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CRRAB II Week 7 > Shortness of Breath > Flashcards

Shortness of Breath Flashcards

1
Q

What is Dyspnea?

A

“Abnormally uncomfortable awareness of breathing”

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2
Q

What may or may not Dyspnea be related to?

A

Exertion

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3
Q

What is the mechanism behind Dyspnea?

A
  1. Peripheral afferents (chemoreceptors) sense: Inc. PaCO2, Dec. PaO2, Dec. pH. + Stretch receptors on the lung sense stretch
  2. Information goes to the Brain respiratory center.
  3. Then to sensory cortex
  4. Then to motor cortex
  5. Then to brain respiratory center
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4
Q

What is the Ddx for Dyspnea on exertion (DOE)?

A
  • Congestive heart failure
  • Angina (anginal equivalent)
  • Obstructive pulmonary disease
  • Pleural Effusion
  • Anemia
  • Hypothyroid
  • Metabolic acidosis
  • Anxiety and hyperventilation
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5
Q

Why is COPD so important?

A
  • Fourth-ranked cause of death in U.S.

- Most important lung disease in U.S.

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6
Q

What is the definition of Chronic Obstructive Pulmonary Disease?

A

“disease state characterized by airflow limitation that is not fully reversible, progressive and associated with an abnormal inflammatory response of the lungs to noxious particle or gases.”

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7
Q

What is Chronic bronchitis?

A

Chronic productive cough for three months in two successive years.

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8
Q

What is Emphysema?

A

Pathological term in which there is enlargement of airspaces with destruction of bronchiole walls

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9
Q

What is Asthma?

A

Inflammatory disease of airways with significantly reversible narrowing

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10
Q

What are the three types of COPD?

A
  • Chronic bronchitis
  • Emphysema
  • Asthma
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11
Q

What patients with asthma don’t have COPD?

A

Patients with asthma whose airflow obstruction is completely reversible are not considered to have COPD.

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12
Q

What are patients with unremitting asthma classified as?

A

COPD

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13
Q

What are patients with chronic bronchitis or emphysema without airflow obstruction classified as?

A

NOT HAVING COPD

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14
Q

What is different between the airflow limitation in asthma and the airflow limitation in COPD?

A

Airway limitation in asthma is completely reversible. COPD is completely irreversible.

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15
Q

What is the pathology of asthma?

A

Sensitizing agent –> asthmatic airway inflammation –> CD4+ T lymphocytes, Eosinophils –> airflow limitation

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16
Q

What is the pathology of COPD?

A

Noxious agent –> COPD airway inflammation –> CD8+ T lymphocytes, Macrophages, Neutrophils —> Airflow limitation

17
Q

What are the clinical features of COPD?

A
  • Patients have usually smoked at least 20 cigarettes per day for 20 or more years
  • Usually starts with a chronic cough
  • Dyspnea may not occur until 10-20 years later
18
Q

What test is needed to establish a diagnosis of COPD?

A

Spirometry

19
Q

What key indicators should you use when considering COPD diagnosis?

A
  • Chronic cough
  • Chronic sputum production
  • Dyspnea that is progressive, persistent, worse on exercise and with infections, described as heaviness, gasping
  • History of exposure to risk factors (tobacco smoke, dust, chemicals, cooking and heating fuels)
20
Q

What is on the Ddx for COPD?

A
  • Asthma
  • CHF
  • Bronchiectasis
  • Tuberculosis
  • Obliterative Bronchiolitis
  • Diffuse Panbronchiolitis
21
Q

What symptoms occur as COPD progresses?

A
  • Chronic clear sputum production
  • Weight loss
  • Morning headache
  • Hypercapnia with hypoxemia
  • Cor pulmonale
22
Q

When does FEV1 start to decrease in COPD?

A

Around age 35-40

23
Q

When does FEV1 reach 25% its value at age 25 yrs in COPD patients?

A

Around age 70

24
Q

What is FEV1?

A

Forced expiratory volume in one second

25
Q

What are the different stages of COPD?

A

O: At risk
I: Mild COPD
II: Moderate COPD
III: Severe COPD

26
Q

What do you see with Stage 0 COPD (at risk)?

A 
Normal spirometery 
Chronic symptoms (cough, sputum production)
27
Q

What do you see with Stage I COPD (Mild COPD)?

A
  • FEV1/FVC /= 80 percent predicted

- With or without chronic symptoms (cough, sputum production)

28
Q

What do you see with Stage II COPD (Moderate COPD)?

A

-FEV1/FVC

29
Q

What do you see with Stage III COPD (Severe COPD)?

A

-FEV1/FVC

30
Q

What will you see on physical exam of COPD?

A
  • Prolonged expiration
  • Hyperinflation - Increased A-P diameter
  • Hyperresonent to percussion
  • Depressed diaphragm
  • Decreased breath sounds
  • Wheezes - airflow obstruction
31
Q

What will you see on physical exam of End-stage COPD?

A
  • Accessory muscle use (sternocleidomastoid and intercostal muscles)
  • Pursed lips
  • Cyanosis
  • Enlarged liver
  • Asterixis (flapping tremor)
32
Q

What tests should you use for diagnosis of COPD?

A
  • CXR
  • Chest CT
  • Pulmonary function tests
33
Q

What will pulmonary function tests show in COPD?

A
  • Decreased FEV1
  • Decreased FEV1/FVC
  • Increased total lung capacity
  • Absence of bronchodialator response
34
Q

What does COPD show on chest X-ray?

A 
AP view: 
-Hyperlucent lung fields
-Vascular crowding with curvilinear pattern
Lateral view: 
-Significantly increased AP diameter
-Flattening of diaphragms
-Increased retrosternal air space
-Hyperlucent lung fields
35
Q

What does Panlobular emphysema show on CT?

A

Paucity (scarcity) of vascular structures in both lower lobes

CRRAB II Week 7 (8 decks)

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