302 The case of the breathless teenager and pathophysiology of asthma

Question 1

What is dyspnoea?

Answer 1

An unpleasant awareness of increased respiratory effort

Question 2

What is tachypnoea?

Answer 2

An increased respiratory rate

Question 3

What is orthopnoea?

Answer 3

Breathlessness when laying flat

Question 4

What is bradypnoea?

Answer 4

Inappropriately reduced respiratory rate

Question 5

What are cheyne stokes?

Answer 5

Abnormal breathing pattern characterised by progressively deeper or faster breather

-Caused by an issue in the respiratory centres of the brainstem

Question 6

What are some pulmonary causes of breathlessness?

Answer 6

-Airway obstruction
-Anaphylaxis
-PE
-Asthma
-COPD
-Pneumonia
-Pleural effusion
-Neoplasm
-Fibrosis

Question 7

What are some cardiovascular causes of breathlessness?

Answer 7

-Pulmonary oedema
-ACS
-Arrhythmia
-Cardiac tamponade
-DCM
-Valvular heart disease
-Pneumothorax

Question 8

What is ACS?

Answer 8

Acute coronary syndrome

-A range of conditions associated with sudden, reduced blood flow to the heart

Question 9

What is a tamponade?

Answer 9

When the pericardium fills with fluid like blood

Question 10

What is DCM?

Answer 10

Dilated cardiomyopathy

-The heart chambers enlarge and lose their ability to contract

Question 11

What are some infection causes of breathlessness?

Answer 11

-Pneumonia
-Epiglottitis

Question 12

What are some traumatic causes of breathlessness?

Answer 12

-Pneumothorax
-Haemothorax
-Flail chest
-Pulmonary contusion

Question 13

What is a flail chest?

Answer 13

Two or more contiguous rib fractures with two or more breaks per rib

Question 14

What is a pulmonary contusion?

Answer 14

An injury to the lung parenchyma in the absence of laceration to lung tissue or any vascular structures

Question 15

What are some abdominal causes of breathlessness?

Answer 15

-Ascites
-Obesity
-Pregnancy

Question 16

What are some psychological causes of breathlessness?

Answer 16

-Anxiety
-hyperventilation

Question 17

What are some metabolic causes of breathlessness?

Answer 17

-Metabolic acidosis
-Renal failure
-Toxins

Question 18

What are some neuromuscular causes of breathlessness?

Answer 18

-Cerebral vascular accident (CVA)
-Motor neurone disease
-Guillain-Barré syndrome

Question 19

What is a cerebral vascular accident (CVA)?

Answer 19

An interruption of blood flow to the brain

Question 20

What is Guillain-Barré syndrome?

Answer 20

Autoimmune destruction of nerves
-This harm causes muscle weakness and sometimes paralysis

Question 21

Which cells indicate airway inflammtion?

Answer 21

Eosinophils

Question 22

What are some tests for airway inflammation?

Answer 22

-Eosinophil count
-FeNO

Question 23

What is a FeNO test?

Answer 23

A fractional exhaled nitric oxide test

-When you breathe out, your breath can show if you have inflamed airways by testing how much FeNO there is in your breath

Question 24

Why won’t bronchodilation work in COPD?

Answer 24

Because it’s a fixed airflow limitation

Question 25

What are some disease that mimic asthma?

Answer 25

-Airway obstruction
-Inducible laryngeal obstruction (ILO)
-Exercise-induced laryngeal obstruction (ELIO)
-Sinusitis
-Cough hypersensitivity
-GORD

Question 26

What is Inducible laryngeal obstruction (ILO)?

Answer 26

An inappropriate, transient, reversible narrowing in the larynx in response to external triggers

Question 27

How does sinusitis mimic asthma?

Answer 27

Both are caused by inflammation caused by an allergen or irritation

Question 28

How does magnesium sulphate act as a bronchodilator?

Answer 28

It’s a mast cell stabiliser that prevents further inflammation and it relaxes bronchial muscles