Breathless Teenager

Question 1

what is hyperventilation?

Answer 1

increased work of breathing results in a reduction alveolar and arteriolar pCO2

Question 2

what is hyperpnoea?

Answer 2

greater than normal level of ventilation

Question 3

what is cheyne stokes?

Answer 3

abnormal breathing pattern characterised by progressivley deeper and or faster breathing ( brainstem issue/end of life)

Question 4

where do you have receptors that may influence breathlessness?

Answer 4

intrapulmonary parenchymal stretch receptors, carotid body and central medullary chemoreceptors, peripheral vascular receptors, pulmonary artery baroreceptors

Question 5

why do you need to think about oral contraceptive in someone who is breathless?

Answer 5

risk factor for pulmonary embolism

Question 6

diagnosis of asthma is done how?

Answer 6

clinically: wheeze, breathlessness, chest tightness and cough and exercise related symptoms

Question 7

tests for asthma?

Answer 7

PEFR variability (bakers asthma every 2 hours at work)
spirometry- variable air flow obstruction/ reversibility
inducible airways hyperesponsiveness (methacholine/histamine)
airway inflammation (eosinophil count, FeNO)

Question 8

bronchodilator reversibility 400mg slbutamol changes?

Answer 8

greater than 12% in FEV1 or 200ml

Question 9

what change would you expect to see in FeNO?

Answer 9

> 40ppb

Question 10

direct bronchial challenge test?

Answer 10

looking for a fall of 20% in FEV1, a provocative concentration of 8mg/ml or less is regarded as positive

Question 11

asthma mimics?

Answer 11

inducible laryngeal obstruction, exercise induced laryngeal obstruction, sinus disease, airway obstruction, cough hypersensitivity, GORD

Question 12

why give magnesium?

Answer 12

mast cell stabiliser

Question 13

when is research ethical approval required?

Answer 13

studies involving humans/animals if you are gathering novel data and creating knowledge that can be generalised beyond participant sample or setting

Question 14

which do not require ethic approval?

Answer 14

service evaluation/quality improvement
clinical audit (against a benchmark)

Question 15

prevalence?

Answer 15

frequency of cases of a disease in a given population at a designated time

Question 16

point prevalence?

Answer 16

proportion of population that has the characterisitic at a specific point in time

Question 17

lifetimes prevalence

Answer 17

have you ever had…?

Question 18

point and period prevalence are better?

Answer 18

patient recall, tracking changes

Question 19

lifetime prevalence is better for

Answer 19

short fluctuating and episodic conditions

Question 20

cross-sectional study?

Answer 20

defined population is surveyed to measure variable of interest outcome or exposure. inclusion and exclusion criteria selected.

Question 21

advantaged of cross sectional study?

Answer 21

compare prevalence in exposed and non exposed group to risk factors, quick and inexpensive, can be used to initally explore/inform a hypothesis

Question 22

disadvantages of a cross sectional study?

Answer 22

not suitable for rare disease, cannot separate cause exposure and outcome , cannot measure rate of new cases arising

Question 23

Supplementary prescriber?

Answer 23

someone able to prescribe medicines in accordance with a pre-agreed care plan that has been drawn up between doctor and patient