Formative Assessment Pointers Week 2

Question 1

Normal expiration

Answer 1

Is a passive process, controlled by the gaps in firing of dorsal neurons within the medulla

Question 2

Forceful expiration

Answer 2

Is an active process, controlled by the firing of ventral neurons in the medulla

Question 3

Normal inspiration

Answer 3

Is an active process, controlled by the firing of dorsal neurons within the medulla

Question 4

Theophylline

Answer 4

A methylxanthine drug with bronchodilator and anti-inflammatory action. Has many side effects and drug interactions.

Question 5

Fexofenadine

Answer 5

A competitive H1 receptor antagonist used to treat allergic rhinitis.

Question 6

Ipratropium

Answer 6

A short acting drug that blocks acetylcholine receptors non-selectively. Can be delivered intranasally to treat rhinorrhoea.

Question 7

Tiotropium

Answer 7

An anticholinergic drug, selective for M3 receptors with a long half life.

Question 8

Monteleukast

Answer 8

A cysteinyl leukotriene receptor antagonist used to treat asthma and allergice rhinitis.

Question 9

Beclometasone

Answer 9

An inhaled corticosteroid. Used in combination with a beta-2 adrenoceptor agonist, particularly in frequent exacerbations of COPD.

Question 10

Equals inspiratory reserve volume plus tidal volume plus expiratory reserve volume.

Answer 10

Vital Capacity

Question 11

The volume of air in the lungs at the end of a normal, passive expiration

Answer 11

Functional Residual Capacity

Question 12

A 59 year old man presents to his GP with a cough that he has been suffering from for at least six months. He tells you he brings up clear phlegm daily, but that it has occasionally been green and unpleasant when he gets a cold. He has come in today because he heard that long term coughs should be checked by a doctor. He smokes approximately 40 cigarettes a day, and has been smoking for over 30 years. He is much more breathless when walking around than he used to be.

Answer 12

Chronic Bronchitis

Question 13

A 78 year old woman is admitted to hospital short of breath. She feels that even sitting talking to you is too much effort, and she is struggling to get up to the bathroom without help. She is generally unwell, with a temperature of 38.2, but no other investigations have been returned yet. She has a 50 pack-year smoking history. She has a cough, which she says is normal for her, but she is bringing up thick yellow sputum, which she does not normally. She takes regular inhaled medicines, but feels these are not helping her as they usually do.

Answer 13

Acute Exacerbation of COPD

Question 14

A 35 year old woman visits her GP complaining of shortness of breath. She finds she feels her chest is tight and that she is struggling to breathe. This mostly affects her at home, and tends not to be as bad any other time. She is coughing at night, but this is non-productive. On examination she has a generalised wheeze, but no other abnormal findings. When you are discussing your thoughts, she mentions that her and her partner recently bought a kitten, and wonders if this is the cause of her problem.

Answer 14

Extrinsic Asthma

Question 15

These chemoreceptors detect arterial oxygen partial pressure. When stimulated, they cause hyperventilation and increased cardiac output.

Answer 15

Peripheral Chemoreceptors

Question 16

These chemoreceptors are found in the brainstem. They respond to CSF [H+].

Answer 16

Central Chemoreceptors in the Medulla

Question 17

These chemoreceptors, when stimulated, can compensate for metabolic acidosis by triggering increased elimination of CO2

Answer 17

Peripheral Chemoreceptors

Question 18

Chronic adaptation caused by hypoxia

Answer 18

Increased mitochondria, 2,3-BPG, capillaries and polycythaemia with a metabolic acidosis

Question 19

Acute mountain sickness

Answer 19

Fatigue, headache, tachycardia, dizziness and shortness of breath, slipping into unconsciousness

Question 20

Diabetic ketoacidosis

Answer 20

Hyperventilation with a severe metabolic acidosis.

Question 21

An 18 year old man is admitted to hospital acutely short of breath. He cannot speak in full sentences and is audibly wheezing. He has been given a beta-2 adrenoceptor agonist and steroids, and his doctor wishes to give him a further inhaled drug

Answer 21

Nebulised ipratropium

Question 22

A 68 year old man with long-standing COPD has been prescribed several medications. However, he is struggling to cope at home, and when he is examined you see is SaO2 is 82%.

Answer 22

Domicilary oxygen

Question 23

A 22 year old woman has been using a reliever inhaler for some time, but is finding she is now wheezing and feels more breathless when she exercises.

Answer 23

Inhaled beclometasone

Question 24

Results in increased pulmonary compliance, produces hyperinflated lungs and will show an obstructive defect on spirometry

Answer 24

Emphysema

Question 25

Causes shortness of breath on exertion, a restrictive defect on spirometry and reduced pulmonary compliance but no sign of infection.

Answer 25

Pulmonary Fibrosis

Question 26

Will show a low FVC, a low FEV1 and a low FEV1/FVC% on spirometry

Answer 26

Combined Restrictive-Obstructive Lung Disease

Question 27

Rofumilast

Answer 27

A PDE4 inhibitor given orally for severe COPD

Question 28

Sodium cromoglicate

Answer 28

Mast cell stabiliser used in asthma and allergic rhinitis

Question 29

Prednisolone

Answer 29

An oral steroid used in severe or intractable rhinitis, acute asthma or an exacerbation of COPD

Question 30

A 25 year old woman visits her GP. She is normally fit and well, but has been finding running increasingly difficult, particularly when it is cold. She complains of feeling short of breath and wheezing. There are no abnormal findings on examination and no significant past medical history

Answer 30

Intrinsic Asthma

Question 31

A 68 year old man is admitted to hospital having become increasing short of breath over the past two days. He has had a cough for many months, but is now coughing up green sputum. He already takes tiotropium and salmeterol. He is a smoker, smoking 20 cigarettes per day for the past 40 years

Answer 31

Acute Infective exacerbation of COPD

Question 32

A 12 year old boy is brought to the GP by his parents. He says he feels like he sometimes can’t get air in, and his mother is worried he has hayfever as it seems to be worse in the summer. He has a past history of eczema and his father has asthma and says he has allergies. On auscultation he has a generalised wheeze

Answer 32

Atopic Asthma

Question 33

A 40 year old woman has been treated for asthma for several years, and has known allergies to various allergens including the house dust mite. She has been escalated through the available therapy and is still poorly controlled, with frequent exacerbations and hospital admissions. She already takes a beta-2 adrenoceptor agonist, an inhaled and an oral steroid and several add-on treatments. She is particularly worried about steroid side effects

Answer 33

Subcutaneous Omalizumab

Question 34

A 66 year old man with a long-standing history of COPD is finding it increasingly difficult to breathe, despite being on several different medications. He tells his GP that he cannot cough as easily and struggles to expectorate sputum. He is already receiving physiotherapy

Answer 34

Oral carbocysteine

Question 35

A 20 year old woman visits her GP complaining of occasional shortness of breath, brought on by exercise. She wheezes and has a night-time cough but no other symptoms. She takes no other medication, has no known allergies, and is otherwise fit and well

Answer 35

Salbutamol as required