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Tracheal stenosis — SCE Respiratory MCQ

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HardRespiratory PhysiologyTracheal stenosisSCE Respiratory

A patient with prior intubation has FEV1 2.1 L and PEF 180 L/min. Both inspiratory and expiratory limbs are flattened. The FEV1/PEF ratio is 11.7 mL/L/min. What does this support?

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Correct answer: A — Fixed central upper-airway obstruction requiring anatomical assessment

Explanation lettering: E = shown as A · A = shown as B · B = shown as C · C = shown as D · D = shown as E

E is correct. FEV1/PEF above about 10 mL/L/min (Empey index) plus flattening of both limbs supports fixed central/upper-airway obstruction, consistent with post-intubation stenosis. Variable extrathoracic and intrathoracic lesions predominantly flatten one limb. Asthma produces concave expiratory flow, and muscle weakness reduces volumes without the characteristic box-shaped loop. CT and bronchoscopy define anatomy and intervention.

Reference: ERS/ATS interpretive strategies for lung-function tests: https://publications.ersnet.org/content/erj/60/1/2101499