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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

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2
Q

Dynamic/variable extra-thoracic obstruction

A

Functional vocal cord paralysis
Extra-thoracic tracheomalacia
Polychondritis

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3
Q

Dynamic/Variable intra-thoracic obstruction

A

Tracheomalacia
Tracheal lesions

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4
Q

Fixed upper airway obstruction

A

Tracheal stenosis
Extra-thoracic compression (tumour/goitre)

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5
Q

Peripheral/lower airways obstruction

A

COPD
Asthma
Brochiolitis

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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

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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)

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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

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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

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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

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11
Q

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

A
  • Pneumonectomy
  • Chest wall disease
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12
Q

TLCO and KCO: Airflow obstruction

A

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

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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)

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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)

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15
Q

Isolated reduced TLCO with normal spirometry

A
  • May suggest pulmonary vascular disease
  • Anaemia
  • CPFE
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16
Q

Raised TLCO and KCO

A

Polycythaemia, left to right shunt or pulmonary haemorrhage

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17
Q

Type 1 respiratory failure conditions

A

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

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18
Q

Difference between pneumonia and COPD on an x-ray

A

Pneumonia: consolidation on one side, wheeze

COPD: symmetrical, hyperinflated (bigger)

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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

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20
Q

How does the trachea move in a chest x-ray

A

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

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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
Treatment for pulmonary embolism
Initial treatment: low molecular weight heparin and Rivaroxaban (Factor Xa inhibitor) Long term: Warfarin (vitamin K antagonist)
26
Mechanism of salbutamol
Beta 2 adrenoreceptor agonist
27
What measurement is used for grading the severity of airflow obstruction in COPD
Forced expiratory volume (FEV1)
28
When should you/ should not offer oxygen therapy
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
Spirometry contraindications
MI, pneumothorax, haemoptysis, stroke, unstable angina, uncontrolled hypertension
30
What is found in a heart failure examination
Displaced apex beat Heart murmurs Crackles in the base of lungs Oedema
31
What is found in a COPD exam
Reduced crico-sternal distance Barrel chest Hyper-resonant lungs Focal crackles (if exacerbated) Reduced breath sounds
32
Chest x-ray COPD
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
Chest x-ray heart failure
Increased cardio-thoracic ratio (bigger heart) Kerley B lines Lots of white at the bottom Bats wing appearance Fluid in the fissure
34
Blood test for heart failure
Pro-BNP Will be raised in heart failure Released from cardiac myocytes due to stress
35
COPD non-medical management
Smoking cessation Pulmonary rehab Vaccination Medication and diet Management for anxiety (CBT)
36
When do you not give ICS in COPD
If there is infection risk
37
How to differentiate infection from PE
Infection: fever, unilateral consolidation, green sputum, more history PE: pleuritic chest pain, breathlessness with no sputum, acute
38
PE risk factors
Immobility, cancer, pregnancy, oestrogen, COPD, HRT, previous PE or DVT, obesity, trauma, operation, family history
39
Ground glass opacification
Opacification but you can see the lung architecture
40
Treatment for mild pneumonia
Amoxicillin 500mg 3 times a day
41
Red flags for lung cancer
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
Investigations for lung cancer
Endo-bronchial ultrasound- take a biopsy CT guided biopsy CT scan- in the lung as well as looking for metastasis
43
Ischaemic heart disease
A reduction in blood supply to the heart, can cause heart failure or MI Major causes: atherosclerosis, coronary artery spasma
44
Treatment for ischaemic heart disease
Medicine: Nitrates, aspirin, beta blockers, statins, calcium channel blockers Surgery: Percutaneous coronary angioplasty (inserting a small balloon), coronary artery biopsy
45
Co-morbidities which increase the risk of ischaemic heart disease
Diabetes Hypertension Chronic kidney disease Inflammatory conditions i.e. rheumatoid arthritis Atypical antipsychotic medications
46
Secondary prevention for cardiovascular disease
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
Notable side effects of statins
Myopathy- check for creatine kinase in patients with muscle pain or weakness Type 2 diabetes Haemorrhagic stroke
48
Management of PE
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
Wells score: PE
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
Investigations PE
CT pulmonary angiogram Ventilation-perfusion (VQ) scan- perfusion will be reduced
51
VTE prophylaxis
Prophylaxis: LMWH i.e. enoxaparin Unless contraindicated with active bleeding or using warfarin or NOAC

Medicine year 3- EOCP (27 decks)

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