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  • Question 1 - A senior citizen who has been a lifelong smoker visits the respiratory clinic...

    Incorrect

    • A senior citizen who has been a lifelong smoker visits the respiratory clinic for a check-up on his emphysema. What alterations in his lung function test results would you anticipate?

      Your Answer: Increased residual volume and increased vital capacity

      Correct Answer: Increased residual volume and reduced vital capacity

      Explanation:

      Emphysema causes an increase in residual volume, leading to a decrease in vital capacity. This is due to damage to the alveolar walls, which results in the formation of large air sacs called bullae. The lungs lose their compliance, making it difficult to fully exhale and causing air to become trapped in the bullae. As a result, the total volume that can be exhaled is reduced, leading to a decrease in vital capacity.

      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
      28.6
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  • Question 2 - A 38-year-old woman visits her GP with a solitary, painless tumour in her...

    Correct

    • A 38-year-old woman visits her GP with a solitary, painless tumour in her left cheek. Upon further examination, she is diagnosed with pleomorphic adenoma. What is the recommended management for this condition?

      Your Answer: Surgical resection

      Explanation:

      Surgical resection is the preferred treatment for pleomorphic adenoma, a benign tumor of the parotid gland that may undergo malignant transformation. Chemotherapy and radiotherapy are not effective in managing this condition. Additionally, salivary stone removal is not relevant to the treatment of pleomorphic adenoma.

      Understanding Pleomorphic Adenoma

      Pleomorphic adenoma, also known as a benign mixed tumour, is a non-cancerous growth that commonly affects the parotid gland. This type of tumour usually develops in individuals aged 40 to 60 years old. The condition is characterized by the proliferation of epithelial and myoepithelial cells of the ducts, as well as an increase in stromal components. The tumour is slow-growing, lobular, and not well encapsulated.

      The clinical features of pleomorphic adenoma include a gradual onset of painless unilateral swelling of the parotid gland. The swelling is typically movable on examination rather than fixed. The management of pleomorphic adenoma involves surgical excision. The prognosis is generally good, with a recurrence rate of 1-5% with appropriate excision (parotidectomy). However, recurrence may occur due to capsular disruption during surgery. If left untreated, pleomorphic adenoma may undergo malignant transformation, occurring in 2-10% of adenomas observed for long periods. Carcinoma ex-pleomorphic adenoma is the most common type of malignant transformation, occurring most frequently as adenocarcinoma.

    • This question is part of the following fields:

      • Respiratory System
      18.7
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  • Question 3 - A 72-year-old male has unfortunately been diagnosed with lung cancer after a brief...

    Correct

    • A 72-year-old male has unfortunately been diagnosed with lung cancer after a brief illness during which he visited his GP with a cough and loss of weight. The GP has received the histology report after a recent bronchoscopy, which revealed a squamous cell carcinoma. What symptoms would you anticipate in this patient based on the diagnosis?

      Your Answer: Clubbing

      Explanation:

      Hypertrophic pulmonary osteoarthropathy (HPOA) is linked to squamous cell carcinoma, while small cell carcinoma of the lung is associated with excessive secretion of ADH and may also cause hypertension, hyperglycemia, and hypokalemia due to excessive ACTH secretion (although this is not typical). Lambert-Eaton syndrome is also linked to small cell carcinoma, while adenocarcinoma of the lung is associated with gynecomastia.

      Lung cancer can present with paraneoplastic features, which are symptoms caused by the cancer but not directly related to the tumor itself. Small cell lung cancer can cause the secretion of ADH and, less commonly, ACTH, which can lead to hypertension, hyperglycemia, hypokalemia, alkalosis, and muscle weakness. Lambert-Eaton syndrome is also associated with small cell lung cancer. Squamous cell lung cancer can cause the secretion of parathyroid hormone-related protein, leading to hypercalcemia, as well as clubbing and hypertrophic pulmonary osteoarthropathy. Adenocarcinoma can cause gynecomastia and hypertrophic pulmonary osteoarthropathy. Hypertrophic pulmonary osteoarthropathy is a painful condition involving the proliferation of periosteum in the long bones. Although traditionally associated with squamous cell carcinoma, some studies suggest that adenocarcinoma is the most common cause.

    • This question is part of the following fields:

      • Respiratory System
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  • Question 4 - A 10-year-old boy is recuperating the day after a tonsillectomy. His parents report...

    Incorrect

    • A 10-year-old boy is recuperating the day after a tonsillectomy. His parents report that he hasn't had anything to eat for 6 hours prior to the surgery and he is feeling famished. However, he is declining any attempts to consume food or water. There are no prescribed medications or known drug allergies listed on his medical records.

      What would be the most appropriate first step to take?

      Your Answer: Start maintenance fluids

      Correct Answer: Prescribe analgesia and encourage oral intake

      Explanation:

      Effective pain management is crucial after a tonsillectomy to promote the consumption of food and fluids.

      Prescribing analgesics and encouraging oral intake is the best course of action. This will alleviate pain and enable the patient to eat and drink, which is essential for a speedy recovery.

      Starting maintenance fluids or partial nutritional feeds, obtaining IV access, or waiting for two hours before reviewing the patient are not the most appropriate options. Analgesia should be the primary consideration to facilitate oral fluid therapy and promote healing.

      Tonsillitis and Tonsillectomy: Complications and Indications

      Tonsillitis is a condition that can lead to various complications, including otitis media, peritonsillar abscess, and, in rare cases, rheumatic fever and glomerulonephritis. Tonsillectomy, the surgical removal of the tonsils, is a controversial procedure that should only be considered if the person meets specific criteria. According to NICE, surgery should only be considered if the person experiences sore throats due to tonsillitis, has five or more episodes of sore throat per year, has been experiencing symptoms for at least a year, and the episodes of sore throat are disabling and prevent normal functioning. Other established indications for a tonsillectomy include recurrent febrile convulsions, obstructive sleep apnoea, stridor, dysphagia, and peritonsillar abscess if unresponsive to standard treatment.

      Despite the benefits of tonsillectomy, the procedure also carries some risks. Primary complications, which occur within 24 hours of the surgery, include haemorrhage and pain. Secondary complications, which occur between 24 hours to 10 days after the surgery, include haemorrhage (most commonly due to infection) and pain. Therefore, it is essential to weigh the benefits and risks of tonsillectomy before deciding to undergo the procedure.

    • This question is part of the following fields:

      • Respiratory System
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  • Question 5 - A 67-year-old man with a suspected ruptured abdominal aortic aneurysm is brought to...

    Incorrect

    • A 67-year-old man with a suspected ruptured abdominal aortic aneurysm is brought to the emergency department. Upon arrival, the patient appears pale, cold, and clammy. His vital signs are as follows: temperature 35.3 degrees Celsius, respiratory rate 40, heart rate 116bpm, and blood pressure 90/65mmHg.

      When there is a decrease in the concentration of oxygen in the blood, the inspiratory center is stimulated, and any voluntary cortical control of breathing pattern is overridden. Where are the peripheral chemoreceptors located that detect these changes?

      Your Answer: Internal carotid artery

      Correct Answer: Aortic arch

      Explanation:

      The peripheral chemoreceptors, found in the aortic and carotid bodies, are capable of detecting alterations in the levels of carbon dioxide in the arterial blood. These receptors are located in the aortic arch and at the bifurcation of the common carotid artery. However, they are not as sensitive as the central chemoreceptors in the medulla oblongata, which monitor the cerebrospinal fluid. It is important to note that there are no peripheral chemoreceptors present in veins.

      The Control of Ventilation in the Human Body

      The control of ventilation in the human body is a complex process that involves various components working together to regulate the respiratory rate and depth of respiration. The respiratory centres, chemoreceptors, lung receptors, and muscles all play a role in this process. The automatic, involuntary control of respiration occurs from the medulla, which is responsible for controlling the respiratory rate and depth of respiration.

      The respiratory centres consist of the medullary respiratory centre, apneustic centre, and pneumotaxic centre. The medullary respiratory centre has two groups of neurons, the ventral group, which controls forced voluntary expiration, and the dorsal group, which controls inspiration. The apneustic centre, located in the lower pons, stimulates inspiration and activates and prolongs inhalation. The pneumotaxic centre, located in the upper pons, inhibits inspiration at a certain point and fine-tunes the respiratory rate.

      Ventilatory variables, such as the levels of pCO2, are the most important factors in ventilation control, while levels of O2 are less important. Peripheral chemoreceptors, located in the bifurcation of carotid arteries and arch of the aorta, respond to changes in reduced pO2, increased H+, and increased pCO2 in arterial blood. Central chemoreceptors, located in the medulla, respond to increased H+ in brain interstitial fluid to increase ventilation. It is important to note that the central receptors are not influenced by O2 levels.

      Lung receptors also play a role in the control of ventilation. Stretch receptors respond to lung stretching, causing a reduced respiratory rate, while irritant receptors respond to smoke, causing bronchospasm. J (juxtacapillary) receptors are also involved in the control of ventilation. Overall, the control of ventilation is a complex process that involves various components working together to regulate the respiratory rate and depth of respiration.

    • This question is part of the following fields:

      • Respiratory System
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  • Question 6 - A 35-year-old man visits his GP with complaints of persistent cough and difficulty...

    Incorrect

    • A 35-year-old man visits his GP with complaints of persistent cough and difficulty breathing for over four months. Despite not being a smoker, he is puzzled as to why his symptoms have not improved. Upon further investigation, he is diagnosed with chronic obstructive pulmonary disease (COPD). The GP suspects a genetic factor contributing to the early onset of the disease and orders blood tests. The results reveal a deficiency in a protein responsible for shielding lung cells from neutrophil elastase. What is the name of the deficient protein?

      Your Answer: Surfactant protein D

      Correct Answer: Alpha-1 antitrypsin

      Explanation:

      COPD is typically found in older smokers, but non-smokers with A-1 antitrypsin deficiency may also develop the condition. This genetic condition is tested for with genetic and blood tests, as the protein it affects would normally protect lung cells from damage caused by neutrophil elastase. C1 inhibitor is not related to early onset COPD, but rather plays a role in hereditary angioedema. Plasminogen activator inhibitor-1 deficiency increases the risk of fibrinolysis, while surfactant protein D deficiency is associated with a higher likelihood of bacterial lung infections due to decreased ability of alveolar macrophages to bind to pathogens. Emphysema is primarily caused by uninhibited action of neutrophil elastase due to a1- antitrypsin deficiency, rather than elastin destruction.

      Alpha-1 antitrypsin (A1AT) deficiency is a genetic condition that occurs when the liver does not produce enough of a protein called protease inhibitor (Pi). This protein is responsible for protecting cells from enzymes like neutrophil elastase. A1AT deficiency is inherited in an autosomal recessive or co-dominant manner and is located on chromosome 14. The alleles are classified by their electrophoretic mobility, with M being normal, S being slow, and Z being very slow. The normal genotype is PiMM, while heterozygous individuals have PiMZ. Homozygous PiSS individuals have 50% normal A1AT levels, while homozygous PiZZ individuals have only 10% normal A1AT levels.

      A1AT deficiency is most commonly associated with panacinar emphysema, which is a type of chronic obstructive pulmonary disease (COPD). This is especially true for patients with the PiZZ genotype. Emphysema is more likely to occur in non-smokers with A1AT deficiency, but they may still pass on the gene to their children. In addition to lung problems, A1AT deficiency can also cause liver issues such as cirrhosis and hepatocellular carcinoma in adults, and cholestasis in children.

      Diagnosis of A1AT deficiency involves measuring A1AT concentrations and performing spirometry to assess lung function. Management of the condition includes avoiding smoking and receiving supportive care such as bronchodilators and physiotherapy. Intravenous alpha1-antitrypsin protein concentrates may also be used. In severe cases, lung volume reduction surgery or lung transplantation may be necessary.

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      • Respiratory System
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  • Question 7 - A 70-year-old man presents with haemoptysis and undergoes a bronchoscopy. The carina is...

    Correct

    • A 70-year-old man presents with haemoptysis and undergoes a bronchoscopy. The carina is noted to be widened. Where does the trachea bifurcate?

      Your Answer: T5

      Explanation:

      The trachea divides into two branches at the fifth thoracic vertebrae, or sometimes the sixth in individuals who are tall.

      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.

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      • Respiratory System
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  • Question 8 - A 55-year-old man from Hong Kong complains of fatigue, weight loss, and recurrent...

    Correct

    • A 55-year-old man from Hong Kong complains of fatigue, weight loss, and recurrent nosebleeds. During clinical examination, left-sided cervical lymphadenopathy is observed, and an ulcerated mass is found in the nasopharynx upon oropharyngeal examination. Which viral agent is typically associated with the development of this condition?

      Your Answer: Epstein Barr virus

      Explanation:

      Nasopharyngeal carcinoma is typically diagnosed through Trotter’s triad, which includes unilateral conductive hearing loss, ipsilateral facial and ear pain, and ipsilateral paralysis of the soft palate. This condition is commonly associated with previous Epstein Barr Virus infection, but there is no known link between the development of nasopharyngeal carcinoma and the other viruses mentioned.

      Understanding Nasopharyngeal Carcinoma

      Nasopharyngeal carcinoma is a type of squamous cell carcinoma that affects the nasopharynx. It is a rare form of cancer that is more common in individuals from Southern China and is associated with Epstein Barr virus infection. The presenting features of nasopharyngeal carcinoma include cervical lymphadenopathy, otalgia, unilateral serous otitis media, nasal obstruction, discharge, and/or epistaxis, and cranial nerve palsies such as III-VI.

      To diagnose nasopharyngeal carcinoma, a combined CT and MRI scan is typically used. The first line of treatment for this type of cancer is radiotherapy. It is important to catch nasopharyngeal carcinoma early to increase the chances of successful treatment.

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      • Respiratory System
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  • Question 9 - As the pregnancy progresses, at what stage does the foetus typically begin producing...

    Incorrect

    • As the pregnancy progresses, at what stage does the foetus typically begin producing surfactant?

      A mother has been informed that she will have to deliver her baby prematurely due to complications in the pregnancy. To decrease the chances of neonatal distress syndrome, doctors have administered steroids to stimulate surfactant production in the foetus. They clarify that the foetus is already generating its own surfactant, and these steroids will enhance the process.

      Your Answer: Week 30

      Correct Answer: Week 22

      Explanation:

      Lung development in humans begins at week 4 with the formation of the respiratory diverticulum. By week 10, the lungs start to grow as tertiary bronchial buds form. Terminal bronchioles begin to form around week 18. The saccular stage of lung development, which marks the earliest viability for a human fetus, occurs at around 22-24 weeks when type 2 alveolar cells start producing surfactant. By week 30, the primary alveoli form as the mesenchyme surrounding the lungs becomes highly vascular.

      The Importance of Pulmonary Surfactant in Breathing

      Pulmonary surfactant is a substance composed of phospholipids, carbohydrates, and proteins that is released by type 2 pneumocytes. Its main component, dipalmitoyl phosphatidylcholine (DPPC), plays a crucial role in reducing alveolar surface tension. This substance is first detectable around 28 weeks and increases in concentration as the alveoli decrease in size. This helps prevent the alveoli from collapsing and reduces the muscular force needed to expand the lungs, ultimately decreasing the work of breathing. Additionally, pulmonary surfactant lowers the elastic recoil at low lung volumes, preventing the alveoli from collapsing at the end of each expiration. Overall, pulmonary surfactant is essential in maintaining proper lung function and preventing respiratory distress.

    • This question is part of the following fields:

      • Respiratory System
      28.6
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  • Question 10 - A seven-year-old boy who was born in Germany presents to paediatrics with a...

    Incorrect

    • A seven-year-old boy who was born in Germany presents to paediatrics with a history of recurrent chest infections, steatorrhoea, and poor growth. He has a significant medical history of meconium ileus. Following a thorough evaluation, the suspected diagnosis is confirmed through a chloride sweat test. The paediatrician informs the parents that their son will have an elevated risk of infertility in adulthood. What is the pathophysiological basis for the increased risk of infertility in this case?

      Your Answer: Post-infective testicular damage

      Correct Answer: Absent vas deferens

      Explanation:

      Men with cystic fibrosis are at risk of infertility due to the absence of vas deferens. Unfortunately, this condition often goes undetected in infancy as Germany does not perform neonatal testing for it. Hypogonadism, which can cause infertility, is typically caused by genetic factors like Kallmann syndrome, but not cystic fibrosis. Retrograde ejaculation is most commonly associated with complicated urological surgery, while an increased risk of testicular cancer can be caused by factors like cryptorchidism. However, cystic fibrosis is also a risk factor for testicular cancer.

      Understanding Cystic Fibrosis: Symptoms and Other Features

      Cystic fibrosis is a genetic disorder that affects various organs in the body, particularly the lungs and digestive system. The symptoms of cystic fibrosis can vary from person to person, but some common presenting features include recurrent chest infections, malabsorption, and liver disease. In some cases, infants may experience meconium ileus or prolonged jaundice. It is important to note that while many patients are diagnosed during newborn screening or early childhood, some may not be diagnosed until adulthood.

      Aside from the presenting features, there are other symptoms and features associated with cystic fibrosis. These include short stature, diabetes mellitus, delayed puberty, rectal prolapse, nasal polyps, and infertility. It is important for individuals with cystic fibrosis to receive proper medical care and management to address these symptoms and improve their quality of life.

    • This question is part of the following fields:

      • Respiratory System
      38.7
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Respiratory System (4/10) 40%
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