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► Med Misc 46 > CPC 1 (breathlessness) and basic resp > Flashcards

CPC 1 (breathlessness) and basic resp Flashcards

1
Q

Causes of clear grey mucoid sputum

A

Chronic bronchitis and COPD

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2
Q

Causes of white viscid mucoid sputum

A

Asthma

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3
Q

Causes of purulent yellow sputum

A

Acute bronchopulmonary infection. Asthma.

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4
Q

Causes of purulent green sputum

A

Longer standing infection; pneumonia, bronchiectasis, cystic fibrosis, lung abscess.

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5
Q

Rusty red sputum

A

Pneumococcal pneumonia.

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6
Q

Classes of causes of haemoptysis

A

Tumour, infection, vascular, vasculitis, trauma, cardiac, haematological.

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7
Q

Classes of causes of central chest pain

A

Tracheal, cardiac, oesophageal, great vessels.

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8
Q

Causes of chronic cough in a non-smoker with a normal X-ray.

A

GORD, chronic sinus disease or ACE inhibitors.

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9
Q

Causes of chronic wheezy cough

A

COPD and asthma.

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10
Q

Feeble non-explosive ‘bovine’ cough

A

lung cancer invading the left recurrent laryngeal nerve.

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11
Q

Harsh, barking, painful cough with stridor

A

laryngeal inflammation, infection or tumour.

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12
Q

Persistent moist cough in the morning.

A

Chronic bronchitis.

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13
Q

Dry, centrally painful, non-productive cough

A

tracheitis and pneumonia.

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14
Q

Chronic dry cough

A

interstitial lung disease

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15
Q

Inspiratory stridor

A

narrowing at the vocal cords

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16
Q

Biphasic stridor

A

tracheal obstruction

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17
Q

Expiratory stridor

A

tracheobronchial obstruction.

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18
Q

respiratory systems review

A 
Shortness of breath
Cough 
Wheeze
Sputum production (colour, amount)
Blood in sputum
Chest pain
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19
Q

coarse crackles can be caused by…

A

pneumonia, exacerbation of COPD, bronchiectasis

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20
Q

Bilateral wheeze is caused by

A

Asthma, exacerbation of COPD, (LVF)

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21
Q

Bilateral fine crackles are caused by

A

LVF, (or exacerbation of COPD)

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22
Q

Focal reduced air entry

A

Pneumonia

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23
Q

Purulent phlegm

A

Pneumonia, exacerbation of COPD, (asthma).

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24
Q

Questions about cough

A

Onset,

Timing (on swallowing? Weekends?)

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25
Q

Questions about sputum

A

Colour
Amount
Taste or smell
Solid material

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26
Q

Questions about haemoptysis

A

Onset
Amount
Appearance

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27
Q

Haemoptysis for more than a week raises concern over…

A

Lung cancer.

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28
Q

Haemoptysis with purulent sputum suggests…

A

Infection

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29
Q

Coughing up large amounts of pure blood suggests…

A

Lung cancer, bronchiectasis, tuberculosis and lung abscess.

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30
Q

Causes of breathlessness while lying flat

A

LVF, resp muscle weakness, large pleural effusion or pressure on chest e.g. obesity, massive ascites

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31
Q

Causes of breathlessness lying on one side

A

Unilateral lung disease, dilated cardiomyopathy or tumour pressing on mediastinum.

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32
Q

Causes of breathlessness waking patient from sleep

A

Typical of asthma or LVF

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33
Q

Causes of breathlessness on walking or other exercise

A

COPD, may improve on coughing. Asthma, may continue to worsen for several minutes after stopping exercise.

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34
Q

Causes of tachypnoea due to increased ventilatory drive.

A

Fever, acute asthma and exacerbation of COPD.

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35
Q

Causes of tachypnoea due to reduced ventilatory capacity

A

Pneumonia, pulmonary oedema and interstitial lung disease.

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36
Q

Causes of bradypnoea

A

Opioid toxicity, hypercapnia, hypothyroidism, raised ICP and hypothalamic lesions.

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37
Q

What is one pack year

A

Smoking 1 pack of 20 cigarettes per day for a year equates to a single pack year.

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38
Q

Causes of bronchiectasis

A

Whooping cough or measles, especially if complicated by pneumonia.
Can be idiopathic.

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39
Q

Lung complications of connective tissue disorders and rheumatoid arthritis.

A

Pulmonary fibrosis, effusions, bronchiectasis.

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40
Q

Exposures causing pulmonary fibrosis

A

Asbestos, quartz, coal, beryllium (nuclear and aerospace industries)

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41
Q

Exposures other than smoking causing COPD

A

Coal, in coal mining.

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42
Q

Exposures causing malignancy

A

Asbestos and radon (in metal miners)

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43
Q

Exposures causing byssinosis

A

Cotton, flax or hemp.

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44
Q

Investigations for suggested asthma

A

Peak flow rate, eosinophil count (allergic asthma), allergen tests (specific IgE, skin prick).
Bronchial challenge test can exclude asthma

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45
Q

Causes of hyper-resonance

A

Pneumothorax

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46
Q

Causes of dullness on percussion

A

Consolidation, pulmonary collapse, severe fibrosis.

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47
Q

Causes of stony dullness

A

Pleural effusion, haemothorax.

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48
Q

Causes of early inspiratory crackles

A

Small airway disease e.g. bronchiolitis

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49
Q

Causes of middle to late inspiratory crackles

A

Pulmonary edema (middle and late), pulmonary fibrosis, COPD, pneumonia, abscess, TB (coarse).

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50
Q

Causes of biphasic coarse crackles

A

Bronchiectasis.

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51
Q

Causes of bronchial breathing

A

Common; pneumonia causing consolidation.

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52
Q

Whispering pectoriloquy

A

The whispering is not heard over normal lung, only over consolidation.

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53
Q

Common causes of chronic shortness of breath

A

Obesity, COPD, anaemia, congestive heart failure, asthma

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54
Q

Less common causes of chronic shortness of breath.

A

Bronchiectasis, many small PEs, malignancy, effusion, aortic stenosis, fibrosing alveolitis.

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55
Q

Define dyspnoea

A

Difficulty breathing

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56
Q

Define tachypnoea

A

Increased rate of breathing

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57
Q

Hyperpnoea

A

Increased level of ventilation as in metabolic acidosis.

58
Q

Hyperventilation

A

Over breathing resulting in decreased alveolar and arterial pCO2.

59
Q

Pulmonary causes of acute, sudden onset dyspnoea

A

Pneumothorax, inhaled foreign body, anaphylaxis

60
Q

Cardiovascular causes of acute sudden onset dyspnoea

A

PE

61
Q

Pulmonary causes of acute dyspnoea, onset over hours

A

Acute bronchitis, pneumonia, asthma

62
Q

Cardiovascular causes of acute dyspnoea onset over hours

A

LVF, pericardial tamponade, high altitude.

63
Q

Psychogenic causes of acute dyspnoea, onset over hours

A

Anxiety, panic attacks

64
Q

Metabolic causes of acute dyspnoea onset over hours

A

Diabetic ketoacidosis, ureamia, poisons

65
Q

Types of causes of acute dyspnoea

A

Pulmonary, cardiovascular, psychogenic, metabolic.

66
Q

Types of causes of chronic dyspnoea

A

Respiratory, cardiovascular, neuromuscular, mechanical, endocrine.

67
Q

Resp causes of chronic dyspnoea

A

Pleural effusion, tumour, interstitial lung disease, TB, emphysema, chronic bronchitis.

68
Q

Cardiac causes of chronic breathlessness

A

CCF, recurrent PEs, pulmonary hypertension, anaemia.

69
Q

Neuromuscular causes of chronic breathlessness

A

Myasthenia gravis, MND, myopathies.

70
Q

Mechanical causes of chronic breathlessness

A

Chest wall deformities, obesity.

71
Q

Endocrine causes of chronic breathlessness

A

Thyroid disease

72
Q

Definition of asthma

A

Variable airflow obstruction that is reversible either spontaneously of with treatment

73
Q

Diagnosis of acute severe asthma

A 
One of the following;
PEF 33-50% of best or predicted
RR more than 25 per minute
HR greater than 110 per minute
Inability to complete sentence in one breath
74
Q

Investigations for acute dyspnoea

A

CXR, thoracic CT,
resp function test,
Blood gas interpretation

75
Q

Diagnosis of near fatal asthma

A

Raised PaCO2, and/or requiring mechanical ventilation.

76
Q

Life-threatening asthma

1) PEF
2) SpO2
3) PaO2
4) PaCO2
5) on ausculatation
6) appearance
7) circulation
8) mental state.

A

1) PEF less than 33% best or predicted
2) SpO2 less than 92%
3) PaO2 less than 8
4) normal PaCO2 (4.6-6.0 kPa)
5) silent chest
6) cyanosis and feeble respiratory effort
7) bradycardia, arrhythmia, hypotension
8) exhaustion, confusion,
coma

77
Q

Seasonal allergen variations (pollens and spores)

A

Grass in early summer
trees in spring
weeds across summer
mould in late summer.

78
Q

IgE mediated responses to allergen challenge (timescale)

A

immediate phase = 20-40 mins

late phase = 6-12 h

79
Q

Immediate response in asthma mediated by…

A

histamine

80
Q

Effects of histamine in asthma

A

Increased local blood vessel permeability, bronchial smooth muscle contraction, stimulation of vagal receptors.

81
Q

Asthma late response profile

A

Mast cells in secretory state (remodelling)
IL-4, IL-5, IL-13, TNFa
neutrophils, eosinophils, and Th2 cells
Proliferation of airway epithelial cells and smooth muscle cells.

82
Q

Sputum and BAL findings in asthma

A

Curschmann’s spirals, creola bodies, charcot-Leyden crystals and eosinophils.

83
Q

Bronchial asthma

A

severe end of disease, expiratory airway collapse

84
Q

Gross pathology of asthma

A

Over-inflated lungs, collapsed tissue, mucus plugs.

85
Q

Microscopic pathology of asthma (6)

A

1) eosinophilic sputum
2) changes to airways
3) mucus hypersecretion
4) oedema
5) smooth muscle hyperplasia
6) epithelial denudation.

86
Q

Physiology behind mucus hypersecretion in asthma

A

Differentiation of epithelial and goblet cells, induced proteases, IL-13, IL-9, TNFa, increased mucin, MUC5AC and MUC5C .

87
Q

Resp function test: decreased FEV1, normal FVC, FEV1/FVC below 70%

A

Obstruction

88
Q

Sources of H+ in the blood

A

CO2 (oxidation of S containing aa, incomplete oxidation of energy substrates)

89
Q

A normal pO2

A

11-15 kPa

90
Q

A normal pCO2

A

4.5-6 kPa

91
Q

normal pH

A

7.35 - 7.45

92
Q

Causes of Type 1 resp failure

A

pulmonary oedema, pneumonia, cryptogenic fibrosing alveolitis and ideopathic pulmonary fibrosis.

93
Q

Causes of Type 2 resp failure

A

COPD, chest wall deformation, respiration muscles weakness, opiate overdose.

94
Q

Causes of of metabolic acidosis

A

Diabetic ketoacidosis, renal failure, lactic acidosis (circulatory failure or toxicity)

95
Q

normal CRP

A

less than 10 mg/l

96
Q

Raised CRP

A

Bacterial infections and inflammation.

97
Q

Filling of alveoli in consolidation

A

Pus (= infection), blood (= alveolar haemorrhage), fluid (pulmonary oedema), tumour cells (lipidic adenocarcinoma, lymphoma), protein ( alveolar proteinosis).

98
Q

Results of interstitial lung disease

A

Reduced elasticity resulting in a restrictive deficit on spirometry.
Increased diffusion distance resulting in impaired gas transfer.

99
Q

Cause of interstitial fibrosis

A

After usual interstitial pneumonia or after non-specific interstitial pneumonia with a connective tissue disorder.

100
Q

Types of interstitial lung disease.

A

Those with a known cause or association.
Idiopathic interstitial pneumonias
Granulomatous disorders (inc. sarcoidosis)
Cystic lung diseases.

101
Q

Radiology of usual interstitial pneumonia

A

Subpleural distribution, honeycombing (heterogenous both temporally and spatially), increased risk of lung cancer.

102
Q

Prognosis of usual interstitial pneumonia

A

Poor. Median survival is 3 years from diagnosis.

103
Q

Epidemiology of interstitial pulmonary fibrosis. Age, sex and risk factors.

A

Males over 60. Risk factors include smoking, occupational hazards and family history.

104
Q

Asbestos related diseases.

A

Asbestosis, mesothelioma, lung cancer, pleural fibrosis and fibrous pleural plaque formation.

105
Q

Risk factors for PE

A

Smoking, DVT, contraceptive pill, immobility, malignancy, previous PE, being pregnant, obesity, HRT, increased abdominal pressure.

106
Q

PE basic obs

A

Increased respiratory rate, decreased O2 stats, increased heart rate. (Occasionally febrile. Decreased BP if absolutely massive PE.)

107
Q

PE on examination

A

Look for signs of DVT or varicosity. No other major signs on examination unless PE really massive, then cyanosis and signs of shock.

108
Q

PE investigations

A

Baseline bloods, D-dimer for degrading clot, coag. screen, troponin to rule out MI.
Radiology: CSR (ruling out other), CT PA.
Special tests: V/Q scan for pregnant women.

109
Q

PE treatment

A 
Oxygen if hypoxic.
Fluid bolus. 
Thrombolise
Analgesia
Anti-coagulants (low molecular weight heparin for 5 days to cover start of warfarin). 
Occasionally vena cava filter.
110
Q

Causes of emphysema

A

Smoking (increased alveolar macrophages, effect on neutrophil elastase).
Alpha-1-antitrypsin deficiency.

111
Q

Radiographic findings in emphysema

A

Hyper-transradiancy.
Changes in vascular pattern
Bulla
Hyperinflation.

112
Q

Radiology. Reticular pattern in the lung resembles…

A

A net.

113
Q

Radiological appearance of interstitial fibrosis

A

Interstitial thickening, architectural distortion, airway dilatation, honey-combing and ground glass.

114
Q

Radiology. Key point of fibrotic reticular pattern.

A

Peripheral distribution.

115
Q

Causes of fibrotic reticular pattern on an X-ray.

A

Idiopathic pulmonary fibrosis, asbestosis, drug related fibrosis, collagen vascular disease, non-specific interstitial pneumonia and hypersensitivity pneumonitis.

116
Q

Causes of paroxysmal nocturnal dyspnoea

A

Left-sided heart failure

117
Q

Sudden onset dyspnoea

A

Obstruction, anaphylaxis, pneumothorax, PE, asthma

118
Q

Dyspnoea onset over hours

A

Asthma, pneumonia, pulmonary oedema, extrinsic allergic alveolitis, cardiac tamponade.

119
Q

Dyspnoea onset over days

A

Asthma, COPD, diffuse parenchymal lung disease, heart failure, pleural effusion, cancer, anaemia.

120
Q

PEFR

A

Peak expiratory flow rate; useful in detecting airway limitation and in monitoring response to treatment in asthma.

121
Q

FEV1:FVC > 75%

A

Restrictive lung disease.

122
Q

Increased total lung capacity (TLC) and residual volume (RV) suggests…

A

Obstructive lung disease

123
Q

Reduced total lung capacity (TLC) and residual volume (RV) suggests…

A

Restrictive lung disease such as fibrosis.

124
Q

Investigations for asthma

A

Demonstration of variable airflow limitation by PEFR.

If not FEV1

125
Q

Features of acute severe asthma

A

Unable to complete sentence in one breath.
RR > 25 breaths/min
HR > 110 bpm
PEFR 33-50% of predicted or best

126
Q

Features of near fatal asthma

A

Silent chest, cyanosis or feeble resp effort
Exhaustion
Bradycardia/hypotension
PEFR

127
Q

Which pneumonia can cause lymphopenia?

A

Legionella

128
Q

Marked red cell agglutinationn of blood film is sometimes raised in which pneumonia?

A

Mycoplasma

129
Q

Which pneumonias cause a sagging horizontal fissure sign?

A

Strep and Klebsiella

130
Q

Differential diagnoses for increased ankle swelling and shortness of breath at night.

A

1) Congestive cardiac failure secondary to ischaemic heart disease
2) Congestive cardiac failure secondary to valvular heart disease
3) Right ventricular failure secondary to pulmonary disease
4) Deep venous thrombosis with recurrent pulmonary emboli. More commonly unilateral

131
Q

Classic dyspnoea associated with cardiac disease

A

Orthopnoea (worse on lying down), requiring several pillows to sleep at night.
Paroxysmal nocturnal dyspnoea.

132
Q

Dyspnoea associated with pulmonary emboli

A

Acute onset, often associated with pleuritic chest pain.

133
Q

How can asthma and COPD cause RVF?

A

RVF can be secondary to pulmonary hypertension. Generally exacerbated by lying flat.

134
Q

Timescale of asthma symptoms

A

Worse in the night (cough) and morning (breathlessness), getting better throughout the day.

135
Q

General examination findings suggestive of cardiac cause of breathlessness.

A

Sinus tachycardia, elevated JVP, displaced cardiac apex, a third heart sound, bibasal crepitations (and possibly pleural effusions) and pedal +/- sacral oedema.

136
Q

Examination findings suggestive of mitral valve cardiac cause of breathlessness.

A

Atrial fibrillation, elevated JVP, displaced and heaving cardiac apex, a third heart sound, a pansystolic murmur heard loudest at the apex and radiating into the axilla, bibasal crepitations (and possibly pleural effusions) and pedal +/- sacral oedema.

137
Q

What are the NYHA grades of heart failure?

A

I No limitation No symptoms during usual activity
II Mild limitation Comfortable at rest or with mild exertion
III Moderate limitation Comfortable only at rest. Dyspnoea with mild exertion
IV Severe limitation Dyspnoea at rest

138
Q

What conditions can cause cardiac decompensation in the setting of previously adequate cardiac function, leading to breathlessness and pitting oedema?

A

Anaemia, hyperthyroidism and renal failure.

139
Q

What should you check on a pleural tap?

A

Check protein, glucose, lactate dehydrogenase.
More importantly cytology to check for malignant mesothelial cells.
Microscopy, culture and sensitivity in case of a parapneumonic effusion.
Acid fast bacilli culture and sensitivity in TB.

140
Q

Key cytokines in asthma.

A

IL-4, IL-13 and IL-9

141
Q

Obstructive lung diseases

A

Asthma, COPD, bronchiectasis

► Med Misc 46 (31 decks)

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