Respiratory Flashcards
List and descuss the NYHA 1-4
Class 1: No limitation with ordinary physical activity
Class II: Slight limitation with physical activity, comfortable at rest
Class III: Maked limitation of physical activity. Comfortable at rest, but less than ordinary physical activity results in undue breathlessness
Class IV: unable to carry out physical activity without discomfort , symptoms can be present even at rest
List and discuss the MRC classification of dyspnoea
mMRC 0: with strenuous exercise
1: when hurrying up on level or walking up a slight hill
2: walk slower than people my age on th level because of breathlessness
3: stops for breath after walking 100m or a few min on the level
4: too breathless two leave the house, breathlessness when dressing and undressing
Define dyspnoea
difficult, labored, uncomfortable breathing: it is an unpleasant type of breathing, though it is not painful in the usual sense of the word (Comroe, 1966)
What is the main investigation you do for a pt if you suspect asthma
In a low resourced: Peak expiration volume
But ideally Spirometer
What further investigations would you do for a pt presenting with dyspnoea, normal X-ray and ecg
What is the diagnosis
V/Q scan
CTPA
Thromboembolic pulmonary hypertension
List some of the Resp causes of dyspnoea 10
- Pulmonary:
-Increased airflow resistance
COPD
Asthma
Exercise-induced
Vocal cord dysfunction
Upper airway obstruction - Decreased compliance
Interstitial lung disease
Pulmonary congestion
LVF
lymphangitis
Pleural disease
Effusion or fibrothorax
Pneumothorax
Kyphoscoliosis
-V-Q mismatching
Interstitial lung disease
Pulmonary congestion
Pneumonia
-Reflex
Pulmonary oedema
Pulmonary embolism
-Respiratory muscle weakness
Guillain-Barre syndrome
Myasthenia gravis
Diaphragmatic paralysis
-Pulmonary vascular disease
Primary pulmonary hypertension
Recurrent thromboembolism
List 2 cardiac causes of dyspnoea
Myocardial infarction
Valvular lesions
List 5 miscellaneous causes of dyspnoea
Obesity
Anaemia
Thyrotoxicosis
Inactivity & deconditioning
Psychogenic (hyperventilation syndrome)
Malingering
List some of the cardiac causes of SOB
Pericardium: pericardial effusion, temponade
Muscle: dilated & restricted cardiomyopathy, ARVC
Vessel: IH, MI
Endocardium : Aortic stenosi, Mitral stenosis
Electricity: AF
List 4 respiratory causes of SOB according to the different areas affected
Pleura: pleural effusion, pneumothorax
Parenchyma: infection, pneumonia is
Vessel: Pulmonary embolism, pulmonary HPT
Airway: asthma, bronchiectasis, COAD
List 4 CNS causes of SOB
Brain: brain stem CVA
Spine: paralysis
Nerve: Gillian barre
Junction: myasthenia crisis
MM: muscle dystrophy
What metabolic problem can cause SOB
MUDPILES
Methylene glycol
Uraemia
DKA
Pancreatitis
Infection
Lactic acidosis
Exogenous- metformin
Salicylate OD
What overdoses cause SOB
INH
Ethyl glycol
Methylene glycol
Salicylate OD
Amytriptaline
List the 4 features suggestive of bronchial carcinoma
Clubbing
Nicotine staining
Lymphadenopathy
Superior mediastinal syndrome- if bronchial carc ass/w mediastinal mass
Differentiate between chronic bronchitis and emphysema interns of location and pathophysiology
Chronic bronchitis is a an airflow problem, there is inflammation and structural changes to the bronchiole.
It is associated with chronic cough and sputum
Emphysema is damage to the alveoli affecting diffusion of oxygen, Hypoxic because they can’t exchange gad.
Between asthma and COOD which one will have a bronchodilator response
Asthma
By how much should PEV and peak flow improve if you have asthma and you are given a bronchodilator
PEV1 12% and 200ml
Peak flow should improve by 20%
Outline the step by step management of asthma
A- SABA (CAT<10) CAT is asthma control test (Ipratropium bromide can be added to SABA in moderate or severe attacks)
B- LABA (CAT>/=10)
C- ICS (Inhaled Corticosteroids) +LABA or LAMA
D- ICS + LABA and/or LAMA
Leukotriene receptor antagonist for pt unable or unwilling to take ICS, can be used as monotherapy for mild asthma, mild asthma with exercise induced components, aspirin sensitive asthma, and tx allergic reactions rhinitis concomitant with asthma.
List any 5 advantages of inhaled therapy
Target site of disease
Low dose is needed
Rapid onset of action
Few side effect
Limited systemic absorption
More classes of drugs available in this form
Titration of dose
Outline the goals of COPD therapy
Limit disease progression
Improve lung mechanics
Prevent exacerbations
Improve quality of life
What are the key elements of COPD therapy
Education about the disease
Reduce symptoms
Reduce risk
What is the mainstay tx for asthma
Inhaled corticosteroids
What is the mainstay tx for COPD
Bronchodilators
