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  • Question 1 - A 65-year-old man with uncontrolled diabetes complains of severe otalgia and headaches. During...

    Incorrect

    • A 65-year-old man with uncontrolled diabetes complains of severe otalgia and headaches. During examination, granulation tissue is observed in the external auditory meatus. What is the probable causative agent of the infection?

      Your Answer: Streptococcus pyogenes

      Correct Answer: Pseudomonas aeruginosa

      Explanation:

      The primary cause of malignant otitis externa is typically Pseudomonas aeruginosa. Symptoms of this condition include intense pain, headaches, and the presence of granulation tissue in the external auditory meatus. Individuals with diabetes mellitus are at a higher risk for developing this condition.

      Malignant Otitis Externa: A Rare but Serious Infection

      Malignant otitis externa is a type of ear infection that is uncommon but can be serious. It is typically found in individuals who are immunocompromised, with 90% of cases occurring in diabetics. The infection starts in the soft tissues of the external auditory meatus and can progress to involve the soft tissues and bony ear canal, eventually leading to temporal bone osteomyelitis.

      Key features in the patient’s history include diabetes or immunosuppression, severe and persistent ear pain, temporal headaches, and purulent otorrhea. In some cases, patients may also experience dysphagia, hoarseness, and facial nerve dysfunction.

      Diagnosis is typically done through a CT scan, and non-resolving otitis externa with worsening pain should be referred urgently to an ENT specialist. Treatment involves intravenous antibiotics that cover pseudomonal infections.

      In summary, malignant otitis externa is a rare but serious infection that requires prompt diagnosis and treatment. Patients with diabetes or immunosuppression should be particularly vigilant for symptoms and seek medical attention if they experience persistent ear pain or other related symptoms.

    • This question is part of the following fields:

      • Respiratory System
      25.1
      Seconds
  • Question 2 - A patient in her 50s undergoes spirometry, during which she is instructed to...

    Correct

    • A patient in her 50s undergoes spirometry, during which she is instructed to perform a maximum forced exhalation following a maximum inhalation. The volume of exhaled air is measured. What is the term used to describe the difference between this volume and her total lung capacity?

      Your Answer: Residual volume

      Explanation:

      The total lung capacity can be calculated by adding the vital capacity and residual volume. The expiratory reserve volume refers to the amount of air that can be exhaled after a normal breath compared to a maximal exhalation. The functional residual capacity is the amount of air remaining in the lungs after a normal exhalation. The inspiratory reserve volume is the difference between the amount of air in the lungs after a normal breath and a maximal inhalation. The residual volume is the amount of air left in the lungs after a maximal exhalation, which is the difference between the total lung capacity and vital capacity. The vital capacity is the maximum amount of air that can be inhaled and exhaled, measured by the volume of air exhaled after a maximal inhalation.

      Understanding Lung Volumes in Respiratory Physiology

      In respiratory physiology, lung volumes can be measured to determine the amount of air that moves in and out of the lungs during breathing. The diagram above shows the different lung volumes that can be measured.

      Tidal volume (TV) refers to the amount of air that is inspired or expired with each breath at rest. In males, the TV is 500ml while in females, it is 350ml.

      Inspiratory reserve volume (IRV) is the maximum volume of air that can be inspired at the end of a normal tidal inspiration. The inspiratory capacity is the sum of TV and IRV. On the other hand, expiratory reserve volume (ERV) is the maximum volume of air that can be expired at the end of a normal tidal expiration.

      Residual volume (RV) is the volume of air that remains in the lungs after maximal expiration. It increases with age and can be calculated by subtracting ERV from FRC. Speaking of FRC, it is the volume in the lungs at the end-expiratory position and is equal to the sum of ERV and RV.

      Vital capacity (VC) is the maximum volume of air that can be expired after a maximal inspiration. It decreases with age and can be calculated by adding inspiratory capacity and ERV. Lastly, total lung capacity (TLC) is the sum of vital capacity and residual volume.

      Physiological dead space (VD) is calculated by multiplying tidal volume by the difference between arterial carbon dioxide pressure (PaCO2) and end-tidal carbon dioxide pressure (PeCO2) and then dividing the result by PaCO2.

    • This question is part of the following fields:

      • Respiratory System
      90.8
      Seconds
  • Question 3 - A 16-year-old girl presents to the Emergency department with her mother. The mother...

    Incorrect

    • A 16-year-old girl presents to the Emergency department with her mother. The mother reports that her daughter has been experiencing worsening breathlessness and facial puffiness for the past 30 minutes. Apart from eczema, the girl has been healthy and is currently taking oral contraceptives. On examination, the girl appears to be in distress, with laboured breathing and stridor but no wheezing. What is the probable cause of her breathlessness?

      Your Answer: Acute epiglottitis

      Correct Answer: Angio-oedema

      Explanation:

      Noisy Breathing and Atopy in Adolescents

      The presence of noisy breathing in an adolescent may indicate the possibility of stridor, which can be caused by an allergic reaction even in an otherwise healthy individual. The history of atopy, or a tendency to develop allergic reactions, further supports the diagnosis of angio-oedema. The sudden onset of symptoms also adds to the likelihood of this diagnosis.

      While asthma is a possible differential diagnosis, it typically presents with expiratory wheezing. However, if the chest is silent, it may indicate a severe and life-threatening form of asthma. Therefore, it is important to consider all possible causes of noisy breathing and atopy in adolescents to ensure prompt and appropriate treatment.

    • This question is part of the following fields:

      • Respiratory System
      72.3
      Seconds
  • Question 4 - A 65-year-old man with a 45-pack-year history arrives at the hospital complaining of...

    Incorrect

    • A 65-year-old man with a 45-pack-year history arrives at the hospital complaining of increased difficulty breathing and cachexia. Upon examination, a chest X-ray reveals an elevated left hemidiaphragm, enlarged hilar lymph nodes, and a significant opacification. Which structure is most likely to have been affected?

      Your Answer:

      Correct Answer: Left phrenic nerve

      Explanation:

      It is unlikely that direct injury would result in the elevation of the left hemidiaphragm, especially since there is no history of trauma or surgery. However, damage to the long thoracic nerve could cause winging of the scapula due to weakened serratus anterior muscle. On the other hand, injury to the thoracodorsal nerve, which innervates the latissimus dorsi muscle, can lead to weakened shoulder adduction and is a common complication of axillary surgery.

      The Phrenic Nerve: Origin, Path, and Supplies

      The phrenic nerve is a crucial nerve that originates from the cervical spinal nerves C3, C4, and C5. It supplies the diaphragm and provides sensation to the central diaphragm and pericardium. The nerve passes with the internal jugular vein across scalenus anterior and deep to the prevertebral fascia of the deep cervical fascia.

      The right phrenic nerve runs anterior to the first part of the subclavian artery in the superior mediastinum and laterally to the superior vena cava. In the middle mediastinum, it is located to the right of the pericardium and passes over the right atrium to exit the diaphragm at T8. On the other hand, the left phrenic nerve passes lateral to the left subclavian artery, aortic arch, and left ventricle. It passes anterior to the root of the lung and pierces the diaphragm alone.

      Understanding the origin, path, and supplies of the phrenic nerve is essential in diagnosing and treating conditions that affect the diaphragm and pericardium.

    • This question is part of the following fields:

      • Respiratory System
      0
      Seconds
  • Question 5 - A 59-year-old woman visits the respiratory clinic for spirometry testing. As part of...

    Incorrect

    • A 59-year-old woman visits the respiratory clinic for spirometry testing. As part of the testing, what is the definition of functional residual capacity?

      Your Answer:

      Correct Answer: Functional residual capacity = expiratory reserve volume + residual volume

      Explanation:

      To calculate the volume of air in the lungs after a normal relaxed expiration, one can use the formula for functional residual capacity (FRC), which is determined by the balance between the lungs’ tendency to recoil inwards and the chest wall’s tendency to pull outwards. FRC can be calculated by adding the expiratory reserve volume and the residual volume. In individuals with tetraplegia, decreases in FRC are primarily caused by a reduction in the outward pull of the chest wall, which occurs over time due to the inability to regularly expand the chest wall to large lung volumes. This reduction in FRC can increase the risk of atelectasis.

      Understanding Lung Volumes in Respiratory Physiology

      In respiratory physiology, lung volumes can be measured to determine the amount of air that moves in and out of the lungs during breathing. The diagram above shows the different lung volumes that can be measured.

      Tidal volume (TV) refers to the amount of air that is inspired or expired with each breath at rest. In males, the TV is 500ml while in females, it is 350ml.

      Inspiratory reserve volume (IRV) is the maximum volume of air that can be inspired at the end of a normal tidal inspiration. The inspiratory capacity is the sum of TV and IRV. On the other hand, expiratory reserve volume (ERV) is the maximum volume of air that can be expired at the end of a normal tidal expiration.

      Residual volume (RV) is the volume of air that remains in the lungs after maximal expiration. It increases with age and can be calculated by subtracting ERV from FRC. Speaking of FRC, it is the volume in the lungs at the end-expiratory position and is equal to the sum of ERV and RV.

      Vital capacity (VC) is the maximum volume of air that can be expired after a maximal inspiration. It decreases with age and can be calculated by adding inspiratory capacity and ERV. Lastly, total lung capacity (TLC) is the sum of vital capacity and residual volume.

      Physiological dead space (VD) is calculated by multiplying tidal volume by the difference between arterial carbon dioxide pressure (PaCO2) and end-tidal carbon dioxide pressure (PeCO2) and then dividing the result by PaCO2.

    • This question is part of the following fields:

      • Respiratory System
      0
      Seconds
  • Question 6 - Which of the following physiological changes does not take place after a tracheostomy?...

    Incorrect

    • Which of the following physiological changes does not take place after a tracheostomy?

      Your Answer:

      Correct Answer: Work of breathing is increased.

      Explanation:

      HFNC is a popular option for weaning ventilated patients as it reduces work of breathing and humidified air helps to reduce mucous viscosity.

      Anatomy of the Trachea

      The trachea, also known as the windpipe, is a tube-like structure that extends from the C6 vertebrae to the upper border of the T5 vertebrae where it bifurcates into the left and right bronchi. It is supplied by the inferior thyroid arteries and the thyroid venous plexus, and innervated by branches of the vagus, sympathetic, and recurrent nerves.

      In the neck, the trachea is anterior to the isthmus of the thyroid gland, inferior thyroid veins, and anastomosing branches between the anterior jugular veins. It is also surrounded by the sternothyroid, sternohyoid, and cervical fascia. Posteriorly, it is related to the esophagus, while laterally, it is in close proximity to the common carotid arteries, right and left lobes of the thyroid gland, inferior thyroid arteries, and recurrent laryngeal nerves.

      In the thorax, the trachea is anterior to the manubrium, the remains of the thymus, the aortic arch, left common carotid arteries, and the deep cardiac plexus. Laterally, it is related to the pleura and right vagus on the right side, and the left recurrent nerve, aortic arch, and left common carotid and subclavian arteries on the left side.

      Overall, understanding the anatomy of the trachea is important for various medical procedures and interventions, such as intubation and tracheostomy.

    • This question is part of the following fields:

      • Respiratory System
      0
      Seconds
  • Question 7 - A 70-year-old man visits a respiratory clinic complaining of shortness of breath even...

    Incorrect

    • A 70-year-old man visits a respiratory clinic complaining of shortness of breath even with minimal activity. Upon conducting a thorough assessment, you suspect that he may have idiopathic pulmonary fibrosis. To aid in your diagnosis, you decide to review his previous medical records. You come across the following spirometry results:

      Measurement volume (ml)
      Vital Capacity (VC) 4400
      Inspiratory Reserve Volume (IRV) 3000
      Functional Residual Capacity (FRC) 2800
      Residual Volume (RV) 1200

      What is the total lung capacity (TLC) of this patient?

      Your Answer:

      Correct Answer: 5600ml

      Explanation:

      The correct answer is 5600ml, which represents the total lung capacity. This value is obtained by adding the vital capacity, which is the maximum amount of air that can be breathed out after a deep inhalation, to the residual volume, which is the amount of air that remains in the lungs after a maximal exhalation. The vital capacity is composed of three volumes: the inspiratory reserve volume, the tidal volume, and the expiratory reserve volume. Other formulas are available to calculate different lung volumes, but they are not as commonly used.

      Understanding Lung Volumes in Respiratory Physiology

      In respiratory physiology, lung volumes can be measured to determine the amount of air that moves in and out of the lungs during breathing. The diagram above shows the different lung volumes that can be measured.

      Tidal volume (TV) refers to the amount of air that is inspired or expired with each breath at rest. In males, the TV is 500ml while in females, it is 350ml.

      Inspiratory reserve volume (IRV) is the maximum volume of air that can be inspired at the end of a normal tidal inspiration. The inspiratory capacity is the sum of TV and IRV. On the other hand, expiratory reserve volume (ERV) is the maximum volume of air that can be expired at the end of a normal tidal expiration.

      Residual volume (RV) is the volume of air that remains in the lungs after maximal expiration. It increases with age and can be calculated by subtracting ERV from FRC. Speaking of FRC, it is the volume in the lungs at the end-expiratory position and is equal to the sum of ERV and RV.

      Vital capacity (VC) is the maximum volume of air that can be expired after a maximal inspiration. It decreases with age and can be calculated by adding inspiratory capacity and ERV. Lastly, total lung capacity (TLC) is the sum of vital capacity and residual volume.

      Physiological dead space (VD) is calculated by multiplying tidal volume by the difference between arterial carbon dioxide pressure (PaCO2) and end-tidal carbon dioxide pressure (PeCO2) and then dividing the result by PaCO2.

    • This question is part of the following fields:

      • Respiratory System
      0
      Seconds
  • Question 8 - A 65-year-old man is undergoing an upper GI endoscopy due to difficulty swallowing....

    Incorrect

    • A 65-year-old man is undergoing an upper GI endoscopy due to difficulty swallowing. During the procedure, a suspicious-looking blockage is found at 33 cm from the incisors. The endoscopist tries to widen the area with a balloon, but the tumor causes a rupture in the oesophageal wall. Where will the contents of the oesophagus now drain?

      Your Answer:

      Correct Answer: Posterior mediastinum

      Explanation:

      The oesophagus is expected to remain within the thoracic cavity and situated in the posterior mediastinum at this point.

      The mediastinum is the area located between the two pulmonary cavities and is covered by the mediastinal pleura. It extends from the thoracic inlet at the top to the diaphragm at the bottom. The mediastinum is divided into four regions: the superior mediastinum, middle mediastinum, posterior mediastinum, and anterior mediastinum.

      The superior mediastinum is the area between the manubriosternal angle and T4/5. It contains important structures such as the superior vena cava, brachiocephalic veins, arch of aorta, thoracic duct, trachea, oesophagus, thymus, vagus nerve, left recurrent laryngeal nerve, and phrenic nerve. The anterior mediastinum contains thymic remnants, lymph nodes, and fat. The middle mediastinum contains the pericardium, heart, aortic root, arch of azygos vein, and main bronchi. The posterior mediastinum contains the oesophagus, thoracic aorta, azygos vein, thoracic duct, vagus nerve, sympathetic nerve trunks, and splanchnic nerves.

      In summary, the mediastinum is a crucial area in the thorax that contains many important structures and is divided into four regions. Each region contains different structures that are essential for the proper functioning of the body.

    • This question is part of the following fields:

      • Respiratory System
      0
      Seconds
  • Question 9 - You are on call for the pediatric ward at night and are urgently...

    Incorrect

    • You are on call for the pediatric ward at night and are urgently called to a child who is choking on a piece of hot dog visible in their oropharynx. The child is in extremis with saturations of 87% and there is no effective cough.

      What is the most appropriate immediate management for this pediatric patient?

      Your Answer:

      Correct Answer: Back blows

      Explanation:

      Resuscitation Council (UK) Recommendations for Choking Emergencies

      When faced with a choking emergency, the Resuscitation Council (UK) recommends a specific course of action. If the patient is able to cough effectively, encourage them to do so. If not, but they are conscious, try five back blows followed by five abdominal thrusts (Heimlich manoeuvre) and repeat if necessary. However, if the patient becomes unconscious, begin CPR immediately. It is important to note that a finger sweep is no longer recommended as it can push the obstruction further into the airway. Additionally, high flow oxygen is necessary for breathing, but nasopharyngeal airways will not help in this situation. Removal with forceps is also not recommended as it can be hazardous. If the Heimlich manoeuvre fails, a cricothyroidotomy should be considered. While this procedure is recommended in the US and UK, it is not encouraged in some countries like Australia due to the risk of internal injury from over-vigorous use.

    • This question is part of the following fields:

      • Respiratory System
      0
      Seconds
  • Question 10 - What causes a cervical rib? ...

    Incorrect

    • What causes a cervical rib?

      Your Answer:

      Correct Answer: Elongation of the transverse processes of the 7th cervical vertebrae

      Explanation:

      Cervical ribs are formed when the transverse process of the 7th cervical vertebrae becomes elongated, resulting in a fibrous band that connects to the first thoracic rib.

      Cervical ribs are a rare anomaly that affects only 0.2-0.4% of the population. They are often associated with neurological symptoms and are caused by an anomalous fibrous band that originates from the seventh cervical vertebrae and may arc towards the sternum. While most cases are congenital and present around the third decade of life, some cases have been reported to occur following trauma. Bilateral cervical ribs are present in up to 70% of cases. Compression of the subclavian artery can lead to absent radial pulse and a positive Adsons test, which involves lateral flexion of the neck towards the symptomatic side and traction of the symptomatic arm. Treatment is usually only necessary when there is evidence of neurovascular compromise, and the traditional operative method for excision is a transaxillary approach.

    • This question is part of the following fields:

      • Respiratory System
      0
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