Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Medicine year 3- EOCP > Breathlessness- extra from lectures > Flashcards

Breathlessness- extra from lectures Flashcards

1
Q

Flow volume loops

A

Plot of Inspiratory and Expiratory Flow (y-axis) against volume (x-axis)
Maximally forced inspiratory and expiratory manoeuvres
Useful for identifying the location of obstruction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Dynamic/variable extra-thoracic obstruction

A

Functional vocal cord paralysis
Extra-thoracic tracheomalacia
Polychondritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Dynamic/Variable intra-thoracic obstruction

A

Tracheomalacia
Tracheal lesions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Fixed upper airway obstruction

A

Tracheal stenosis
Extra-thoracic compression (tumour/goitre)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Peripheral/lower airways obstruction

A

COPD
Asthma
Brochiolitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Different measurements of lung volume

A

Tidal Volume = Volume of air in and out during normal breathing
Functional Residual Capacity = Volume of air in lungs at end of normal expiration
Total Lung Capacity = Volume of air in lungs after full inspiration
Residual Volume = Gas remaining in the lungs after full expiration
Vital Capacity = Volume of air expelled by a full expiration from position of full inspiration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Conditions causing increased and decreased lung volume

A

Increased lung volume- airflow obstruction (particularly raised residual volume), Emphysema
Decreased lung volume- Restrictive lung disease (lung parenchyma or extra-pulmonary)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

TLCO and KCO

A

TLCO- Transfer factor for the Lung Carbon Monoxide. Measures the total ability of the lungs to transfer gas into the blood stream

KCO- transfer coefficient. Gas transfer per unit volume, reflects alveolar volume in the lung

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What causes a reduced TLCO or KCO

A

Anything disrupting the alveolar membrane or reducing pulmonary capillary volume.

Conditions: Emphysema, Interstitial lung disease, Pulmonary hypertension, Pneumonia, Multiple PTE, Anaemia, Low cardiac output

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What causes TLCO or KCO to be increased

A

By anything increasing the pulmonary capillary volume
- Asthma (decreased intrathoracic pressure)
- Alveolar haemorrhage (recent)
- Left to right shunts
- Polycythaemia
- Exercise

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Conditions which cause the gas transfer (TLCO) to be reduced but the kco to not change

A
  • Pneumonectomy
  • Chest wall disease
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

TLCO and KCO: Airflow obstruction

A

Low TLCO : emphysema//bronchiolitis obliterans
Normal TLCO: COPD/bronchitis but no emphysema
Raised TLCO : Asthma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

TLCO and KCO: Restriction (reduced FVC and reduced lung volume)

A

Low TLCO : ILD
Raised KCO: Extra pulmonary Restriction (obesity, pleural effusion, kyphoscoliosis, muscular weakness, pulmonary haemorrhage)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

TLCO and KCO: Restriction (reduced FVC and reduced lung volume)

A

Low TLCO: ILD
Raised KCO: Extra pulmonary Restriction (obesity, pleural effusion, kyphoscoliosis, muscular weakness, pulmonary haemorrhage)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Isolated reduced TLCO with normal spirometry

A
  • May suggest pulmonary vascular disease
  • Anaemia
  • CPFE
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Raised TLCO and KCO

A

Polycythaemia, left to right shunt or pulmonary haemorrhage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Type 1 respiratory failure conditions

A

Pulmonary fibrosis
Pulmonary embolism
Pneumothorax
Acute severe asthma- only life threatening asthma is type 2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Difference between pneumonia and COPD on an x-ray

A

Pneumonia: consolidation on one side, wheeze

COPD: symmetrical, hyperinflated (bigger)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Heart failure- chest x-ray

A

In chronic heart failure you get pleural effusion
Pleural effusion has a meniscus
There may be an absent costophrenic angle due to fluid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

How does the trachea move in a chest x-ray

A

Pleural effusion: Trachea shifts away
Lung collapse: Trachea shifts towards

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Emphysema: chest x-ray

A

Hyperinflation
Narrow mediastinum
Hyperluency
Bullae

22
Q

How many ribs cover the lungs

A

5th-7th rib hits the diaphragm
In emphysema it is more

23
Q

Tension pneumothorax treatment

A

Air is let into the pleural space which causes a pressure imbalance
Put a needle into the 2nd intercostal midclavicular line to treat it
Then put the pleural drain int the 5th intercostal space midaxillary line

24
Q

What investigation confirms the diagnosis of pulmonary embolism

A

CT pulmonary angiogram

25
Q

Treatment for pulmonary embolism

A

Initial treatment: low molecular weight heparin and Rivaroxaban (Factor Xa inhibitor)

Long term: Warfarin (vitamin K antagonist)

26
Q

Mechanism of salbutamol

A

Beta 2 adrenoreceptor agonist

27
Q

What measurement is used for grading the severity of airflow obstruction in COPD

A

Forced expiratory volume (FEV1)

28
Q

When should you/ should not offer oxygen therapy

A

Do not offer long term oxygen therapy to current smokers

Offer oxygen therapy to patients with pulmonary hypertension and an FEV1 of less than 30% predicted

29
Q

Spirometry contraindications

A

MI, pneumothorax, haemoptysis, stroke, unstable angina, uncontrolled hypertension

30
Q

What is found in a heart failure examination

A

Displaced apex beat
Heart murmurs
Crackles in the base of lungs
Oedema

31
Q

What is found in a COPD exam

A

Reduced crico-sternal distance
Barrel chest
Hyper-resonant lungs
Focal crackles (if exacerbated)
Reduced breath sounds

32
Q

Chest x-ray COPD

A

Hyper-lucency (darker)
Flattened diaphragm- lung will appear between the heart and the diaphragm
Hyper-inflation
Reduced cardio-thoracic ratio
Bullae (no lung markings)

33
Q

Chest x-ray heart failure

A

Increased cardio-thoracic ratio (bigger heart)
Kerley B lines
Lots of white at the bottom
Bats wing appearance
Fluid in the fissure

34
Q

Blood test for heart failure

A

Pro-BNP
Will be raised in heart failure
Released from cardiac myocytes due to stress

35
Q

COPD non-medical management

A

Smoking cessation
Pulmonary rehab
Vaccination
Medication and diet
Management for anxiety (CBT)

36
Q

When do you not give ICS in COPD

A

If there is infection risk

37
Q

How to differentiate infection from PE

A

Infection: fever, unilateral consolidation, green sputum, more history
PE: pleuritic chest pain, breathlessness with no sputum, acute

38
Q

PE risk factors

A

Immobility, cancer, pregnancy, oestrogen, COPD, HRT, previous PE or DVT, obesity, trauma, operation, family history

39
Q

Ground glass opacification

A

Opacification but you can see the lung architecture

40
Q

Treatment for mild pneumonia

A

Amoxicillin 500mg 3 times a day

41
Q

Red flags for lung cancer

A

Persistent cough or change in cough for 3 weeks
Unexplained weight loss, loss of appetite, fatigue
Haemoptysis
Chest and shoulder tip pain which cant be explained by anything
Chest infection which isnt getting better
Hoarse voice for more than 3 weeks

42
Q

Investigations for lung cancer

A

Endo-bronchial ultrasound- take a biopsy
CT guided biopsy
CT scan- in the lung as well as looking for metastasis

43
Q

Ischaemic heart disease

A

A reduction in blood supply to the heart, can cause heart failure or MI
Major causes: atherosclerosis, coronary artery spasma

44
Q

Treatment for ischaemic heart disease

A

Medicine: Nitrates, aspirin, beta blockers, statins, calcium channel blockers
Surgery: Percutaneous coronary angioplasty (inserting a small balloon), coronary artery biopsy

45
Q

Co-morbidities which increase the risk of ischaemic heart disease

A

Diabetes
Hypertension
Chronic kidney disease
Inflammatory conditions i.e. rheumatoid arthritis
Atypical antipsychotic medications

46
Q

Secondary prevention for cardiovascular disease

A

4 A’s
A – Aspirin (plus a second antiplatelet such as clopidogrel for 12 months)
A – Atorvastatin 80mg
A – Atenolol (or other beta-blocker – commonly bisoprolol) titrated to maximum tolerated dose
A – ACE inhibitor (commonly ramipril) titrated to maximum tolerated dose

47
Q

Notable side effects of statins

A

Myopathy- check for creatine kinase in patients with muscle pain or weakness
Type 2 diabetes
Haemorrhagic stroke

48
Q

Management of PE

A

Initial: LMWH either apixaban or rivaroxaban
Switch to long term anticoagulation: warfarin, NOAC or LMWH. Continue for 3 months if there is an obvious reversible cause. Or 6 months if the cause is unclear or there is active cancer
Thrombolyse if there is a massive PE with haemodynamic compromise

49
Q

Wells score: PE

A

Outcome:
Likely: perform a CT pulmonary angiogram
Unlikely: perform a d-dimer and if positive perform a CTPA

Takes into account recent surgery, tachycardia and haemoptysis

50
Q

Investigations PE

A

CT pulmonary angiogram
Ventilation-perfusion (VQ) scan- perfusion will be reduced

51
Q

VTE prophylaxis

A

Prophylaxis: LMWH i.e. enoxaparin

Unless contraindicated with active bleeding or using warfarin or NOAC

Medicine year 3- EOCP (27 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions