Respiratory Medicine Flashcards

A young tall man presents with sudden pleuritic chest pain and breathlessness; chest X-ray shows a 1 cm rim of air with no mediastinal shift. What is the appropriate management?

Answer: Observation with high-flow oxygen and reassessment

A small primary spontaneous pneumothorax without significant breathlessness can be managed conservatively with observation and oxygen.

Which clinical sign indicates a tension pneumothorax requiring immediate decompression?

Answer: Tracheal deviation away from the affected side with hypotension

Tension pneumothorax causes mediastinal shift with tracheal deviation, hypotension and distended neck veins, requiring emergency decompression.

Spirometry shows FEV1/FVC ratio of 0.62 with reduced FEV1. This pattern is characteristic of which condition?

Answer: Obstructive airways disease such as COPD

A reduced FEV1/FVC ratio below 0.7 indicates an obstructive ventilatory defect such as COPD or asthma.

Which spirometry pattern is typical of idiopathic pulmonary fibrosis?

Answer: Restrictive pattern with reduced FVC and preserved or increased FEV1/FVC ratio

Pulmonary fibrosis produces a restrictive defect with reduced lung volumes and a preserved or raised FEV1/FVC ratio.

A patient with idiopathic pulmonary fibrosis is most likely to have which examination finding?

Answer: Fine bibasal end-inspiratory crackles and clubbing

Fine bibasal end-inspiratory crackles with finger clubbing are characteristic of pulmonary fibrosis.

Which is the most appropriate first-line investigation for suspected obstructive sleep apnoea?

Answer: Overnight polysomnography or sleep study

A sleep study (polysomnography) is the diagnostic investigation for obstructive sleep apnoea.

What is the first-line treatment for moderate to severe obstructive sleep apnoea?

Answer: Continuous positive airway pressure (CPAP)

CPAP is the mainstay treatment for moderate to severe obstructive sleep apnoea.