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Dyspnea Flashcards

1
Q

_______ is the subjective sensation of breathlessness that is excessive for any given level of physical activity

A

Dyspnoea

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2
Q

The most common cause of dyspnoea encountered in family practice is airflow obstruction, which is the basic abnormality seen in___ and _______

A

chronic asthma and

chronic obstructive pulmonary disease (COPD).

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3
Q

_______which is a continuous musical or
whistling noise, is an indication of airflow
obstruction

A

Wheezing,

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4
Q

Dyspnoea is not inevitable in lung cancer but

occurs in about_______of cases

A

60%

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5
Q

NYHA classification for breathlessness

A

Grade 1 No breathlessness
Grade 2 Breathlessness on severe exertion
Grade 3 Breathlessness on mild exertion
Grade 4 Breathlessness at rest

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6
Q

Wheeze includes_____, which is an inspiratory wheeze.

A

stridor

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7
Q

Features of dyspnea from lung etiology

A 
History of respiratory disease
Slow development
Present at rest
Productive cough common
Aggravated by respiratory infection
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8
Q

Features of dyspnea from cardiac etiology

A

Rapid development
Mainly on exertion
Cough uncommon and then ‘dry
Usually unaffected by respiratory infection

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9
Q

The term_____ is used to describe a wheezing sensation such as that experienced with paroxysmal nocturnal dyspnoea

A

‘cardiac asthma’

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10
Q

Dyspnoea

Mainly inspiratory_______

Mainly expiratory______

A

Cardiac

Lung

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11
Q

Cough

Precedes dyspnoea

Follows dyspnoea

A

Lung

Cardiac

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12
Q

Sputum

Pink and frothy

Thick and gelatinous

A

Cardiac

Lung

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13
Q

Lung signs

Mainly crackles

Mainly wheezes

A

Cardiac

Lung

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14
Q

Asthma vs COPD

Symptoms

<35 years

Common _____

Unusual________

A

Asthma

COPD

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15
Q

Asthma vs COPD

Chronic cough

Uncommon_____

Common_______

A

Asthma

COPD

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16
Q

Asthma vs COPD

Dyspnoea

Diurnal and variable________

Constant and progressive_____

A

Asthma

COPD

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17
Q

Asthma vs COPD

Nocturnal waking with symptoms

UnCommon

common

A

COPD

Asthma

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18
Q

Drugs must also be considered in the assessment of dyspnea, especially as
a cause of ________ that
presents with dyspnoea, cough and fever

A

interstitial pulmonary fibrosis

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19
Q

Drugs that cause IPF

A 
cytotoxic agents (especially bleomycin, cyclophosphamide, methotrexate), amiodarone, 
sulphasalazine,
 penicillamine,
nitrofurantoin,
 gold salts and 
adrenergic nasal sprays
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20
Q

Poisons that may cause ________are

salicylate, methyl alcohol, theophylline overdosage and ethylene glycol

A

hyperventilation

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21
Q

Dyspnoea is unlikely
to be caused solely by chronic anaemia unless the
haemoglobin level is less than____

A

8 g/dL

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22
Q

In true ________ chest
X-rays and pulmonary function tests are normal but symptoms are often reproduced after 15–30 seconds of voluntary hyperventilation

A

psychogenic dyspnoea,

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23
Q

Wheeze is often (but not always) present in asthma and ______

A

chronic airflow obstruction

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24
Q

The sudden onset of dyspnoea at rest is suggestive of _____ or ______

A

pulmonary embolism

or pneumothorax.

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25
Q

Severe dyspnoea developing over

1 or 2 hours is most likely due to_______

A

left heart failure or bronchial asthma

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26
Q

A complaint of ‘suffocation or feeling smothered’ or ‘just not getting enough air’
may be a pointer to________

A

functional dyspnoea

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27
Q

A coarse tremor or flap of the outstretched

hands indicates_______

A

carbon dioxide intoxication

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28
Q

Wheezes are high-pitched continuous sounds heard either in expiration or inspiration, being more pronounced in
______

A

expiration.

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29
Q

________previously referred
to as crepitations, occur typically in lobar pneumonia and diffuse interstitial fibrosis, and are not cleared by coughing

A

Fine crackles,

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30
Q

Medium crackles are typical of __________ and coarse crackles indicate _______

A

congestive cardiac failure,

airway mucus and usually clear on coughing

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31
Q

The most practical instrument for office use to
detect chronic airway obstruction due to asthma or chronic bronchitis is the mini peak flow meter, which measures _______

A

peak expiratory flow rate (PEFR).

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32
Q

________ is the gold standard test for PFT

A

Spirometry

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33
Q

How to measure ventilatory deficit in Spirometry

A

The measurement
of the forced vital capacity (FVC) and the forced
expiratory volume in one second (FEV 1 ) provide a very
useful guide to the type of ventilatory deficit

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34
Q

What are the variables for FVC and FEV1 ?

A

sex, age and height

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35
Q

The FEV 1 expressed as a percentage of the FVC is an excellent measure of ________

A

airflow limitation

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36
Q

Normal FEV1

A

70%

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37
Q

______ and _______ can be measured by a simple spirometer

A

Tidal volume (TV) and vital capacity (VC)

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38
Q

What measures total lung capacity and residual volume?

A

measured by the helium dilution method in a respiratory laboratory

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39
Q

This test measures the carbon monoxide uptake by a single breath analysis for whole lungs

A

Diffusing capacity (gas transfer factor)

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40
Q

In normal lungs the transfer factor is a true measure of the diffusing capacity of the lungs for oxygen and depends on the
_________

A

thickness of the alveolar-capillary membrane

41
Q 
Gas transfer is usually reduced in patients with severe degrees of
1
2
3
4
A

emphysema and fibrosis, anaemia and

congestive cardiac failure

42
Q

This test indicates the presence of airway or bronchial hyper-reactivity, which is a fundamental feature with asthma.

A

Histamine challenge test

43
Q

To whom should the histamine test not be done?

A

The test should not be performed on those

with poor lung function

44
Q

Detection of Pleural Effusion

  • Can be detected on X-ray if _____ mL fluid in pleural space
  • Can be detected clinically if ____mL fluid
A

> 300

> 500

45
Q

Characteristics of Transudate

A

Protein content <30 g/L;

lactic dehydrogenase <200 IU/

46
Q

Causes of transudative PE

A

• Heart failure (90% of cases)
• Hypoproteinaemia, e.g. nephrotic syndrome
• Liver failure with ascites
• Constrictive pericarditis
• Hypothyroidism
• Ovarian tumour—right-sided effusion (Meigs
syndrome

47
Q

Characteristics of Exudative PE

A

Protein content >30 g/L;

lactic dehydrogenase >200 IU/L

48
Q

Causes of transudative PE

A 
• Infection—bacterial pneumonia, pleurisy,
empyema, TB, viral
• Malignancy—bronchial carcinoma,
mesothelioma, metastatic
• Pulmonary infarction
• Connective tissue diseases (e.g. SLE, RA)
• Acute pancreatitis
• Lymphoma
• Sarcoidosis
• HIV with parasitic pneumonia
49
Q

MC cause of dyspnea in chidlren

A

asthma, bronchiolitis and

pulmonary infections

50
Q

The important infections that

can be fatal in children—

A

croup, epiglottitis and myocarditis—

51
Q

_______ is an important cause of respiratory distress in infants under 6–12 months. It should not be confused with asthma

A

Bronchiolitis

52
Q

The respiratory system, like most other bodily

systems, matures until about the age of ______and subsequently slowly loses efficiency

A

25 years

53
Q

Dyspnoea is a common early

symptom of CHF as pulmonary congestion causes___ and _______

A

hypoxia (increased ventilation) and decreased compliance (increased work)

54
Q

Right failure is invariably secondary to ___

A

left failure.

55
Q

________comprise a group of disorders that have the common features of inflammation (pneumonitis) and fibrosis of the interalveolar septum, representing a non-specific reaction of the lung to injury of various causes

A

Interstitial lung diseases

56
Q

Consider possibility of fibrosis of lungs in chronic dyspnoea and a _______

A

dry cough with normal resonance

57
Q

PFT features of ILD

A

— restrictive ventilatory deficit

— decrease in gas transfer factor

58
Q

CT features of ILD

A

‘honeycomb lung’.

59
Q

______ is a multisystemic disorder of unknown aetiology which is characterised by non-caseating granulomatous inflammation that involves the lung in about 90% of affected patients

A

Sarcoidosis

60
Q

Distinct feature of ILD

A

bilateral hilar lymphadenopathy

61
Q

Other associations of ILD

A
  • Erythema nodosum

* Ocular lesions (e.g. anterior uveitis)

62
Q

Erythema nodosum with an acute swinging fever, malaise and arthralgia in a young adult female is diagnostic of________

A

sarcoidosis

63
Q

MR of sarcoidosis

A

2–5%

64
Q

Dx of Sarcoidosis

A

Histological evidence from biopsy specimen, usually transbronchial biopsy

65
Q

A better modern diagnostic method for Sarcoidosis is biopsy via ___

A

videoassisted thoracoscopy

66
Q

Other supportive tests for sarcoidosis

A
  • elevated serum ACE (non-specific
  • ± ve Kveim test (not recommended these days)
  • serum calcium
67
Q

What sarcoidosis does not involve Tx

A

(hilar lymphadenopathy without lung involvement does

not require treatment

68
Q

Indications for giving corticosteroids

A
  • no spontaneous improvement or worsening after 3–6 months
  • symptomatic pulmonary lesions
  • eye, CNS and other systems involvement
69
Q

Other Indications for giving corticosteroids

A

hypercalcaemia, hypercalciuria
• erythema nodosum with arthralgia
• persistent cough

70
Q

How do give steroids for sarcoidosis

A

Prednisolone 20–40 mg (o) daily for 6–8 weeks, then reduce to lowest dose that maintains improvement

71
Q

How to taper steroids according to response

A

If there is no response, taper the

dose to zero. If there is a response, taper the dose to 10–15 mg (o) daily as a maintenance dose for 6–12 months.

72
Q

How do give steroids for erythema nodosum sarcoidosis

A

Prednisolone 20–30 mg for 2 weeks for erythemanodosum of sarcoidosis

73
Q

Other names for IPF

A

idiopathic fibrosing interstitial pneumonia and

cryptogenic fibrosing alveolitis,

74
Q

What is the most common diagnosis among patients presenting with interstitial
lung disease.

A

IPF

75
Q

CXR of IPF

A

Chest X-ray abnormalities are variable but include bilateral diffuse nodular or reticulonodular shadowing favouring the
lung bases.

76
Q

Prognosis of IPF

A

The usual prognosis is poor with death occurring about 2–5 years after
diagnosis.

77
Q

Dx of IPF

A

Chest CT

78
Q

Tx for IPF

A

The usual treatment is high doses of oral

corticosteroids with azathioprine and no smokin

79
Q

_________is characterised by a widespread diffuse inflammatory reaction in both the small airways of the lung and the alveoli,

A

Extrinsic allergic alveolitis (hypersensitivity

pneumonitis)

80
Q

Causes of Extrinsic allergic alveolitis

A

thermophilic actinomycetes in ‘farmer’s lung’ or (more commonly) avian protein
from droppings or feathers in ‘bird fancier’s lung

81
Q

Presentation of Extrinsic allergic alveolitis

A

Illness may present as acute or subacute episodes of pyrexia, chills and malaise with dyspnoea and a peripheral neutrophil several hours after exposure

82
Q

How to Tx acute Sx

A

May give CS

83
Q

ddx of extrinsic allergic alveolitis

A

It should be pointed
out that this allergic disorder is different from the
infection psittacosis.

84
Q

Drug induced ILD

Alveolitis with or without pulmonary fibrosis.

This is mainly due to ______

A

cytotoxic drugs, nitrofurantoin and amiodarone

85
Q

Drug induced ILD

Eosinophilic reactions

A

various antibiotics, NSAIDs, cytotoxic agents,
major tranquillisers and antidepressants, and
anti-epileptics

86
Q

Drug induced ILD

Non-cardiogenic acute pulmonary oedema

A

opioids, aspirin, hydrochlorothiazide, β 2-adrenoceptor agonists (given IV to suppress premature labour),
cytotoxics, interleukin-2, heroin.

87
Q

The term ‘_________ refers to the accumulation of dust in the lungs and the reaction of tissue to its presence, namely chronic fibrosis.

A

pneumoconiosis’

88
Q

The main cause worldwide of pneumoconiosis’ is inhalation of ______, a specific severe variety being progressive massive fibrosis

A

coal dust

89
Q

Pulmonary asbestosis has classic X-ray changes but highresolution
CT scans may be required to confirm the
presence of _______

A

calcified pleural plaques.

90
Q

It usually takes ______ years from exposure for asbestosis to develop and ______ years for mesothelioma to develop

A

10–20

20–40

91
Q

acute hypoxaemic respiratory failure following a pulmonary or systemic insult with no apparent cardiogenic cause of pulmonary oedema

A

ARDS

92
Q

The most common cause is_______ which accounts for about onethird
of ARDS patients.

A

sepsis

93
Q

CXR of ARDS

A
  • Bilateral pulmonary infiltrates on X-ray

* No apparent evidence of heart failure

94
Q

a respiratory illness of varying severity (mild

to severe) with a known mortality rate of about 10% of clinically established cases

A

SARS

95
Q

SARS

All cases to date exhibit _____

A

a high fever of >38 ° C.

96
Q

SARS

It is considered to be an atypical pneumonia caused by a quite unique
______

A

coronavirus.

97
Q

Dyspnoea in the presence of lung cancer may be caused by many factors, such as pleural effusion, lobar collapse, upper airway obstruction and _______

A

lymphangitis carcinomatosis

98
Q

If a patient develops a relapse of dyspnoea while on digoxin therapy, consider the real possibility of ______ and/or electrolyte abnormalities leading to left heart failure

A

digoxin toxicity

99
Q

Recurrent attacks of sudden dyspnoea, especially waking the patient at night, are suggestive of
_______

A

asthma or left heart failure

MC (90 decks)

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