Breathless Betty Flashcards
How to differentiate physiological and pathological shortness of breath from exercise
It can be difficult but generally it is judged by comparing yourself to your past self or those around you
Significance of sputum colour (grey or green)
Grey or green generally indicates elevated WBCs; could be infection but not necessarily
But this is compared to the patient’s ‘norm’
Causes of cough
Cold Acute Bronchitis Tracheitis Pneumonia COPD Asthma Anxiety Foreign Body TB Bronchiectasis Congestive Heart Failure Lung Cancer
Drug-induced: e.g. ACE Inhibitors
Pneumonia
Alveoli become full of fluid as a result of infection
Bronchiectasis
Can be genetic or acquired
Damage to alveoli and so damage ciliary mucous so mucous stagnates and does not clear
REVISE AND ADD
Differentiate between smoker’s cough and COPD cough
It is difficult to do so; smokers with a PERSISTENT smoker’s cough are suggested to present for further investigation
Alerting symptoms regarding COPD or Lung Cancer - im not rly sure :’(
Cough > 3 weeks
Smoking history associated with Haemoptysis
Change in ‘smoker’s cough’
Haemoptysis
Coughing up blood
Sound heard during percussion of fluid in lungs
Dullness, unlike percussion of air which is more crisp
Symptoms OE of COPD patients
Prolonged Exhalation
Polyphonic Wheeze (multi note breath)
Unusual dull percussion of lungs
Reduced chest movements (I THINK)
REVISE
What does a lowered PEF Indicate
A lot of very different things that are hard to diagnose
What do stained fingers on COPD indicate
Tar staining (indicate that they are a current smoker)
What does no ankle swelling tell us of a COPD patient
It indicates that the patient likely does not have chronic congestive heart failure
What is spirometry used for in COPD
It is not used to diagnose COPD but it does confirm it when other data and history is indicative of it
It also identifies those most at risk of complications
Just as a bonus, it also scares some patients straight if you tell them they have lungs of a 90 year old
How to diagnose between COPD and Emphysema
COPD is an umbrella term for those with chronic bronchitis and emphysema; they are clumped together because usually one would include at least an element of the other
Describe the FEV1:FVC in obstructive and restrictive lung disease
FEV1 is low in both but FVC is normal in obstructive while being lowered in restrictive
Obstructive: Low FEV1:FVC
Restrictive: Normal FEV1:FVC
eGFR
Estimated Glomerular Filtration Rate
Measures Renal Function
eGFR must be kept in mind in certain prescriptions
(Declines during aging)
Why is Haemoglobin elevated for those with COPD
Body’s response to hypoxia
Polycythaemia
Having a high concentration of red blood cells in your blood
Amoldipine
Calcium-channel blocker used for hypertension and angina
Ramipril
Used for high blood pressure and congestive heart failure
Atorvastatin
Statin
Are beta blockers indicated for COPD patients with hypertension
Yes definitely, as long as a spirometer does not indicate asthma (but monitor their progress with spirometry)
What are COPD patients vulnerable to
Winter infection and Covid
In what way does the x-ray indicate COPD
idk REVISE
Should a chest X-ray be done for COPD Patients and why
Yes for sure, to ensure that there are no other concurrent infections
Fundamental Five COPD Interventions
Smoking Cessation (MOST IMPORTANT ASF)
Pulmonary Rehabilitation (VERY IMPORTANT AS WELL)
Vaccination
Self Management Plan
Assess Co-morbidities (including mental health)
Recommended Vaccinations for COPD Patients
Covid
Flu Vaccine
Pneumococcal
Dyspnoea
Opposite of Apnoea
Shortness of Breath
How is tiotropium taken up
It is taken via inhalation
Mucolytics
Medicines that make the mucus less thick and sticky and easier to cough up
Often makes patients cough up copious amounts and almost feel like they’re drowing from how much there is
Should we suggest e-cigarettes for smoking cessation
This is up to the doctor
Generally, use it with caution as a last resort if other methods of cessation do not work
Fostair 100/6
REVISE THIS SEEMS INTERESTING
What improvement is expected in COPD patients with medication
Usually the medication is not expected to solve the issue, instead just to improve lifestyle like allowing tying your shoes without breathlessness
Pulmomary Rehabilitation
Getting COPD patients to do simpler movements to strengthen their lungs
Referrals from the COPD Clinic Include:
Severe disease Frequent exacerbators Suspect genetic cause Breathelssness doesn't match up with spirometry severity Cor Pulmonale Increasing palliative care needs Paid decline
