Respiratory medicine is a vital branch of medical science that focuses on the diagnosis, treatment, and management of disorders affecting the respiratory system. The respiratory system plays a fundamental role in our overall health by facilitating the exchange of oxygen and carbon dioxide between our bodies and the external environment.
As a medical student, understanding the intricacies of the respiratory system is crucial, as respiratory disorders are incredibly common and can have a significant impact on patients’ quality of life. By studying respiratory medicine, you will learn about a wide range of conditions, including asthma, chronic obstructive pulmonary disease (COPD), pneumonia, lung cancer, and many others.
To reinforce your knowledge in this field, take the following multiple-choice questions. By doing so, you will not only enhance your knowledge but also prepare yourself for future clinical practice where respiratory conditions are encountered frequently.
Match the clinical findings with the condition:
- Lobar Collapse
- Pleural Effusion
- Pulmonary Embolism
- Pulmonary fibrosis
|Expansion||Air entry||Percussion||Auscultation||Vocal resonance|
|Reduced affected side||Reduced affected side||Hyper-resonant||Reduced air entry||Reduced|
|Reduced both sides & hyperinflated||Reduced bilaterally||Hyper-resonant||Wheeze+/-\: expiratory polyphonic||Reduced|
|Reduced both sides||Reduced bilaterally||No change / Reduced||Crackles-fine inspiratory DO NOT clear on coughing||No change / Reduced|
|Reduced both sides||Reduced bilaterally||No change / Reduced||Crackles-fine inspiratory DO clear on coughing||No change / Reduced|
|Reduced both sides during active disease||?both sides during active disease||Hyper-resonant||Wheeze\: expiratory polyphonic||No change|
|Reduced both sides||?both sides||No change||Wheeze\:inspiratory often monophonic||No change|
|Reduced side of collapse(ipsilaterally), trachea pulled to that side||Reduced ipsilaterally||Reduced ipsilaterally||Reduced air entry||Reduced|
|Reduced side of collapse||Reduced ipsilaterally||Reduced ipsilaterally||Bronchial breathing, Reduced air entry||Reduced|
|No change||No change||No change (Reduced if infarcted tissue)||Possible pleural rub (crunching through snow) often heard over area||No change|
|Reduced side of effusion (ipsilaterally), trachea pushed to other side||Reduced ipsilaterally||Reduced ipsilaterally, stoney dull||Reduced air entry||Reduced|
Obstructive Sleep Apnoea (OSA)
What is the The treatment of choice for obstructive sleep apnoea?
A female presents to A&E with mild pleuritic right sided chest pain. A Chest X-ray reveals a small (<1cm) ring of air outside the lung at the apex. What is the correct management?
- Observation Only
- Aspiration under ultrasound guidance
- Aspiration without ultrasound
- Chest drain (seldinger technique)
- Chest drain (trochar technique)
COPD vs Asthma
What is the key distinguishing factor between COPD and asthma in pulmonary function tests?
- Severity of obstruction
- Response to bronchodilators
Bronchiectasis vs ILD
Which clinical feature is most useful in differentiation of pulmonary fibrosis and bronchiectasis?
- Forced expiratory time
- FEV1 at bedside spirometry
- The presence of fixed crackles
- Presence of a pleural effusion
In COPD which of the following suggests a patient requires LTOT (long term oxygen therapy).
ABG CO2 >8
*ABG PO2<7.3 kPA
Exercise tolerance of <10 yards limited by SOB
FEV1 <33% prediced
- ABG PH<7.35
- ABG CO2 >7.5
- ABG PO2<7.3 kPA
- Exercise tolerance of <10 yards limited by SOB
- FEV1 <33% prediced
Obstructive Sleep Apnoea
What proportion of patients with obstructive sleep apnoea (OSA) have a formal diagnosis of OSA?
Lung Cancer Operability
A patient with lung cancer is worked up for an operation. He has the following lung function tests:
FEV1 0.8L (29% Predicted)
FVC 3.1 L (92% Predicted)
He has had a CT scan chest abdo pelvis and a PET scan which show no metastatic spread and a solitary lung lesion in the right middle lobe. The cancer is biopsied at bronchoscopy and is found to be an adenocarcinoma.
Is this operable?
Lung function tests
A patient has the following lung function tests.
FEV1 1.6L (50% Predicted)
FVC 3.2 L (92% Predicted)
What is the abnormality shown on the lung function tests?
- Obstructive airways disease (Mild)
- Obstructive airways disease (Moderate)
- Obstructive Airways disease (severe)
- Type I respiratory Failure
- Restrictive Airways disease