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Breathlessness > Investigations > Flashcards

Investigations Flashcards

1
Q

What are the investigations for puemonia? (7)

A
  • O2 sats (less than 92%)
  • X ray
  • Blood culture: bateraemia
  • FB: WWC, ESR, CRP, anaemia=abscess
  • Sputum sample
  • Signs of shock e.g urea
  • Us and Es: kidney function
  • HIV serology
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2
Q

What investigations should be done for asthma? (7)

A
  • Pulmonary function tests (PFTs)
  • Peak flow rate
  • Spironmetry
  • FV1/PEF bronchodilator improvement
  • Bloods: esoinophils
  • Normal CXR in case pneumothorax
  • Skin prick test
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3
Q

What do PFTs show in asthma? (4)

A

Obstructive lung disease profile

  • Decreased FEV1 (less than 80%)
  • Decreased peak flow rate
  • Decreased FEV1/VC ratio (less than 0.7)
  • 15% FV1/PEF improvement with bronchodilator
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4
Q

What do obstructive lung diseases show in PFTs? (4)

A
  • Decreased FEV1 (less than 80%)
  • Decreased FVC but not as much as FEV1
  • Decreased peak flow rate
  • Decreased FEV1/FVC ratio (less than 0.7)
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5
Q

What pulmonary function tests (PFTs) can be done? (4)

A
  • Peak flow rate (PEFR)
  • FEV1
  • FVC
  • FEV1: FVC ratio
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6
Q

What do restrictive lung diseases show in LFTs? (4)

A
  • Normal peak flow
  • Reduced FVC
  • Reduced FEV1
  • Normal FEV1:FVC ratio
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7
Q

What investigations should be done to confirm a diagnosis of COPD? (3)

A
  • Spirometery: Post bronchodilator FEV1/FVC = <0.70
  • Chest Xray (exclusion)
  • Blood tests (exclusion)
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8
Q

How is COPD classified? (4)

A
  • All COPD: FEV1/FVC ratio= <0.7
  • Mild FEV1: >80%
  • Moderate FEV1: 50-79%
  • Severe: 30-49%
  • Very severe: Less than 30%
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9
Q

How is degree of breathlessness assessed?

A

MRC dyspnoea scale

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10
Q

What is FEV1?

A

Volume of air the patient can exhale in the first second of forced expiration

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11
Q

What is FVC?

A

Total volume of air the patient can forcibly exhale in one breath

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12
Q

What do persistent x ray changes in pneumonia suggest?

A

Underlying carcinoma with secondary pneumonia

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13
Q

What additional test should be done for occupational asthma?

A

Allergen provocation test

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14
Q

Pleural effusion investigations (6)

A

1) Diagnostic aspiration
- Biochem= protein, LDH: transudate/exudate?
- Glucose (low, infection), pH (check empyema)
- Bacteria culture
- Cytology
2) Check systemic causes
- Protein (albuminaemia)
- LFTs
- Us&Es:

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15
Q

What makes pleural fluid an exudate? (2)

A
  • Serum protein more than 0.5

- LDH more than 0.6

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16
Q

What is an transudate (protein containing) pleural effusion caused by? (6)

A
  • Puenmonia
  • TB
  • Inflammatory conditions (arthirtus)
  • PE
  • Pancreatitus
  • Cancer
17
Q

What is an exudate (low protein) pleural effusion caused by? (5)

A

General systemic overload:

  • Cardiac failure activating RAAS
  • Hepatic failure: low albumin
  • Pericarditus
  • Nephrotic syndrome: protein excretion
  • PE
18
Q

What does an effusion with low glucose indicate?

A

Infection

19
Q

What does an effusion with low pH and low glucose indicate?

A

Empyema

20
Q

Severe asthma investigations (3)

A

ABG: Type 1 resp failure turning to type 2 as patient starts to tire and CO2 rises

  • ECG; Sinus Tachy
  • Hypokalaemia risk: excessive beta agonist use can drive potassium into the cells
21
Q

Lung cancer - ptosis/myosis//adelynclosis (2)

A
  • Bronchoscopy

- Chest x ray

22
Q

Fibrosis (4)

A
  • FBC: raised ERS? ANA?
  • Chest x ray
  • Lung function: restrictive
  • ABG: hypoxaemia
23
Q

Heart failure investigations (8)

A
  • Hypokalaemia (RAAS/K+ sparing diuretics) or hyperkalaemia (ACE inhibitors)
  • Anaemia
  • Hyponatraemia
  • LFTs
  • Us&Es
  • Echo
  • Exclude lung disease: pulmonary function
24
Q

Contraindications to CTPA (5)

A
  • Allergy to medium
  • Pregnancy
  • Kidney failure
  • Bone marrow damage
  • Risk of cancer (breast)
25
Q

General breathlessness (5)

A
  • Xray
  • Pleural fluid
  • Sputum sample
  • Biochem (calcium increased in carcinoma, decreased Na+)
  • Peak flow and spirometry
26
Q

CRB65 score for pneumonia criteria

A

1 point for each:

  • Confusion
  • Resp rate (+30)
  • Low BP (diastolic <60/systolic <90)
  • Age 65+
27
Q

CRB65 score for pneumonia interpretation

A

0: low risk
1-2: intermediate mortality risk
3-4: high mortality risk

Breathlessness (9 decks)

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