Dyspnea

Question 1

Define dyspnea

Answer 1

a subjective experience of breathing discomfort that consists of qualitatively distinct sensations that vary in intensity

Question 2

What tool can be used to help quantify the dyspnea felt by the patient?

Answer 2

mMRC dyspnea scale (modified Medical Research Council)

Question 3

COPD is diagnosed with spirometry. A post bronchodilator FEV1/FVC ratio of less than ____ confirms the diagnosis.

Answer 3

0.7

Question 4

Prognostication in COPD has few validated scales. Once such scale that can be useful is called ____

Answer 4

BODE

Body mass index, Airflow obstruction, dyspnea and exercise capacity Index

Question 5

Treatment for advanced-stage COPD is based upon what guidelines?

Answer 5

GOLD guidelines

Global Initiative for Chronic Obstructive Lung Disease guidelines

Question 6

What is the gold standard investigation for diagnosing a pulmonary emoblism?

Answer 6

computer tomography pulmonary angiography (CTPA)

Question 7

What is the most common EKG finding in a patient with a PE?

Answer 7

Sinus tachycardia

Question 8

What is the standard of care for the management of venous thromboembolic disease?

Answer 8

anticoagulation

Question 9

What novel oral anticoagulant (NOAC) is associated with less VTE recurrence in the cancer patient population?

Answer 9

Rivaroxaban

anticoagulant that inhibits factor Xa

Question 10

What are the major risk factors for VTE disease?

Answer 10

VIrchow’s triad: 1) stasis of blood flow, 2) endothelial damage, and 3) hypercoagulability

Question 11

What clinical findings may you see with a large pleural effusion?

Answer 11

Decreased breath sounds
Dullness to percussion
Decreased tactile fremitus
Assymetric chest expansion (if large) as well as mediastinal shift away from the side on which the effusion is located

Question 12

How do you diagnose a malignant pleural effusion?

Answer 12

Thoracentesis

Question 13

TRUE or FALSE
Malignant pleural effusions always result in hypoxemia.

Answer 13

FALSE

Question 14

What 2 cancers are most commonly associated with malignant pleural effusions?

Answer 14

1) Lung
2) Breast

Question 15

What cancer most commonly causes superior vena cava obstruction?

Answer 15

Lung

Question 16

What is the 2nd most common cause of superior vena cava obstruction?

Answer 16

non-hodgkins lypmphoma

Question 17

What clinical findings may you see in a patient with superior vena cava obstruction?

Answer 17

1) Flushing in the face & neck
2) Facial or perioorbital edema
3) Increased venous markings in the upper chest and neck
4) Elevated JVP

Question 18

List 4 treatment options for SVC syndome.

Answer 18

Radiation
Chemotherapy
Steroids
Stenting

Question 19

What is lymphangitic carcinomatosis?

Answer 19

Invasion and obstruction of the lymphatic vessels in the lung parenchyma by tumor cells.

Question 20

What cancers are most commonly associated with lymphangitic carcinomatosis?

Answer 20

Lung
GI
Gynecological

Question 21

What is the clinical presentation of lymphangitic carcinomatosis?

Answer 21

dyspnea
dry cough
hypoxaemia

Question 22

What is the treatment for lymphangitic carcinomatosis?

Answer 22

Supportive care

Very little txt available for lymphangitic carcinomatosis. Some providers will use steroids, but lacking evidence.

Question 23

If an IPF patient has acute worsening of their dyspnea, what needs to be ruled out?

Answer 23

1) PE
2) Pneumonia

Question 24

What are the major side effects of the medications used to treat IPF?

Answer 24

Gastrointestinal issues (nausea, vomiting, diarrhea)

Medications: pirfenidone and nintedanib