Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Y3 - presentations based > SOB > Flashcards

SOB Flashcards

1
Q

DDx 1

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

DDx 2

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are some things that are important to derive from the history in a respiratory history?

A
  • Wheeze
  • Breathlessness
  • Cough
    • Sputum? If so, colour?
    • Haemoptysis
    • Weight loss
  • FLAWS - signs of malignancy
    • Fever
    • Lethargy
    • Appetite loss
    • Weight loss
    • Night sweats
  • Tender limbs (DVT)
    • Think PE
  • Weakness - suggests MND or NMJ diseaese
    • Guillan-Barre
    • Myasthenia gravis
  • Blood loss - menstrual rectal bleeding and melaena
    • Because of anaemic exacerbation
  • Normal history things
    • Smoking
    • Pets - allergies
    • Occupational history
    • Medications - some drugs can cause hypersensitivity pneumonitis e.g. amiodarone, methotrexate, nitrofurantoin, bleomycin
    • PMH - autoimmune conditions - RA, SLE - can cause ILD and pleural effusions
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the nature of coughs in the following pathologies - type and timeline or other special features?

1) Pneumonia
2) Chronic bronchitis
3) Asthma
4) Left ventricular failure
5) PE
6) Lung cancer
7) Cavitating pneumonia

A

1)

Pneumonia

  • Persistent, productive cough over last few days

2)

Chronic bronchitis

  • Persistent, productive cough most days of the past 3 months and spanning at least 2 consecutive years

3)

Asthma

  • Dry cough during SOB episodes
  • Dry cough at night

4)

Left ventricular failure

  • Same as in asthma - dry cough during SOB or at night

5)

PE

  • Bloodstained sputum

6)

Lung cancer

  • Bloodstained sputum
  • AND / OR…
  • Bovine cough (due to recurrent laryngeal nerve palsy)

7)

Cavitating pneumonia

  • Bloodstained pneumonia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

DDx of productive cough?

A
  • Pneumonia - persistent productive cough over past few days
  • Chronic bronchitis - persistent productive cough most days over at least 3 months spanning at least 2 consecutive years
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

1) DDx of dry cough?
2) What is the pattern of when the dry cough happens in these pathologies?

A

1)

  • Asthma
  • Left ventricular failure

2)

  • During SOB episodes
  • Nocturnal
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

When may you get coughing with bloodstained sputum - give a DDx?

A
  • PE
  • Lung cancer
  • Cavitating pneumonia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is croup, what does it sound like and when do you get it?

A
  • A characteristic type of cough that sounds like a barking cough
  • In certain viral infections
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is bovine cough and when does it occur?

A
  • Characteristic sounding cough that occurs in recurrent laryngeal nerve palsy (in lung cancer)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What type of chest pain often occurs alongside SOB and which ddx’s does this point you towards?

A
  • Pleuritic chest pain (chest pain upon inspiration)
  • Causes:
    • PE
    • Pneumothorax
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What can muscular weakness alongside SOB be due to - what ddx’s does this point you towards?

A
  • Guillan-Barre - a demyelinating LMND
  • Myasthenia gravis - NMJ disease
  • MND (Motor Neurone Disease)
  • Lambert-Eaton syndrome
  • Polymyositis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What does a tender limb - red, tender, warm and shiny looking limb - alongside SOB suggest - what ddx?

A
  • PE
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the constellation of other symptoms that can present alongside shortness of breath in malignancy - it is a common acronym?

A
  • FLAWS
  • Fevers
  • Lethargy
  • Appetite loss
  • Weight loss
  • Night sweats
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

1) What does blood loss alongside SOB suggest?
2) What sources of blood loss should you look out for in the respiratory history?

A

1)

  • Anaemia can be the cause of breathlessness or there can be anaemic exacerbation of respiratory conditions
  • You can also query lung mets in blood loss for example from rectal bleeding or melaena causing SOB

2)

  • Heavy menstrual bleeding
  • Fresh rectal blood
  • Melaena
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What diseases does the umbrella term COPD comprise?

A
  • Chronic bronchitis
  • Emphysema

Not sure about this but double check:

  • Refractory Asthma (non-reversible)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Define chronic bronchitis

A
  • Persistent productive cough most days for at least 3 months over the course of at least 2 consecutive years
  • Permanent, largerly ireversible SOB
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are some risk factors for COPD?

A
  • Smoking (usually > 20 pack years)
  • Occupational exposure to lung irritants
  • Alpha-antitrypsin deficiency - in lung disease or FHx
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Give some signs of COPD

A
  • Hyperexpanded chest
  • Breathing through pursed lips
  • Reduced air entry / chest expansion
  • Prolonged expiratory phase
  • Hyper-resonant percussion note
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

1) What are some triggers or time points when asthma is exacerbated?
2) Which medications can exacerbate asthma?
3) What are risk factors for asthma derived from the family history?

A

1)

  • Worse at night or in the early morning
  • Worse during exercise
  • Worse when exposed to allergens
  • Worse in the cold

2)

  • Beta-blockers
  • NSAIDS
  • Aspirin

3)

  • Family history of atopic diseases (allergies, eczema, hayfever, nasal polyps)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

1) What key risk factors in ILD are there?
2) What are some common signs on examination in ILD?

A

1)

  • Exposure to particulates
    • Asbestos
    • Silica
    • Coal (pneumoconioses causing ILD)
  • Exposure to certain drugs
    • Methotrexate
    • Amiodarone

2)

  • Clubbing
  • Reduced air entry / chest expansion
  • Late inspiratory, fine crackles (may be heard at either bases or at apices)

2)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What would bronchiectasis present like and what is often in the PMH in bronchiectasis?

A
  • Productive cough
  • Reccurent chest infections
  • Common PMH of CF (Cystic Fibrosis)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What are the risk factors for HF?

A
  • Ischaemic Heart Disease (including previous MI etc) and all the risk factors for IHD itself (hypercholesterolaemia, HTN, hyperglycaemia, south Asian descent, strong family history)
  • Other atherosclerotic disease - stroke, TIA, PVD - limb claudication
  • HTN
  • Cardiomyopathy (dilated)
  • Valvular disease (e.g. aortic stenosis)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What are the presenting symptoms of HF?

A
  • Exertional dyspnoea
  • Orthopnoea
  • Paroxysmal nocturnal dyspnoea
  • Swollen ankles (peripheral ankle oedema) - in Right Ventricular Failure
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Why may the absence of angina and MI not exclude ischaemic heart disease in some patients?

A
  • ‘Silent infarcts / ischaemia’ may present in diabetics - angina or MI without chest pain
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Outline the treatment of HF

A
  • Sit the patient up
  • 60-100% Oxygen (and consider CPAP)
  • Diamorphine (venodilator - reduces preload + anxiolytic)
  • GTN infusion (venodilator –> reduced preload)
  • IV furosemide (venodilator and later diuretic effect)
    • Potassium sparing diuretic aldosterone receptor antagonist (e.g. spironolactone, eplerenone) - i.e. remember aldosterone reabsorbs Na+ and secretes K+. So by antagonising the aldosterone receptor you are promoting the retention of K+ within blood and the secretion of Na+ and water follows sodium out into the renal tubules and ultimately into the urine
  • Beta-blockers - reduces myocardial oxygen demand since heart doesn’t work as hard due to ↓ HR
  • ACEi’s - prevent RAAS upregulation and therefore prevents the subsequent sodium and water retention

Severe HF:

  • Digoxin
  • Cardiac resynchronisation therapy (biventricular pacemakers)
  • Implantable Cardioversion Devices (ICDs)
  • Mechanical assist devices
  • Heart transplantation
26
Q

What are the signs and symptoms of lung cancer?

A
  • Dry cough
  • Haemoptysis
  • Hoarse voice
  • FLAWS
    • Fever
    • Lethargy
    • Appetite loss
    • Weight loss
    • Night sweats
  • Cervical lymphadenopathy
  • Horner’s syndrome
  • CXR - ‘coin lesions’
27
Q

List some causes of breathlessness post-operatively and give some detail on why they occur

A
  • Atelectasis (alveolar collapse) - due to pain preventing adequate breathing and therefore preventing mucus expectoration. Mucus plugs the bronchioles, preventing air entry and areas of the lung collapse as the trapped air is gradually absorbed into surroundig tissue
  • Pneumonia - poor mucus clearance and weakened immune response post-operatively
  • Pulmonary oedema - due to HF or XS fluids post-operatively
  • PE - trauma and immobility risk factors for clotting - DVT - PE
  • Anaemia - blood loss
  • Pneumothorax - iatrogenic due to interventions near the chest e.g. intercostal nerve block
28
Q

How is the FEV1:FVC ratio measured and what will the individual FEV1 and FVC predicted value percentages and FEV1: FVC ratios show in…

1) An obstructive airway disease?
2) A restrictive airway disease?

A
  • Measured by spirometry

1)

Golden rule of 70% in both cases - if either FEV1 or FVC values themselves are < 70% then this is bad

  • FEV1 < 70% predicted value
  • < 0.70 are suggestive of airflow limitation with an obstructive pattern

2)

Golden rule of 70% in both cases - if either FEV1 or FVC values themselves are < 70% then this is bad

  • FVC < 70%
  • Restrictive lung diseases often produce a FEV1/FVC ratio which is either normal or high
29
Q

What will FEV1:FVC show in asthma?

A
  • It will show an obstructive pattern so < 0.70
30
Q

Outline the management of asthma

A
  • Avoidance of triggers - smoke, allergens, exercising in cold air etc
  • Bronchodilation - induced using Beta-agonists such as salbutamol or phosphodiesterase inhibitors such as theophylline or anti-muscarinics (anti-parasympathetic)
  • Immunosuppression - corticosteroids, montelukast (leukotriene receptor antagonist), omalizumab (anti-IgE antibody)
31
Q

What does a hyperinflated chest / lungs suggest?

A
  • COPD (in particular, emphysema)
32
Q

What will FEV1:FVC ratio show in COPD?

A
  • COPD has an obstructive pattern
  • FEV1:FVC
  • Due to reduced FEV1
33
Q

Outline the management of COPD

A
  • Smoking cessation
  • Inhaled therapy -
    • Short and long-acting beta-agonists
    • And / or anti-muscarinics
    • Corticosteroids alongside long-acting beta-agonists decreases exacerbation frequency in patients with FEV1 < 50% predicted value
  • Pulmonary rehabilitation
    • Physio
    • Exercise
    • Education
  • Vaccination
  • Non-invasive ventilation
  • Long-term oxygen
    • In hypoxic patients with PaO2 < 7.3 kPa on air or < 8.0 kPa with pulmonary HTN
    • This prevents the development of Cor Pulmonale - HF secondary to pulmonary HTN
  • Manage exacerbations
    • Self-management advice
    • Corticosteroids and / or antibiotics
    • Use of NIV when indicated
    • Hospital at home or assisted-discharge schemes
34
Q

What is the criteria for diagnosis of Type II respiratory failure from an ABG?

A
  • PaO2 < 8 kPa - so hypoxic obviously
  • BUT ALSO
  • PaCO2 >6.5 kPa - so hypercapnic also
35
Q

Outline the management of Type II respiratory failure, including the special consideration in terms of oxygen delivery

A
  1. Controlled O2 therapy - you cannot give high oxygen saturation oxygen supplemenation to patients with type II respiratory failure since they are used to hypercapnic states so their central drive to breath no longer comes from [CO2] but rather by detecting low [O2], therefore this will actually depress their respiration. So instead deliver 24-35% O2 via venturi masks. Monitor CO2 using repeat ABGs
  2. Improve ventilation - ensure airway is patent
  3. Treat underlying cause - e.g. airway obstruction due to reduced consciousness or opiate medication
36
Q

1) What clinical picture does Pneumocystis Jiroveci Pneumonia give?
2) What population of patients does it usually affect?

A

1)

  • Dry cough
  • SOB
  • Low O2 sats / desaturation on exercise
  • Diffuse interstitial shadowing throughout lungs on CXR

2)

  • African ethnicity
  • Immunosuppressed patients - e.g. in HIV
  • Those who also have TB
37
Q

Question about TB but not on Y3 curriculum so revisit another time - pg 184

A

…………

38
Q

What is the approach to diagnosing ILD (interstitial lung disease)?

A
  • Fine crackles on auscultation
  • Flow spirometry showing FEV1 and FVC and FEV1:FVC ratio with a restrictive pattern
  • Absence of another obvious diagnosis
39
Q

List some causes of ILD (interstitial lung disease)

A
  • Congenital causes
    • Neurofibromatosis
    • Gaucher’s disease
  • Systemic inflammatory diseases
    • Rheumatoid Arthritis
    • Ankylosing Spondyliti
    • Sarcoidosis
  • Chemical irritation
    • Silica
    • Asbestos
    • Coal dust
    • Chlorine
  • Drugs
    • Methotrexate
    • Amiodarone
  • Allergic reactions
    • Bird-fanciers lung
  • Radiation
40
Q

What do NICE guidelines suggest to manage heavy menstruations - menorrhagia?

A
  • Levonergestrel releasing IUD (intra-uterine device)
  • Combined oral contraceptive pill (COCP)
41
Q

For the following neurological signs, identify if they are upper or lower motor neurone pathologies

1) Wasting of hand muscles
2) Fasciculations in a leg
3) Upgoing plantar reflex

A

1)

  • Lower

2)

  • Lower

3)

  • Upper
42
Q

What type of neurological signs do you get in MND?

A
  • Combination of upper and lower motor neurone pathology signs
43
Q

If, on neurological examination, you find a patient has a combination of upper and lower motor neurone disease, what disease do they have?

A
  • Motor neurone disease
44
Q

What are the 2 typse of effusions in pleural effusion?

A
  • Transudate
    • Protein < 25g/L
    • Due to osmotic forces
  • Exudate
    • Protein > 35g/L
    • Due to infiltration of pleural space by metastatic cancer cells, infectious agents or inflammatory proteins
45
Q

How can you investigate pleural effusions (aside from CXR)?

A
  • Thoracocentesis
  • To identify the nature of the effusion - whether it is transudate or exudate
  • If it is transudate it is due to osmotic forces
  • If it is exudate - it is due to infection, inflammation or malignancy
46
Q

What investigation can you arrange for upon finding cervical lymphadenopathy?

A
  • Fine needle aspiration
47
Q

What is the main difference between asthma and COPD?

A
  • Asthma - transient and reversible
  • COPD - irreversible and progressive
48
Q

Drugs used in obstructive lung diseases - see pg 187 oxford cases

A
49
Q

What is the difference between bronchitis and pneumonia?

A
  • Bronchitis is a disease of the airways
  • Pneumonia is a disease of the alveoli
  • Bronchitis is due to XS mucus production building in the airways and partial airway obstruction resulting in cough and, less commonly, SOB
  • Pneumonia is due to XS mucus in the alveolar lining resulting in SOB and cough simultaneously often]
50
Q

What is the difference between broncho- and lobar pneumonia?

A
  • Bronchopneumonia - focal areas are affected in a patchy distribution that may involve one or more lobes
  • Lobar pneumonia - most or all of a single lobe
51
Q

Question about altitude sickness and acetazolamide - not really relevant for Y3 I think - revisit later - pg 188

A

….

52
Q

What is the main cause of epiglottitis?

A
  • Haemophilus Influenzae B infection
53
Q

Describe Type I and Type II respiratory failure and then give examples of pathologies that cause either of these

A

Type I respiratory failure:

  • Hypoxaemic respiratory failure (only low PaO2)
  • Causes - any lung disease e.g.:
    • Asthma
    • COPD
    • Pneumonia
    • Pulmonary fibrosis
    • Pulmonary fibrosis

Type II respiratory failure:

  • Hypercapnic respiratory failure (low PaO2 and raised PaCO2)
  • Caused by ventilatory failure
  • Causes:
    • Decreased respiratory drive e.g. opiates, stroke, head trauma
    • COPD
    • Kyphoscoliosis
    • Obesity
    • Neuromuscular impairment (e.g. motor neurone disease)
54
Q

What are ‘pink puffers’ and ‘blue bloaters’?

A

Pink puffers:

  • Respond to hypoxaemia and hypercapnia by increaseing respiratory rate - resulting in normal PaO2 levels and a ‘pink’ appearance
  • Barrel-shaped, hyper-inflated chest
  • Breathe through pursed lips
  • SOB on mild exertion
  • Better prognosis than ‘blue bloaters’

Blue bloaters:

  • Chronically high PaCO2
  • Depend on hypoxic drive rather than capnic drive
  • Chronic cyanosis - hence ‘blue’
  • Bloated - widespread peripheral oedema caused by right heart failure secondary to lung problems (e.g. cor pulmonale)
  • Poor prognosis
55
Q

What is Eisenmenger’s syndrome - this is nor relevant to Y3 curriculum so revisit this later - pg 190

A

…..

56
Q

Which muscles are responsible for inspiration and expiration - include the accessory muscles for each in italics (i.e. those used in forced inspiration and forced expiration)?

A

INSPIRATION

  • Diaphragm
  • External intercostals
  • Scalene
  • Sternocleidomastoid

EXPIRATION

  • Diaphragm (natural elastic recoil)
  • Internal intercostals
  • Abdominal muscles
57
Q

What is the ddx for bibasal crepitations?

A
  • Pulmonary oedema
  • ILD (interstitial lung disease)
  • Bronchiectasis
  • Pneumonia
58
Q

What 2 medications can cause ILD (interstitial lung disease)?

A
  • Methotrexate
  • Amiodarone
59
Q

If a patient presents with acute exacerbation of COPD, what is the treatment plan - short and long term?

A
  • Short term - corticosteroids
  • Long term - first test by MC&S (microscopy) and then decide on what antibiotic to give based on sensitivities
60
Q

Which class of drugs is contra-indicated in HF and why, also give 2 examples of these drugs?

A
  • First-generation calcium channel blockers (CCBs) e.g. diltiazem, verapamil
  • Because they are negative inotropes
  • Note: second-generation calcium channel blockers (CCBs) e.g. amlodipine, nifedipine
61
Q

What is the best way to confirm a postulated diagnosis of ILD, what will you see?

A
  • CT chest
  • Characteristic linear reticular opacities and ‘ground-glass’ appearance

Y3 - presentations based (6 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions