Respiratory Core Clinical Problems Flashcards
CO2 retention headache
- characteristically a headache on wakening
- doesn’t change with posture
- “thick head”
- not unlike a hangover
main symptoms of CO2 toxicity (hypercarbia/ hypercapnia)?
- dimmed sight
- reduced hearing
- drowsiness
- mild narcosis
- dizziness
- confusion
- headache
- unconsciousness
- sweating
- SOB
- increased heart rate and BP
- tremor
what happens to the Vt (tidal volume) in normal nocturnal ventilation?
It is reduced
What happens to the respiratory rate in normal nocturnal ventilation?
It is reduced
What happens to the pO2 and pCO2 in normal nocturnal ventilation?
They are maintained
Symptoms of sleep apnoea
- episodic apnoeas
- neurological arousal
- fragmented sleep
- poor quality sleep
- daytime somnolence
- early morning headache
effects of sleep deprivation
- irritability
- cognitive impairment
- memory lapses or loss
- impaired moral judgement
- severe yawning
- hallucinations
- symptoms similar to ADHD
- increased heart rate variability
- risk of heart disease
- decreased reaction time and accuracy
- tremors
- aches
- impaired immune system
- risk of type 2 diabetes
- growth suppression
- risk of obesity
- decreased temperature
signs of obesity hypoventilation
- snores little
- Vt falls dramatically
- pO2 falls and pCO2 rises steadily throughout the night
- high CO2 in morning
any cause of chronic type 2 respiratory failure will be worsened overnight. True/ False?
True.
What are features of chest pain caused by cardiac system?
- pain is central
- heavy, dull pain
- radiates to jaw/ arms/ back
- autonomic symptoms
- exertional
- relieved by GTN spray
What are features of chest pain caused by respiratory system?
- worse on inspiration and coughing: suggests pleural irritation
- dull discomfort may suggest soft tissue mass, pleural mass, or local invasion
What are features of chest pain caused by gastrointestinal system?
- indigestion
- heartburn
- spasms difficult to differentiate from cardiac
- relation to posture and food
What are features of chest pain caused by musculoskeletal system?
- history of trauma
- worse on breathing, movement, and touch
PE pain changes with posture, movement, and inspiration/ expiration. True/ False?
True
Ischaemic heart disease is worse in hot weather. True/ False?
False. It is worse in cold weather.
What kind of pain is ischaemic heart disease pain?
crushing, gets better when the person sits down for a few minutes.
Ischaemic pain occurs during heart attacks and angina
what is pleuritic pain like?
sharp, and is pain on inspiration
what is bronchiectasis pain like?
it feels like someone is pushing a metal rod against your back
what are oesophageal spasms like?
gripping pain
can pain from the heart be well localised?
no
what kind of pain is worse in inspiration?
pleuritic pain
this can occur in TB, pneumonia
Characteristically, what is the colour of sputum in Strep pneumonia?
rusty coloured (due to blood)
where could haemoptysis be coming from?
- nose
- GI (vomit, haematemesis (vomiting blood - dark and acidotic, melaena - dark sticky faeces which contain partly digested blood as a result of internal bleeding or the swallowing of blood), coffee ground vomitus (classic sign of upper GI bleeding))
- bronchial
what are some possible appearances of haemoptysis?
- frothy
- old
- rusty
- streaks
- mixed with sputum (if not: consider infarction and trauma)
what volume is “massive haemoptysis”?
more than or equal to 600ml in 24 hours
person should be admitted and may need emergency treatment
what volume is “non-massive” haemoptysis?
less than 600ml in 24 hours.
possible causes of haemoptysis?
- trauma
- infective
- neoplastic
- vascular
- parenchymal
- non-pulmonary
what kinds of trauma could cause haemoptysis?
- wounds
- intubation
- foreign body
what kinds of infection could cause haemoptysis?
- pneumonia
- abscess
- acute bronchitis
- tuberculosis
- bronchiectasis
- fungi
what kinds of neoplasia could cause haemoptysis?
- primary
- secondary (lung, breast, brain, prostate, colon, other)
what kinds of vascular problems could cause haemoptysis?
- PE
- Vasculitis (SLE, Wegener’s, RA, Osler-Weber-Rendu)
- Arteriovenous malformation (AVM)
What kinds of parenchymal problems could cause haemoptysis?
- ILDs
- sarcoid
- haemosiderosis
- Good[asture’s syndrome
- Cystic fibrosis
What kinds of non-pulmonary problems could cause haemoptysis?
- CVS (pulmonary oedema, mitral stenosis, aortic aneurysm, Eisenmenger’s syndrome)
- bleeding diathesis (including drug-induced)
what are some different characters of cough?
- brassy (pressure on trachea?)
- hollow/ bovine (laryngeal nerve palsy causing vocal cord dysfunction)
- barking (acute epiglottitis)
- dry (GORD, drugs e.g. ACE-I)
- change in character of a chronic cough should make you consider other pathology
what condition should be considered when a cough is nocturnal?
asthma (early morning cough)
what are some precipitating factors for an asthmatic’s cough?
- emotion
- cold, windy, wet weather
- dust
- allergies
- exercise
- drugs
In a cough with sputum, what factors about the sputum should be considered?
-colour
-volume
-consistency
-pattern
Consider: infections, COPD, CF, bronchiectasis
For a patient who has a cough, what could be some associated symptoms to consider?
- breathlessness
- sputum
- chest pain
- wheeze
- hoarseness
How can ACE inhibitors cause coughing?
By inhibiting the breakdown of bradykinin
Beta blockers can worsen or precipitate underlying asthma sometimes. True/ False?
True
