What Do You Know About Respiratory Protection? Trivia Quiz

Whilst all the above diagnoses are possible (with varying degrees of likelihood), the most likely diagnosis in a smoker with progressive breathlessness is COPD.

The CXR shows a left lower zone mass. This means that there is an abnormality or growth in the lower area of the left lung. The other options, such as pulmonary fibrosis, right apical pneumothorax, cardiomegaly, and pulmonary edema, are not indicated in the CXR.

The important thing to calculate is the FEV1/FVC ratio, which in this instance is 0.95. If the ratio is normal or raised, then looking at the FVC reveals the answer; If the FVC is normal, then this suggests normal spirometry. In this case the FVC is at 40% of the predicted value for the patient, so is significantly reduced. This demonstrates a restrictive defect.
An obstructive defect would have a reduced FEV1/FVC ratio.

This CXR shows a radio-opaque lesion in the right midzone which obscures the right heart border and has a well-defined superior border (due to the horizontal fissure). This would be consistent with right middle lobe consolidation.

This blood gas interpretation indicates respiratory acidosis and hypoxia. The pH value of 7.29 suggests acidosis, and the elevated PCO2 levels of 8.2 indicate respiratory acidosis. The low PO2 value of 8.1 indicates hypoxia, which is a condition characterized by low oxygen levels in the blood. The bicarbonate level of 32 is within the normal range and does not play a significant role in determining the acid-base imbalance in this case. Therefore, the correct answer is respiratory acidosis and hypoxia.

This CXR shows a massive left-sided pneumothorax. It is under tension - this can be assumed from the trachea and mediastinum being pushed across the midline - and this constitutes a medical emergency. In practice, if a tension pneumothorax is suspected it should be immediately decompressed with a large venflon in the 2nd intercostal space, mid clavicular line (on the same side as pneumothorax) BEFORE being x-rayed. This converts the tension pneumothorax into a simple pneumothorax and a chest drain can be then inserted in more controlled circumstances.

When examining a patient with a pneumothorax, the trachea is displaced away from the side of the lesion. This is because a pneumothorax is the presence of air in the pleural cavity, causing the lung to collapse. As a result, the affected lung becomes smaller and the trachea is pushed away from the collapsed lung towards the unaffected side. This displacement of the trachea is a characteristic finding in patients with pneumothorax.

The chest x-ray reveals the presence of a pleural effusion on the right side. A pleural effusion is an abnormal accumulation of fluid in the pleural space, the area between the lungs and the chest wall. It can be caused by various conditions such as pneumonia, congestive heart failure, or lung cancer. The x-ray may show blunting of the costophrenic angle, increased opacity in the lower lung fields, and a shift of the mediastinum towards the unaffected side. Treatment depends on the underlying cause and may involve draining the fluid or addressing the primary condition.

Risk factors for venous thromboembolism include:

Venous stasis
Hypercoagulable states
Immobilization
Surgery and trauma
Pregnancy
Oral contraceptives and estrogen replacement
Malignancy
Hereditary factors - family history of DVT/PE
Acute medical illness

Post-menopause is not a risk factor itselft, but if she were taking HRT then that would increase her risk.

Clubbing is a condition characterized by the enlargement of the fingertips and nails, resulting in a rounded appearance. It is often associated with underlying medical conditions. Congenital cyanotic heart disease, inflammatory bowel disease, interstitial lung disease, squamous cell lung cancer, bronchiectasis, and subacute bacterial endocarditis are all known causes of clubbing.