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respiratory > breathlessness > Flashcards

breathlessness Flashcards

1
Q

what can be classed as acute breathlessness?

A

less than 4 weeks

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2
Q

what can be pulmonary causes of acute breathlessness?

A

– pneumonia, pneumothorax, PE, asthma, acute exacerbation of COPD, acute resp distress syndrome (COVID, SARS), large airway obstruction eg anaphylaxis, foreign body obstruction, epiglottis (cover that covers trachea swells)

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3
Q

what can be cardiac causes of acute breathlessness?

A

severe PE, acute MI, cardiac arrythmia, pericarditis, pericardial effusion

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4
Q

what can be non cardiac/ pulmonary causes of acute breathlessness?

A
  • pain, diabetic ketoacidosis, drugs (aspirin overdose, opiates, benzyl benzonate, trauma, hyperventilation, panic attack, thyrotoxicosis, altitude sickness
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5
Q

what are pulmonary causes of chronic breathlessness?

A

COPD, emphysema, fibrosis, pleural effusion, lung cancer, asthma, hereditary lung disorder (Cystic fibrosis), pulmonary Tb

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6
Q

what are cardiac causes of chronic breathlessness?

A

left ventricular, heart valve disease (mitral and aortic stenosis), arrhythmias, pericardial causes

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7
Q

what are non cardiac/ pulmonary causes of chronic breathlessness?

A

severe anaemia, psychogenic eg anxiety, thromboembolic disease, thyroid (hyper/ hypo), obesity, neuromuscular eg Guillian- barre syndrome

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8
Q

what should be included within the history taking for breathlessness?

A
  • Onset and duration
  • Timing
  • Severity – MRC scale (medical research council scale to measure breathlessness
  • Course
  • Exacerbating and relieving factors
  • Previous episodes – why see now?
  • associated features
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9
Q

what is the MRC scale?

A

quantifying breathlessness
1. Not troubled by breathlessness on strenuous exercise
2. Short of breath when hurrying on a level or when walking up a slight hill
3. Walks slower than most people on the level, stops after a mile or so or 15 mins walking at own pace
4. Stops for breath after walking 100yrds or after a few mins on level ground
5. Too breathlessness to leave house, breathless when dressing/ undressing – ADL

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10
Q

why are associated features important within breathlessness?

A

rare to be SoB alone

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11
Q

what are common associated features of breathlessness?

A
  • Cough – productive, colour, volume
  • Wheeze – times
  • Haemoptysis
  • Chest pain – SOCRATES
  • Red flags/ systemic – fever/ night sweats/ weight loss. Concerns – red frothy sputum, red blood clots, severe and prolonged
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12
Q

what is important within past med history/ drug history?

A
  • Resp conditions/ cardiac conditions/ allergies
  • Other co-morbidities – anxiety – check physical first so you do not miss anything
  • Hospital admissions/ ITU admissions/ surgical
  • Drug history: helps with naming conditions
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13
Q

what needs to be included within a social history?

A
  • Smoking – calculate pack years
  • Recreational drugs
  • Baseline: activities of daily living – eg dressing
  • Travel history: TB, exotic
  • Occupation: previous/ current – exposures?
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14
Q

what is interstitial lung disease?

A

group of disorders affecting lung interstitum - alveolar and capillary epithelium, basement membranes
cause fibrosis - scarring, loss of elasticity

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15
Q

what are classic ILD symptoms?

A

SoB, dry cough

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16
Q

name some causes of ILD

A

> 200 causes
idiopathic pulmonary fibrosis, hypersensitivity pneumonitis, sarcoidosis (group of inflame cells called granuloma), asbestosis, drug side effects eg methotrexate

17
Q

what is idiopathic pulmonary fibrosis?

A

IPF is reserved when no other underlying cause exists

18
Q

when is the onset of idiopathic PF?

A

50-70yrs

19
Q

what are classic symptoms of idiopathic PF?

A

: progressive exertional dyspnoea, bi-basal crackles on auscultation, dry cough, clubbing, low sats, cyanosis

20
Q

what investigations should be done for idiopathic PF?

A

spirometry, reduced TLCO (total capacity for lung capacity of carbon monoxide), CXR, high resolution CT (ground glass/ frosted glass, honeycomb appearance)

21
Q

what is the management of idiopathic PF?

A

: no cure – can only manage symptoms, pulmonary rehab, pirfenidone (antifibrotic agent may be useful), supplementary O2, lung transplant

22
Q

what is the prognosis of idiopathic PF?

A

3-4 yrs
progressive nature

23
Q

what is sarcoidosis?

A

multi system chronic inflammation
non caseating granuloma across body with predilection for lungs

24
Q

when is the onset for sarcoidosis?

A

mid 20s to mid 40s

25
Q

do black patients have worse outcomes with sarcoidosis

A

yes

26
Q

what are common symptoms of sarcoidosis

A

rashes, nodules, skin lesions, dry eyes, blurry vision, enlarged lymph nodes, cough (with/ out blood), heart complications, enlarged spleen and liver, joint pain, arthritis, swelling of knees

27
Q

what investigations are needed for sarcoidosis?

A

FBC (eosinophils, lymphopenia, Ca can be high), serum ACE, blood films (lymphocytes raised

28
Q

what management is required for sarcoidosis?

A

test eyes, steroids, most resolve spontaneously (20% can result in pulmonary fibrosis), osteoporosis protection, flu vaccine, stop smoking

29
Q

what is bronchiectasis?

A

chronic air way inflammation with dilation of bronchi/ branches

30
Q

what causes bronchictasis?

A
  • Extra mucus made in abnormal airways which is not cleared due to loss cilia
  • Collection of thick viscous mucus results in patients becoming more prone to chest infections
  • Causes: in ½ of cases cannot be found, history of serios lung infection is most common cause eg TB, whooping cough, pneumonia/ measles – childhood infections. Immunosuppression’s eg AIDs, transplant patients, hypogammaglobinaemia. Immune hyperactivity: colitis, crohns disease and RA. Inherited – CF. airway obstruction, aspiration – GORD, chronic alcoholics
31
Q

what are common symptoms of bronchiectasis?

A

cough with lots of phlegm , recurrent chest infections (mucus in the airway forms a broth for bacteria to grow, sputum turns green/ yellow when infected. Bad breath can indicate active infection. Tiredness/ poor concentration, wheeze, SoB, occasional cough up small amounts of blood from inflamed airway

32
Q

what would help to diagnose bronchiectasis?

A

CT - widened bronchi - signet rings
MRI - bronchiectasis of cystic fibrosis

33
Q

what is involved in the management of bronchiectasis?

A

antibiotics (amoxicillin – severe cases/ continuous infections) , resp physio (help cough up and clear airways – 20-30m ins BD), inhaler (SABAs and SAMAs for wheezing in acute attack. Steroid inhalers should not be used unless underlying asthma). Other meds – other bronchodilators

respiratory (10 decks)

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