Respiratory - High

Question 1

FEV1=

Answer 1

-Forced expiratory volume in 1 second

The result is compared with the predicted values, if the FEV1 is 80% or greater than the predicted value = NORMAL
• Thus is the FEV1 is less than 80% of the predicted value = LOW i.e abnormal

Question 2

FVC =

A low FVC =

Answer 2

-forced vital capacity, the total amount of air forcibly expired

The result is compared with the predicted values, if the FVC is 80% or greater than the predicted value = NORMAL
• Thus is the FVC is less than 80% of the predicted value = LOW i.e abnormal

-airway restriction

Question 3

FEV1/FVC ratio:

Answer 3

• If the ratio is below 0.7 = airway obstruction

* If the ratio is high i.e. normal but the FVC is low = airway restriction

Question 4

TYPE 1 RESPIRATORY FAILURE:

Answer 4

• pO2 (partial O2 pressure) is low
• pCO2 (partial CO2 pressure) is low or normal
• With Type 1 = 1 change = low pO2 then normal/low CO2
• Pulmonary embolism (form of ventilation-perfusion mismatch) most
commonly causes Type 1

Question 5

TYPE 2 RESPIRATORY FAILURE:

Answer 5

• pO2 is low
• pCO2 is high
• With Type 2 = 2 changes = low pO2 + high pCO2
• Hypoventilation causes Type 2

Question 6

Restrictive vs. Obstructive Respiratory Disease:

- Obstructive:

Answer 6

• FEV1/FVC below 0.7
• FEV1 lower than FVC
• ASTHMA:
- Variable airflow obstruction
- Reversible
• COPD:
- Relatively fixed airflow obstruction
- May be a mixture of restrictive and obstructive disease
(• Bronchiectasis)

Question 7

Restrictive vs. Obstructive Respiratory Disease:

Restrictive:

Answer 7

• FEV1/FVC above 0.7
• FVC & FEV1 below 80% predicted value
• Due to restriction, lung volumes are small and most of breath is out in
first second
• Interstitial lung disease:
- FIBROSING ALVEOLITIS
- SARCOID

Question 8

COPD clinical presentation

• symptoms
• on examination

Answer 8

-Characteristic symptoms are productive cough with white or clear sputum,
wheeze and breathlessness, usually following many years of a smokers cough
-On examination a patient with severe disease is breathless at rest with
prolonged expiration, chest expansion is poor and the lungs are hyper
inflated (barrel chest)

Question 9

Lung function test

Answer 9

• FEV less than 80% predicted value
• FEV1/FVC less than 0.7 - airway obstruction
• Stages:
- Stage 1 - FEV1 less than 80% of predicted value
- Stage 2 - FEV1 50-79%
- Stage 3 - FEV1 30-49%
- Stage 4 - FEV1 less than 30% of predicted value

Question 10

Two main types of asthma:

Answer 10

• Allergic/eosinophilic asthma (70%):
- Allergens (e.g. fungal allergens and pets etc.) & atopy
• Non-allergic/non-eosinophilic (30%):
- Exercise, cold air & stress
- Smoking & non smoking associated
- Obesity associated

Question 11

Immediate asthma management

Answer 11

• Oxygen therapy to maintain O2 sat (94%-98%)
• Nebulised 5mg salbutamol (+ ipratropium if life threatening) - repeat/IV
infusion
• Prednisolone (with or without hydrocortisone IV)
• Take arterial blood gases and repeat within 2 hours if severe attack or
patient deteriorating
• Chest X-ray if fails to respond to treatment
• Check PEFR within 15-30 mins/regularly
• Oximetry to ensure SaO2 is greater than 92%

Question 12

Anti-inflammatory steroids:
• Inhaled corticosteroids (ICS):

Other agents with bronchodilator activity:

Answer 12

=Prednisolone
• Beclomatasone
• Budesonide

• Leukotriene receptor antagonist e.g. montelukast
• Oral corticosteroid needed for those not controlled on inhaled
corticosteroids e.g. prednisolone
- Steroid-sparing agents:
• Methotrexate
• Ciclosporin
• IV immunoglobulin
• Anti-IgE monoclonal antibody - omalizumab

Question 13

Guideline medication asthma regime:

Answer 13

• SABA mild
• SABA + ICS
• SABA + LABA + ICS
• SABA + LABA + ICS + 4th drug e.g. anti-IgE monoclonal etc. severe

Question 14

BRONCHIECTASIS:

Major pathogens:

Answer 14

• Haemophilus influenza
• Streptococcus pneumoniae
• Staphylococcus Aureus
• Pseudomonas aeruginosa