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Y3(M) - Respiratory > Chronic Dyspnoea > Flashcards

Chronic Dyspnoea Flashcards

1
Q

What is the definition of dyspnoea?

A

Undue awareness of ones own breathing due to a change in either rate, depth or work of breathing (WOB)

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2
Q

What changes can lead to dyspnoea?

A

Changes in 02,CO2 or pH
Lung perfusion
Ventilation
Diffusion related issues (Interstitial lung disease)
Pump failure (spine, diaphragm, muscles)

Exercise
Pregnancy

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3
Q

What is an example of a disease which limits lung perfusion leading to dyspnoea?

A

Pulmonary Embolism

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4
Q

What is a common ventilation issue which can lead to dyspnoea?

A

COPD

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5
Q

What are some issues with muscles that can lead to dyspnoea?

A

Myasthenia gravis
Phrenic nerve palsy
Guillain barre syndrome

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6
Q

What are some systemic causes of dyspnoea?

A

CKD
Heart failure (leading to pulmonary oedema

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7
Q

What is orthopnoea?

A

Breathlessness on lying flat

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8
Q

What are some causes of Orthopnoea?

What is a good question to ask to gauge the severity?

A

Congestive heart failure
Severe COPD

How many pillows do you use to sleep at night

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9
Q

What is the term used to describe waking up in the night coughing due to fluid in lungs?

A

Paroxysmal nocturnal dyspnoea

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10
Q

What can cause paroxysmal nocturnal dyspnoea?

A

Congestive heart failure

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11
Q

What is platypnoea orthodeoxia syndrome?

A

When patient is comfortable lying down but becomes breathless with dropping 02 sats when they stand up

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12
Q

What conditions does Platypnoea orthodeoxia syndrome suggest?

A

AV shunting (Pulmonary AV fistula)
Patent Foramen Ovale

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13
Q

What is trepopnoea?

A

Laying on one side causes breathlessness

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14
Q

What is trepopnoea suggestive of?

A

Unilateral. Lung disease
Compression related to big tumour
Pleural effusion
Aneurysm of aorta
Large hiatus hernia

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15
Q

What is bendopnoea?

What can you ask a patient to gauge?

A

SOB on bending down

Ask if the can tie their shoe laces

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16
Q

What are some causes of bendopnoea?

A

COPD
Congestive heart failure
Pleural effusion

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17
Q

What is the definition of chronic breathlessness?

A

Develops over weeks to months

18
Q

What is the definition of acute breathlessness?

A

Develops over minutes to a few hours

19
Q

What is the definition of subacute breathlessness?

A

Develops over several hours to days

20
Q

List as many causes of chronic breathlessness as possible:

A

Obstructive - COPD, asthma, Bronchiectasis, cystic fibrosis, obstructive sleep apnoea
Restrictive - intersitial lung disease (pulmonary fibrosis, silicosis, asbestosis, pneumoconiosis, byssinosis)

Mesothelioma
TB
Lung cancer
Chronic. PE
Primary pulmonary hypertension
Congestive heart failure
Cardiac issues
Kyphoscoliosis
Renal failure
DKA
Anaemia.

21
Q

What is byssinosis?

A

Interstitial lung disease due to inhalation of cotton

22
Q

What is the most common cardiac issue in older people that causes chronic dyspnoea?

A

Aortic stenosis
Mitral stenosis

23
Q

Hx:

What is important to ask about the presenting complaint for chronic breathlessness?

A

Duration
Onset
Severity (functional impairment)
Factors worsening or alleviating

24
Q

Hx:

What it’s important to understand from a patients Social history with chronic breathlessness?

A

Smoking
Alcohol
Physical activity (exercise TOLERANCE)
Travel history (TB or other travel related infections)
Pets (Bird fanciers lung)
Occupation (asbestosis, pneumoconiosis, silicosis, byssinosis)

25
Q

Hx:

What are some important associated features we would want to ask about which might aid a diagnosis for a cause for chronic breathlessness?

A

Chest pain
Palpitations
Syncope
Weight loss
Fever
Sputum
Cough
Muscle weakness

26
Q

Hx:

What are some drugs that can contribute to chronic dyspnoea?

A

Beta blockers
Amiodarone (amiodarone immunities)
Nitrofurantoin
Methotrexate
Bleomycin

27
Q

What is paradoxical breathing?

A

When the chest falls anal abdomen rises with inhalation

28
Q

What does paradoxical breathing suggest?

A

Diaphragmatic paralysis
Severe muscle weakness (severe asthma exacerbation, COPD exacerbation, myasthenia gravis)

29
Q

What is the NICE criteria for a CXR to query a lung cancer?

A

Over 40yr or ever smoked with unexplainable symptoms:
-cough
-fatigue
-SOB
-chest pain
-weight loss

30
Q

What values on spirometry would you expect to find for obstructive lung disease?

A

FEV1:FVC ratio < 0.7

31
Q

What values on spirometry would you expect to find for restrictive lung disease?

A

FEV1:FVC ratio > 0.8

32
Q

What is interstitial lung disease?

A

Conditions characterised by inflammation of alveolar epithelium and interstitium leading to fibrosis

33
Q

What are some causes of interstitial lung disease?

A

Idiopathic pulmonary r fibrosis
Hypersensitivity pneumonic it’s
Sarcoidosis
Connective tissue disease related pulmonary fibrosis
Drug induced
Occupational (silicosis, asbestosis, pneomconiosis, byssinosis)

34
Q

What investigations would you do on someone with chronic breathlessness?

A

FBC
U+Es
LFTs
ECG
Thyroid function test
CXR
Abdo US. (Ascites? Liver. Cirrhosis?)
Peak expiratory flow rate
Spirometry

35
Q

What is an example of a measure/scale of breathlessness?

A

MRC scale of dyspnoea

36
Q

How is the MRC (medical research council scale for dyspnoea graded?

A

1-5

37
Q

What is grade 1 of the MRC scale of dyspnoea?

A

Not troubled by breathlessness expect on strenuous exercise

38
Q

What is grade 2 of the MRC scale of dyspnoea?

A

Short of breath when hurrying on the level or walking up a slight hill

39
Q

What is grade 3 of the MRC scale of dyspnoea?

A

Walks slower than most people on the level
Stops after a mile or so or stops after 15miins walking at own pace

40
Q

What is grade 4 of the MRC scale of dyspnoea?

A

Stops for breath after walking about 100 yards or after a few minutes on level ground

41
Q

What is grade 5 of the MRC scale of dyspnoea?

A

Too breathless to leave the house or breathless while undressing

42
Q

What are some other scales that we can use to assess breathlessness?

A

CPET (cardiopulmonary exercise testing)
6 minute walking distance and shuttle walk

Y3(M) - Respiratory (3 decks)

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