86 - Physiology of Breathlessness Flashcards

1
Q

What can cause a weak, hoarse voice?

A

Impingement upon recurrent laryngeal nerve.

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2
Q

Effect of impinged recurrent laryngeal nerve on coughing

A

Paralyses larynx. Impaired cough.

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3
Q

Definition of breathlessness

A

Recognition be the subject of an inappropriate relationship between respiratory work and total body work.

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4
Q

Things contributing to work of breathing
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2

A

1) Stretching work (elastic)

2) Airflow work (resistive)

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5
Q

Resistive work of breathing

A

Resisting friction of air going through airways (normally very low, as flow of air is normally laminar).

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6
Q

Things that increase sensation of SOB

A
Increased load (increased work of breathing)
Increased drive (EG: anxiety, hypoxia, anaemia, metabolic acidosis)
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7
Q
Broad categories of disorders that can lead to dyspnoea
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A
Respiratory
Cardiac
Muscle weakness
Metabolic
Anaemia
Psychogenic
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8
Q
Respiratory causes of dyspnoea
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A

1) AIRWAYS DISEASE
a) Upper airways - tumour, foreign body, angioneurotic odema, CROUP
b) Lower airways - asthma, COPD, bronchiolitis
2) ALVEOLAR DISEASE
Pneumonia, lung collapse, pulmonary odema, pulmonary fibrosis
3) PULMONARY VASCULAR DISEASE
Pulmonary embolism, vasculitis, primary pulmonary hypertension
4) PLEURAL and CHEST WALL DISEASE
Pleural effusion, pneumothorax, chest wall deformity
5) RESPIRATORY MUSCLE DISEASE
Respiratory muscle weakness, phrenic nerve palsy

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9
Q

Things that can cause SOB, cough, sputum, wheeze or stridor

A

Airways problem.
Sputum comes up from airways.
Wheeze (lower airway obstruction), stridor (upper airway obstruction) from airways.

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10
Q

When are CT scans used for airway problems

A

Bronchiectasis, cancer

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11
Q

Appearance of lower airway obstruction on a flow/volume loop

A

Lower peak flow, sharp drop off after this

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12
Q

What does reduced diffusing capacity tell you?

A

Impairment of blood/alveolar membrane

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13
Q

SOB, cough, crepitations diagnosis

A

Crepitations from alveolar membrane dysfunction. Can be from air bubbling through fluid (oedema), sudden opening of airways during inspiration (stiff lungs, interstitial lung disease).

Indicates that problem is in terminal bronchioles, alveoli.

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14
Q

SOB+/- haemophtysis, pain

A

Could be pulmonary embolism, pulmonary hypertension, pulmonary vasculitis (rare).

Pain could be from pleural inflammation.

Use risk factors (contraceptive pill, smoking, immobility, etc) to refine diagnosis.

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15
Q

MUD

A

Medically undiagnosed dyspnoea

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16
Q

How often can dyspnoea be diagnosed?

A

~80% of the time.

17
Q

Proportion of atopic asthma in the general adult population

A

~12-15%

18
Q

How can athletic breathlessness be diagnosed?

A

Eucapnoeic voluntary hyperventilation

19
Q
Condition that can be confused with asthma
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A

Vocal cord dysfunction.
Negative eucapnoeic voluntary hyperventilation.
Abnormal endoscopy.
Responds to speech therapy.

20
Q

How can you decide if breathlessness is from being deconditioned, or something else?

A

Incremental exercise test.

Three month aerobic training program and then re-measure exercise capacity. Should improve if just deconditioned.

21
Q
Appearance of incremental exercise test with someone who is deconditioned
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A
Low work load and VO2max
• Steep heart rate response (small stroke volume)
• Early anaerobic threshold
• Excessive VEmax
• No ECG, BP abnormalities or low SaO2
22
Q

How can you determine if SOB is psychogenic?

A
Increase suspicion of MUD:
Need to take deep inspiration
Oppressive chest
Anxiety
Tingling in fingers, face, head.

Absence of following symptoms
Wheezing, cough, stridor