Breathless patient symposia

Question 1

Shortness of breath

i) Give a heart cause
ii) give a lung cause
iii) give a blood cause

Answer 1

i) decreased CO
ii) hypoxia therefore increased effort needed to maintain spO2
iii) anaemia

Question 2

SOB ONSET AND CAUSES

i) give two conditons charac by sudden onset SOB
ii) three conds with SOB over hours
iii) two conds with SOB over days
iv) two conds with SOB over weeks
v) four conds with SOB over months
vi) three conds with SOB over years

Answer 2

i) sudden - PE/pneumothorax
ii) hours - asthma, pneumonia, LVF
iii) over days - pneumonia, LVF
iv) over weeks - pleural effusion, anaemia
v) over months - tumours, ILD, muscle weakness, COPD
vi) over years - COPD, ILD, muscle weakness

Question 3

what is the main abnormality seen in the CXR?

Answer 3

R sided pneumothorax (loss of lung marking in peripheral lung)

Question 4

what is the main abnormality seen in the CXR?

Answer 4

Left hilar mass

Question 5

SPUTUM

i) what colour is mucoid sputum? what colour is purulent sputum?
ii) name two conditions where large amounts may be produced
iii) approx how much sputum does the bronchial tree produce per day?

Answer 5

i) mucoid = clear/white
purulent = yellow/green

ii) large amounts produced in bronchiectasis / lung abscess
iii) bronchial tree produces aorund 100mls per day

Question 6

HAEMOPTYSIS

i) name the three most significant causes

Answer 6

i) PE, lung cancer, TB

Question 7

WHEEZE

i) what causes it?
ii) name two conditons where it is expiratory, diffuse and polyphonic?
iii) in what situation may it be inspiratory/monphonic

Answer 7

i) caused by fast air flow through narrow airways
ii) asthma and COPD
iii) if a large central airway is narrowed eg by a tumour

Question 8

STRIDOR

i) name two characteristics of the noise
ii) what does it indicate? name three areas that may be involved
iii) what needs to be done if stridor is present?

Answer 8

i) harsh inspiratory noise that is high pitched
ii) indicates obstructed airway - supraglottis, glottis, subglottis, trachea
iii) need to contact emergency ENT

Question 9

CHEST PAIN

i) name four conditions where there may be pleuritic chest pain
ii) how is chest wall pain characterised? name two things that can cause it

Answer 9

i) pleuritic - pneumonia, peripheral PE, pneumothorax

ii) chest wall pain = localised pain and tenderness
- bone, muscle, nerve involvement eg rib fracture

Question 10

DRUG HISTORY

i) name two resp symptoms that beta blockers may cause
ii) name two drugs that may cause interstitial lung disease (antiarrhythmic and abx)

Answer 10

i) b blockers can cause SOB and wheeze
ii) ILD - amiodarone & nitrofurantoin

Question 11

O/E - SIGNS OUTSIDE THE CHEST

i) name three causes of LN enlargement in the neck
ii) name two conditons JVP may be raised in
iii) what can cause peripheral oedema?

Answer 11

i) lung cancer, sarcoidosis, TB
ii) raised JVP in RHF and SVC obstruction
iii) RHF causes peripheral oedema