Station - Instructions for candidate
You are a final-year medical student on placement in a general practice in Perth.
Thanh Nguyen, a 62-year-old lawyer, attends a results appointment. Spirometry arranged by the GP two weeks ago has now been reported. You have the print-out in front of you; Mr Nguyen does not.
| From the booking note | Spirometry requested for a six-month history of cough and breathlessness. Current smoker, about 20 cigarettes a day; no known asthma or heart disease; never hospitalised for chest problems. |
|---|---|
| Observations (practice nurse, today) | BP 128/76 mmHg, HR 78/min, RR 16/min, SpO2 96% on room air, temperature 36.8 C |
| Anthropometry | Height 178 cm, weight 84 kg |
Results provided:
Spirometry (post-bronchodilator, performed in the practice)
| Item | Value | Reference range |
|---|---|---|
| FEV1 | 2.05 L | 2.56-3.84 L (80-120% predicted) |
| FVC | 3.40 L | 3.28-4.92 L (80-120% predicted) |
| FEV1/FVC ratio | 0.60 | >0.70 (LLN 0.66) |
| FEV1 % predicted | 64% | >=80% |
| Post-bronchodilator change in FEV1 | +40 mL (+2.0%) after 400 mcg salbutamol | >12% and >200 mL indicates significant reversibility |
Test quality grade A (ATS/ERS). Predicted values from GLI equations for a male aged 62, height 178 cm. Pre-bronchodilator FEV1 2.00 L.
spirometry - read aloud by the examiner
The flow-volume loop shows reduced peak expiratory flow with a concave, scooped expiratory limb and prolonged time to empty. On the volume-time curve about 2.05 L is exhaled in the first second of a 3.40 L breath out.
Look up an example image: LITFL COPD spirometry
Your tasks are to:
- Interpret the spirometry results provided to you.
- Explain what the results show to Mr Nguyen in plain language.
- Tell Mr Nguyen your most likely diagnosis and what it means for him.
- Discuss the initial management with Mr Nguyen and agree the first steps.
- You do not need to examine Mr Nguyen in this station.
- You do NOT need to summarise your findings to the examiner.
- The full spirometry report is printed on this sheet; Mr Nguyen does not have a copy.
This is a 10-minute station, with 2 minutes of reading time.