Respiratory Module 3

Nintedanib is an intracellular tyrosine kinase inhibitor which has been recently shown to be useful in the treatment of idiopathic pulmonary fibrosis.

Which one is the correct target receptors for this drug?

Which one of the following paraneoplastic features is least commonly seen in patients with squamous cell lung cancer?

A patient with Pneumocystis pneumonia treated with co-trimoxazole develops hypoxia. pO2 35.

Which of the following is the most appropriate treament to initiate?

A 40-year-old woman presents with increasing breathlessness and wheeze. Inspiratory and expiratory flow-volume curves show normal expiration but flow limitation during inspiration producing an “inspiratory plateau”.

The most likely diagnosis to explain this flow volume curve is?

A 40-year-old man with 40 pack year smoking history presents with increasing breathlessness and wheeze. Inspiratory and expiratory flowvolume curves are both “flattened” so that the configuration approaches that of a rectangle.

What would be the most likely diagnosis to explain this result?

A 60-year-old man with 30 pack year smoking history presents with increasing breathlessness and wheeze. A flow volume curve shows that all the flow rates are diminished with mean expiratory flow being less than the mean inspiratory flow rate.

What could be the underlying cause to explain this finding?

A 43-year-old woman presents with increasing breathlessness and wheeze. Inspiratory and expiratory flow-volume curves show normal inspiration but flow limitation during expiration producing an “expiratory plateau”.

The flow-volume curves are most likely to be caused by:

A 55-year-old man has the following lung function test results: FEV1 2.0 L (61% predicted) FVC 2.6 L (68% predicted) FEV1/FVC 77% (85% predicted) TLC 72% predicted RV 75% predicted DLCO 64% predicted
KCO 110% predicted His body mass index (BMI) is 31 kg/m2 [18-25].

Which of the following is the best explanation for these results?

A 50-year-old man has the following lung function test results: FEV1 2.0 L (61% predicted) FVC 2.6 L (68% predicted) FEV1/FVC 77% (80% predicted) TLC 70% predicted RV 75% predicted His body mass index (BMI) is 40 kg/m2 [18-25]. ABG shows Hypercapnia.

Which of the following is the best explanation for these results?

A 55-year-old man has the following lung function test results: FEV1 2.0 L (61% predicted) FVC 2.6 L (68% predicted) FEV1/FVC 77% (80% predicted) TLC 70% predicted RV 75% predicted DLCO 48% predicted
His body mass index (BMI) is 31 kg/m2 [18-25]. No bronchodilator response. Normal CXR.

Which of the following is the best explanation for these results?

A 55-year-old man has the following lung function test results: FEV1 1.40 L (56% predicted) FVC 1.9 L (57% predicted) FEV1/FVC (74% predicted) TLC 75% predicted RV 75% predicted DLCO 35% predicted KCO 80% predicted 4% improvement in FEV1 after bronchodilator His body mass index (BMI) is 31 kg/m2 [18-25].

Which of the following is the best explanation for these results?

Which of the following condition is not associated with increased DLCO?

You are asked to consult on the aerial transfer of a sick man with bronchopneumonia. By what amount will you expect the alveolar oxygen to drop when the plane is pressurised at an altitude of 5000 feet?
(The atmospheric pressure at 5000 feet is 647 mmHg. The carbon dioxide level is 45 mmHg, the respiratory quotient is 0.8 and the water vapour pressure is 47 mmHg. These values remain constant. The flight will begin at sea level where the atmospheric pressure is 760 mmHg.)

Hypoventilation is the main mechanism for hypoxemia in the following conditions except?

The alveolar-arterial gradient for oxygen tension in arterial blood (PAaO2) may vary with age.

Which one of the following is considered to be the main physiological mechanism for a normal PA-aO2?

The mechanism of hypoxemia in interstitial lung disease is mainly due to?

The PaO2 are shown below for an individual breathing room air and then 100% oxygen: PaO2 (mmHg) 50.0(breathing air) PaO2 (mmHg) 63.0(on 100% oxygen)

The best explanation for these results is:

The following medications causes reduce REM sleep except?

The following conditions are associated with obstructive sleep apnea except?

A 43-year-old man is referred for investigation of snoring and witnessed apnoeas. A diagnostic sleep study confirms the diagnosis of obstructive sleep apnea. Therapy with nasal continuous positive airway pressure (CPAP) is recommended.

Which one of the following would be the reason why this person would use CPAP for his OSA?

A patient has been newly diagnosed with obstructive sleep apnea. He was reviewed following a motor vehicle accident in which he felt asleep whilst driving.History of daytime sleepiness for 5 years.Weights 100kg.

What is the most appropriate next step in managemenr?

A patient with background of left ventricular failure undergoes a polysomnographic sleep study.
It was noted in this study that during the episodes of reduced oxygen saturation, there was no attempt at breathing.

What could be the underlying cause for this?

A patient is troubled by restless legs especially during the night. Polysomnography shows repetitive highly stereotyped limb movements lasting 0.5-5 seconds in duration. Amplitudee >25% of the toe dorsiflexion during calbration. Blood test reveals normal FBC and U&Es but with a low ferritin.

What should be the next step in management?

A patient presents with excessive daytime sleepiness, cataplexy, sleep paralysis and hypnogogic hallucination.

What is the diagnosis?

The following drugs are useful for narcolepsy except?

A 50 year old man has severe symptoms consistent with obstructive sleep apnea.

Which of the following is likely to happen if this is left untreated?

A 50 year old male smoker presents with cough and weight loss.Examination reveals palpable lymph node over left supraclavicular fossa. CXR shows “white out” of the left lung. Bronchoscopy result shows undifferentiated carcinoma. Serum neuron specific enolase is elevated.

What is the most likely diagnosis?

In the management of non-small cell lung cancer, what is the optimal treatment for someone with resectable Stage II disease?

A 50 year old male smoker presents with 6 months history of cough and weight loss. Now presents with weakness of both arms and legs.Unsteady gait and finding it difficult arising from chair and climbing up stairs.Also describes that his mouth feels dry. On examination there is bilateral ptosis otherwise other cranial nerve unremarkable.An excessive eyelid elevation occurs after sustained upgaze. There is proximal limb weakness without significant muscle atrophy.Absent deep tendon reflexes. But muscle strength seems to improve with activity. The patient is seen by a neurologist who suspects an underlying paraneoplatic manifestation.

What is the most likely underlying malignancy?

In the management of small cell lung cancer, what is the optimal treatment for someone with limited disease and normal performance status?

Which of the following is a characteristic feature of idiopathic pleuroparenchymal fibroelastosis (PPFE)?

Which biomarker has been proposed as a noninvasive diagnostic tool for idiopathic pleuroparenchymal fibroelastosis (PPFE)?

Which treatment option has limited efficacy for idiopathic pleuroparenchymal fibroelastosis (PPFE)?

A 65-year-old with man with a past medical history of hepatocellular carcinoma was started on nivolumab last month and had underwent 2 cycles. He now presents with worsening shortness of breath and is found to be hypoxic with a resting oxygen saturation of 80 percent on arrival to the emergency department.

His HRCT chest shows diffuse ground glass opacities (GGO’s) and infectious workup including blood cultures, sputum cultures and pneumonia workup were all found to be unremarkable.

The following interventions would all be appropriate except?