Dyspnea Flashcards
_______ is the subjective sensation of breathlessness that is excessive for any given level of physical activity
Dyspnoea
The most common cause of dyspnoea encountered in family practice is airflow obstruction, which is the basic abnormality seen in___ and _______
chronic asthma and
chronic obstructive pulmonary disease (COPD).
_______which is a continuous musical or
whistling noise, is an indication of airflow
obstruction
Wheezing,
Dyspnoea is not inevitable in lung cancer but
occurs in about_______of cases
60%
NYHA classification for breathlessness
Grade 1 No breathlessness
Grade 2 Breathlessness on severe exertion
Grade 3 Breathlessness on mild exertion
Grade 4 Breathlessness at rest
Wheeze includes_____, which is an inspiratory wheeze.
stridor
Features of dyspnea from lung etiology
History of respiratory disease Slow development Present at rest Productive cough common Aggravated by respiratory infection
Features of dyspnea from cardiac etiology
Rapid development
Mainly on exertion
Cough uncommon and then ‘dry
Usually unaffected by respiratory infection
The term_____ is used to describe a wheezing sensation such as that experienced with paroxysmal nocturnal dyspnoea
‘cardiac asthma’
Dyspnoea
Mainly inspiratory_______
Mainly expiratory______
Cardiac
Lung
Cough
Precedes dyspnoea
Follows dyspnoea
Lung
Cardiac
Sputum
Pink and frothy
Thick and gelatinous
Cardiac
Lung
Lung signs
Mainly crackles
Mainly wheezes
Cardiac
Lung
Asthma vs COPD
Symptoms
<35 years
Common _____
Unusual________
Asthma
COPD
Asthma vs COPD
Chronic cough
Uncommon_____
Common_______
Asthma
COPD
Asthma vs COPD
Dyspnoea
Diurnal and variable________
Constant and progressive_____
Asthma
COPD
Asthma vs COPD
Nocturnal waking with symptoms
UnCommon
common
COPD
Asthma
Drugs must also be considered in the assessment of dyspnea, especially as
a cause of ________ that
presents with dyspnoea, cough and fever
interstitial pulmonary fibrosis
Drugs that cause IPF
cytotoxic agents (especially bleomycin, cyclophosphamide, methotrexate), amiodarone, sulphasalazine, penicillamine, nitrofurantoin, gold salts and adrenergic nasal sprays
Poisons that may cause ________are
salicylate, methyl alcohol, theophylline overdosage and ethylene glycol
hyperventilation
Dyspnoea is unlikely
to be caused solely by chronic anaemia unless the
haemoglobin level is less than____
8 g/dL
In true ________ chest
X-rays and pulmonary function tests are normal but symptoms are often reproduced after 15–30 seconds of voluntary hyperventilation
psychogenic dyspnoea,
Wheeze is often (but not always) present in asthma and ______
chronic airflow obstruction
The sudden onset of dyspnoea at rest is suggestive of _____ or ______
pulmonary embolism
or pneumothorax.
Severe dyspnoea developing over
1 or 2 hours is most likely due to_______
left heart failure or bronchial asthma
A complaint of ‘suffocation or feeling smothered’ or ‘just not getting enough air’
may be a pointer to________
functional dyspnoea
A coarse tremor or flap of the outstretched
hands indicates_______
carbon dioxide intoxication
Wheezes are high-pitched continuous sounds heard either in expiration or inspiration, being more pronounced in
______
expiration.
________previously referred
to as crepitations, occur typically in lobar pneumonia and diffuse interstitial fibrosis, and are not cleared by coughing
Fine crackles,
Medium crackles are typical of __________ and coarse crackles indicate _______
congestive cardiac failure,
airway mucus and usually clear on coughing
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 _______
peak expiratory flow rate (PEFR).
________ is the gold standard test for PFT
Spirometry
How to measure ventilatory deficit in Spirometry
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
What are the variables for FVC and FEV1 ?
sex, age and height
The FEV 1 expressed as a percentage of the FVC is an excellent measure of ________
airflow limitation
Normal FEV1
70%
______ and _______ can be measured by a simple spirometer
Tidal volume (TV) and vital capacity (VC)
What measures total lung capacity and residual volume?
measured by the helium dilution method in a respiratory laboratory
This test measures the carbon monoxide uptake by a single breath analysis for whole lungs
Diffusing capacity (gas transfer factor)
In normal lungs the transfer factor is a true measure of the diffusing capacity of the lungs for oxygen and depends on the
_________
thickness of the alveolar-capillary membrane
Gas transfer is usually reduced in patients with severe degrees of 1 2 3 4
emphysema and fibrosis, anaemia and
congestive cardiac failure
This test indicates the presence of airway or bronchial hyper-reactivity, which is a fundamental feature with asthma.
Histamine challenge test
To whom should the histamine test not be done?
The test should not be performed on those
with poor lung function
Detection of Pleural Effusion
- Can be detected on X-ray if _____ mL fluid in pleural space
- Can be detected clinically if ____mL fluid
> 300
> 500
Characteristics of Transudate
Protein content <30 g/L;
lactic dehydrogenase <200 IU/
Causes of transudative PE
• Heart failure (90% of cases)
• Hypoproteinaemia, e.g. nephrotic syndrome
• Liver failure with ascites
• Constrictive pericarditis
• Hypothyroidism
• Ovarian tumour—right-sided effusion (Meigs
syndrome
Characteristics of Exudative PE
Protein content >30 g/L;
lactic dehydrogenase >200 IU/L
Causes of transudative PE
• 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
MC cause of dyspnea in chidlren
asthma, bronchiolitis and
pulmonary infections
The important infections that
can be fatal in children—
croup, epiglottitis and myocarditis—
_______ is an important cause of respiratory distress in infants under 6–12 months. It should not be confused with asthma
Bronchiolitis
The respiratory system, like most other bodily
systems, matures until about the age of ______and subsequently slowly loses efficiency
25 years
Dyspnoea is a common early
symptom of CHF as pulmonary congestion causes___ and _______
hypoxia (increased ventilation) and decreased compliance (increased work)
Right failure is invariably secondary to ___
left failure.
________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
Interstitial lung diseases
Consider possibility of fibrosis of lungs in chronic dyspnoea and a _______
dry cough with normal resonance
PFT features of ILD
— restrictive ventilatory deficit
— decrease in gas transfer factor
CT features of ILD
‘honeycomb lung’.
______ 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
Sarcoidosis
Distinct feature of ILD
bilateral hilar lymphadenopathy
Other associations of ILD
- Erythema nodosum
* Ocular lesions (e.g. anterior uveitis)
Erythema nodosum with an acute swinging fever, malaise and arthralgia in a young adult female is diagnostic of________
sarcoidosis
MR of sarcoidosis
2–5%
Dx of Sarcoidosis
Histological evidence from biopsy specimen, usually transbronchial biopsy
A better modern diagnostic method for Sarcoidosis is biopsy via ___
videoassisted thoracoscopy
Other supportive tests for sarcoidosis
- elevated serum ACE (non-specific
- ± ve Kveim test (not recommended these days)
- serum calcium
What sarcoidosis does not involve Tx
(hilar lymphadenopathy without lung involvement does
not require treatment
Indications for giving corticosteroids
- no spontaneous improvement or worsening after 3–6 months
- symptomatic pulmonary lesions
- eye, CNS and other systems involvement
Other Indications for giving corticosteroids
hypercalcaemia, hypercalciuria
• erythema nodosum with arthralgia
• persistent cough
How do give steroids for sarcoidosis
Prednisolone 20–40 mg (o) daily for 6–8 weeks, then reduce to lowest dose that maintains improvement
How to taper steroids according to response
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.
How do give steroids for erythema nodosum sarcoidosis
Prednisolone 20–30 mg for 2 weeks for erythemanodosum of sarcoidosis
Other names for IPF
idiopathic fibrosing interstitial pneumonia and
cryptogenic fibrosing alveolitis,
What is the most common diagnosis among patients presenting with interstitial
lung disease.
IPF
CXR of IPF
Chest X-ray abnormalities are variable but include bilateral diffuse nodular or reticulonodular shadowing favouring the
lung bases.
Prognosis of IPF
The usual prognosis is poor with death occurring about 2–5 years after
diagnosis.
Dx of IPF
Chest CT
Tx for IPF
The usual treatment is high doses of oral
corticosteroids with azathioprine and no smokin
_________is characterised by a widespread diffuse inflammatory reaction in both the small airways of the lung and the alveoli,
Extrinsic allergic alveolitis (hypersensitivity
pneumonitis)
Causes of Extrinsic allergic alveolitis
thermophilic actinomycetes in ‘farmer’s lung’ or (more commonly) avian protein
from droppings or feathers in ‘bird fancier’s lung
Presentation of Extrinsic allergic alveolitis
Illness may present as acute or subacute episodes of pyrexia, chills and malaise with dyspnoea and a peripheral neutrophil several hours after exposure
How to Tx acute Sx
May give CS
ddx of extrinsic allergic alveolitis
It should be pointed
out that this allergic disorder is different from the
infection psittacosis.
Drug induced ILD
Alveolitis with or without pulmonary fibrosis.
This is mainly due to ______
cytotoxic drugs, nitrofurantoin and amiodarone
Drug induced ILD
Eosinophilic reactions
various antibiotics, NSAIDs, cytotoxic agents,
major tranquillisers and antidepressants, and
anti-epileptics
Drug induced ILD
Non-cardiogenic acute pulmonary oedema
opioids, aspirin, hydrochlorothiazide, β 2-adrenoceptor agonists (given IV to suppress premature labour),
cytotoxics, interleukin-2, heroin.
The term ‘_________ refers to the accumulation of dust in the lungs and the reaction of tissue to its presence, namely chronic fibrosis.
pneumoconiosis’
The main cause worldwide of pneumoconiosis’ is inhalation of ______, a specific severe variety being progressive massive fibrosis
coal dust
Pulmonary asbestosis has classic X-ray changes but highresolution
CT scans may be required to confirm the
presence of _______
calcified pleural plaques.
It usually takes ______ years from exposure for asbestosis to develop and ______ years for mesothelioma to develop
10–20
20–40
acute hypoxaemic respiratory failure following a pulmonary or systemic insult with no apparent cardiogenic cause of pulmonary oedema
ARDS
The most common cause is_______ which accounts for about onethird
of ARDS patients.
sepsis
CXR of ARDS
- Bilateral pulmonary infiltrates on X-ray
* No apparent evidence of heart failure
a respiratory illness of varying severity (mild
to severe) with a known mortality rate of about 10% of clinically established cases
SARS
SARS
All cases to date exhibit _____
a high fever of >38 ° C.
SARS
It is considered to be an atypical pneumonia caused by a quite unique
______
coronavirus.
Dyspnoea in the presence of lung cancer may be caused by many factors, such as pleural effusion, lobar collapse, upper airway obstruction and _______
lymphangitis carcinomatosis
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
digoxin toxicity
Recurrent attacks of sudden dyspnoea, especially waking the patient at night, are suggestive of
_______
asthma or left heart failure
