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PBL SEM 2 > PBL 3 - managing respiratory disease > Flashcards

PBL 3 - managing respiratory disease Flashcards

1
Q

what are 5 symptoms of respiratory disease?

A
  • dyspnoea
  • cough
  • chest pain
  • wheeze/stridor
  • haemoptysis
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2
Q

how is dyspnoea diagnosed?

A
  • speed of onset
  • timing of breathlessness
    - PND (paroxysmal nocturnal dyspnoea)
  • positional breathless
    - orthopnoea (lying flat), platypnoea (sitting forward)
  • severity
    - MRC dyspnoea scale
  • personal and family history
    - occupational and environment
    - travel
    - medication (illicit drugs)
    - smoking
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3
Q

causes of instantaneous dyspnoea

A
  • pneumothorax
  • pulmonary embolism
  • asthma
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4
Q

causes of gradual (days) dyspnoea

A
  • pleural effusion (fluid around lung in pleural space)
  • lobar collapse
  • SVC obstruction
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5
Q

causes of acute (mins —> hours) dyspnoea

A
  • pulmonary embolism
  • pneumonia
  • LVF (heart failure)
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6
Q

causes of chronic (months —> years) dyspnoea

A
  • COPD
  • bronchiectasis
  • pulmonary fibrosis
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7
Q

describe cough assessment

A
  • onset and duration — acute and chronic (>8 weeks)
  • sputum production — volume
  • sputum character — colour, smell, consistency
  • cough character — bovine, barking, whoop
  • associated features — eg. impaired cough effort
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8
Q

pleuritic vs visceral pain

A
  • pleuritic pain is in relation to breathing pattern

- visceral pain is a more consistent gnawing pain

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9
Q

what is haemoptysis?

A

coughing up blood — non specific feature of respiratory disease

  • 60-80% infective (TB, pneumonia, bronciectasis), pulmonary embolus
  • 10-20% malignant
  • no cause identified in up to 30%
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10
Q

what is a wheeze?

A

a noisy musical sounds from turbulent flow through the airways

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11
Q

what can a silent chest indicate?

A

severe acute asthma

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12
Q

what is stridor?

A

coarse inspiratory wheeze caused by laryngeal or large airway obstruction

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13
Q

what is the cardinal test to diagnose COPD?

A

FEV1

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14
Q

is COPD non-progressive or progressive?

A

progressive condition

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15
Q

what is important to note when taking a history for COPD?

A
  • exertional breathlessness
  • chronic productive cough
  • wheeze
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16
Q

what is noticeable on examination of COPD?

A
  • chest hyperinflation
  • quiet breath sounds
  • wheeze
  • purse lip breathing
  • accessory muscle use
  • cyanosis
  • cachexia
17
Q

describe the MRC dyspnoea scale?

A
  1. only troubled on strenuous exercise
  2. SOB walking up a hill
  3. walks slower than contemporaries on flat or stops when walking at own pace
  4. stops for breath after walking 100m or after a few minutes on the flat
  5. too breathless to leave the house, or breathless with ADLs
18
Q

FEV1/FVC in obstructive disease vs restrictive disease

A

obstructive: less than 75%
restrictive: more than 75%

obstructive: lower because it is taking a lot longer to actually blow the air out and less is being blown out in 1 second due to the obstruction
restrictive: lungs are stiff due to parenchymal lung damage and most of the air is being blown out within the 1st second, with little more being able to be blown out at 6 seconds

19
Q

what is the dutch hypothesis for the link between smoking and annual decline in FEV1?

A

recurrent airway inflammation leads to airflow obstruction

20
Q

what is the British hypothesis for the link between smoking and annual decline in FEV1?

A

frequent infections caused by mucus hypersecretion caused decline in lung function, but the two are separate

21
Q

what are 4 parts of non-pharmacological COPD management?

A
  1. smoking cessation = most important
  2. pulmonary rehabilitation
  3. nutrition
  4. patient support
22
Q

what is the leading cause of preventable disease and death in the world?

A

smoking

23
Q

what does the stages if change model applied to smoking emphasise?

A

that repeated cycling through the stages occurs before permanent cessation is achieved

24
Q

at what level of oxygen is oxygen therapy required?

A

PaO2 < 7.3kPa OR < 8.0 kPa but in presence of a secondary complication

25
Q

what secondary complications can oxygen therapy be used to prevent in people with severe COPD?

A
  • pulmonary hypertension

- polycythaemia

26
Q

what is the median duration of stay for people with COPD?

A

1 week

27
Q

what is required before discharging a patient with COPD?

A

spirometry (FEV1/FVC)

PBL SEM 2 (44 decks)

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