ions

Question 6

Most of the O2 transported by the blood is

Answer 6

Bound to haemoglobin

Question 7

Pa O2 and pH are sensed by

Answer 7

Peripheral chemoreceptors

Question 8

Pa CO2 is sensed by

Answer 8

Central chemoreceptors

Question 9

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?

Answer 9

Serum calcium

Question 10

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?

Answer 10

CT thorax

Question 11

A 55 year old cigarette smoker attending his general practitioner with a two month history of troublesome cough…

Initial investigation?

Answer 11

Chest x-ray

Question 12

A 79 year old woman with a peripheral speculated opacity on chest x-ray and an enlarged superclavicular lymph node. ..

Initial investigation?

Answer 12

FNA lymph node

Question 13

A 35 year old man with cystic fibrosis…

Likely organism.

Answer 13

Pseudomonas aeruginosa

Question 14

A 50 year old oil executive with lobar pneumonia…

Likely organism.

Answer 14

Streptococcus pneumoniae

Question 15

A 65 year old man with lobar pneumonia whose parrot is unwell…

Likely organism.

Answer 15

Chlamydia psittaci

Question 16

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…

Answer 16

Primary Pneumothorax

Question 17

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…

Answer 17

Empyema Thoracis

Question 18

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…

Answer 18

Aspiration pneumonia

Question 19

A patient with newly diagnosed asthma and waking up at night because of asthma should be commenced on…

Answer 19

Inhaled corticosteroids and inhaled beta-2-agonist

Question 20

Patients at step 2 therapy with poor control should be commenced on an…

Answer 20

Inhaled long acting beta-2-agonist

Question 21

A patient at step 5 of the treatment guidelines will require long-term…

Answer 21

Oral corticosteroid

Question 22

Treatment with an inhaled beta-2-agonist is only recommended for patients at step…

Answer 22

Step 1

Question 23

What is the clinical term for coughing up blood?

Answer 23

Haemoptysis

Question 24

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?

Answer 24

Lung Cancer

Question 25

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?

Answer 25

Finger Clubbing

Question 26

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?

Answer 26

Hepatomegaly

Question 27

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?

Answer 27

Lymphadenopathy SVC Obstruction Tracheal Deviation

Question 28

Lung Cancer: | Give two imaging techniques which would be useful to define the extent of the lesion? (2)

Answer 28

CXR CT MRI

Question 29

Lung Cancer: | Apart from imaging techniques, list two other investigations you would perform at this stage. (2)

Answer 29

Pulmonary Function Test | Biopsy – Percutaneous or Bronchoscopic

Question 30

Lung Cancer: | What are the four major histological types of this condition? (4)

Answer 30

Small cell carcinoma Non-small cell carcinoma: Squamous, Adenocarcinoma, Large Cell undifferentiated carcinoma.

Question 31

Lung Cancer: | List four organs or tissues to which this condition commonly spreads? (4)

Answer 31

``` Bone Brain Liver Adrenal Gland Lymph Nodes ```

Question 32

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)

Answer 32

``` Tachycardia Tachypnoea Hypotension Cyanosis Reduced left-sided chest expansion Dullness to percussion at left base Bronchial Breathing at left base ```

Question 33

Name three micro-organisms which are most commonly responsible for pneumonia in a young previously healthy individual. (3)

Answer 33

``` Streptococcus pneumoniae Mycoplasma pneumoniae Legionella pneumophilia Coxiella burnetti Chlamydia psittaci ```

Question 34

Pneumonia: | What four investigations should be performed to make the diagnosis? (4)

Answer 34

``` CXR Sputum culture FBC ESR/CRP Blood culture ```

Question 35

Pneumonia: What two classes of antibiotics should be used to treat this man before a bacteriological diagnosis is reached? (2)

Answer 35

Beta-lactams | Macrolides

Question 36

Pneumonia: | In addition to antibiotics what three other measures would you instigate to manage this man in hospital? (3)

Answer 36

Supplemental oxygen Analgesia IV fluids.