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Endgames Picture Quiz

A is for airway

BMJ 2010; 340 doi: (Published 10 June 2010) Cite this as: BMJ 2010;340:c2367
  1. Harpreet Ranu, specialist respiratory registrar,
  2. Brendan Madden, professor of cardiothoracic medicine
  1. 1Department of Cardiothoracic Medicine, St George’s Hospital, Tooting, London SW17 0QT
  1. Correspondence to: B P Madden brendan.madden{at}

    A 61 year old man was referred to our outpatient department because of breathlessness. He was able to walk only 50 metres before having to stop to catch his breath. He denied any chest pain or cough. In the 1980s he had fallen down a lift shaft, which had caused substantial trauma. He had needed mechanical ventilation in the intensive care unit, with tracheostomy formation and prolonged respiratory wean. He had never smoked. Examination of his chest was normal. Oxygen saturations on room air were 96%. His chest radiograph was normal. Figure 1 shows the results of another test that was performed.


    • 1 What test has been performed?

    • 2 What does it show?

    • 3 What is the diagnosis?


    1 What test has been performed?

    Short answer

    Spirometry was performed, and maximal expiratory and inspiratory flow volume loops and a flow volume curve were produced. The expected expiratory curve is shown in black and the patient’s observed expiratory and inspiratory curves are shown in blue.

    Long answer

    A variety of pulmonary functions tests are available, including spirometry, flow volume curves, measurement of diffusion capacity, and lung volumes. These tests are effort dependent and require patient cooperation. Predicted values depend on age, height, sex, and race and are determined by published studies of large …

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