Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Year 3 > Shortness of breath (oxford clin cases) > Flashcards

Shortness of breath (oxford clin cases) Flashcards

1
Q

What are the 4 pathophysiological ways shortness of breath can occur?

A

Not enough o2 gets into the lungs
Not enough o2 gets into the blood
Not enough o2 gets around the body
Increased respiratory drive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is an exacerbating factors for shortness of breath due to heart failure?

A

Its worse lying down

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is an exacerbating factor for shortness of breath due to asthma?

A

Worse when exercising, at night, when around dust, in colder climates

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What does a persistent productive cough with shortness of breath for the past 3 days suggest is the diagnosis?

A

Pneumonia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What does a productive cough for most days in the past 3 months and spanning years suggest is the diagnosis?

A

Chronic bronchitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What type of cough will someone with asthma have?

A

Dry cough for periods eg during exercise, at night

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What does sputum with blood in it suggest could be the diagnosis?

A

PE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What type of chest pain is associated with shortness of breath?

A

Pleuritc

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How will a patient describe pleuritic chest pain?

A

A sharp and intense stabbing or burning pain on inhalation or exhalation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What does pleuritic chest pain with shortness of breath point towards?

A

PE
Pneumothorax
Pneumonia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What does muscle weakness with shortness of breath point towards?

A

Neuromuscular disease eg Guillain Barre, myasthenia gravis, motor neurone disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What do tender limbs with shortness of breath point towards?

A

PE due to DVT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What conditions will cause an acute onset shortness of breath (in seconds to mins)

A

Anaphylaxis
Bronchospasm
PE
Tension pneumothorax

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What conditions will cause an onset of shortness of breath in hours to days?

A 
Pneumonia
ARDS
Heart failure
Pleural effusion
Lung collapse
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What conditions will cause an onset of shortness of breath in weeks to months?

A 
Chronic asthma
Pulmonary fibrosis
COPD
Heart failure 
Bronchiectasis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are some signs of COPD

A 
Breathing through pursed lips
Hyper expanded chest
Reduced chest expansion
Prolonged expiration
Hyperesonance to percussion
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are some investigations you might do if you suspect COPD?

A 
Spirometry
Pulse oximetry
Standardised COPD score
ABG
Chest x ray
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

How is COPD managed?

A

Offer smoking cessation
Offer the flu jab
Pulmonary rehab if needed
Treat their co morbidities

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are medical treatments for COPD and when are they used?

A

If symptoms are not relieved and are affecting daily activities, offer SABA+SAMA

If still not relieved, offer LABA+LAMA and then ICS if still not better

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

How will someone with asthma present

A

Wheeze (more when expiring)
Cough worse at night/early morning, cold climates, after exposure to allergens
Chest tightness
Breathlessness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What are some risk factors for developing asthma?

A

Atopic conditions eg eczema/hayfever and family history of these
Allergies
Nasal polyposis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

How is asthma treated in adults (and what age does this mean)

A

17 and above:
Start with SABA alone
If maintenance therapy is needed then ICS low dose with the SABA
If uncontrolled still offer LTRA
If still uncontrolled consider starting a MART regime

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

How is asthma treated in children and young adults (and what age does this mean)

A

5-17 year olds
Start by offering SABA alone
If maintenance therapy is needed give ICS and LTRA 4 week trial if bad
If still uncontrolled ICS and LABA
If uncontrolled consider starting MART regime

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

How is asthma treated in young children (and what age does this mean)

A

Under 5
Start with SABA alone
If maintenance is needed, do an 8 week trial of paediatric moderate dose ICS, then stop and observe symptoms:

If symptoms stop then resolve within 4 weeks of stopping, continue ICS
If symptoms stop then resolve after 4 weeks of stopping ICS, do another 8 week trial
If symptoms are not relieved during the trial, asthma is unlikely to be the diagnosis

If still uncontrolled, consider starting LTRA but few are appropriate for this age

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What is bronchiecstasis?

A

A long term condition where there is widening of the airways which causes mucus production and leaves patients susceptible to chest infections

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

How would bronchiecstasis present?

A 
History of recurrent chest infections
Productive cough
Fatigue
Weight loss
Haemoptysis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What might you hear on auscultation when examining someone with brochiecstasis?

A

Crackles

High pitched inspiratory wheeze

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What are some risk factors for bronchiecstasis?

A

Cystic fibrosis
History of chest infections
Congenital disorders of the airways

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

How is bronchiecstasis managed?

A

Supportive care eg antibiotics for exacerbations
Airway clearance therapy
If very severe them surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What investigations are useful when you suspect bronchiecstasis?

A

Chest CT to diagnose it- you can see dilation of the airway and if there is thickening or not
Chest x ray to monitor it
Sputum testing (to identify causative agents of infections and decide what abx should be used)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

How will someone with heart failure present?

A

Tiredness
Need pillows and to be propped up in order to sleep
Shortness of breath (especially on exertion)
Orthopnoea (worsening shortness of breath when lying down)
Leg oedema
Raised JVP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What are some investigations for heart failure?

A

ECG- will always be abnormal in heart failure
BNP- hormone released by ventricular cells common in heart failure
Bloods- FBC to check for anaemia, cholesterol, glucose levels
Serum electrolytes
Thyroid function tests

33
Q

What are some risk factors for heart failure?

A 
Previous MI 
Diabetes
Smoking 
High cholesterol 
South asian descent
34
Q

Are patients with heart failure hypo or hypertensive?

A

They can be either

35
Q

How is heart failure managed?

A

Ace inhibitor if they can tolerate it
If not beta blocker and angiotensin II receptor antagonist
Diuretic if they have fluid overload
Vasoconstrictor or vasodilator

36
Q

What will show up on an ECG of someone who has had a previous MI?

A

pathological q waves

bundle branch block

37
Q

What is spirometry used to check?

A

If the disease is obstructive or restrictive

38
Q

What is the pathophysiology of obstructive airway disease? Give an example of one

A

It is caused by narrowing of the airway so that less air can be exhaled eg asthma, COPD

39
Q

What is the pathophysiology of restrictive airway disease? Give an example of one

A

It is caused by reduction of total lung volume eg pulmonary fibrosis

40
Q

What happens to FEV1 and total lung capacity in obstructive disease?

A

FEV1= reduced

Total lung capacity= same

41
Q

What happens to FEV1 and total lung capacity in restrictive disease?

A

FEV1= same

Total lung capacity= reduced

42
Q

Failure of what part of the heart causes pulmonary oedema?

A

Left ventricles

43
Q

Failure of what part of the heart causes peripheral oedema?

A

Right ventricle

44
Q

Why do patients with heart failure experience shortness of breath?

A

Their heart is not pumping blood adequately. When there is increased return to the heart (lying down, exercising) the heart struggles to pump out the increased blood and it backlogs into pulmonary vasculature. As this happens fluid is forced out of the vasculature into alveoli causing a feeling of shortness of breath/drowning

45
Q

Why does the apex beat become displaced in heart failure?

A

The heart failure causes the heart muscle to dilate (DO NOT confuse with hypertrophy)

46
Q

What medication may be given in heart failure to prevent pulmonary oedema?

A

Vasoconstrictors eg nitrates and furosemide

Diuretics eg furosemide or spironolactone, epelerenone

47
Q

What are the 2 ways in heart failure to reduce stress on the heart?

A

Reduce its oxygen demand

Inhibit renin-angiotensin

48
Q

What medication reduces oxygen demand of the heart and how?

A

Beta blockers by slowing the heartbeat

49
Q

What medication inhibits renin angiotensin?

A

ACE inhibitor

50
Q

How will someone with lung cancer present?

A 
Chest pain
Dyspnoea
Haemoptysis
Weight loss
Night sweats 
Fatigue 
Lymphadenopathy
They are likely to have a history of smoking or exposure to tobacco, and be older
51
Q

What are the 2 types of lung cancer and which is more common?

A 
Non small cell (NSCLC)- more common (80%)
Small cell (SCLC)
52
Q

What type of cough indicates mucus in the lungs?

A

Rattling

53
Q

When managing asthma, what system do medications target in order to dilate the airway?

A

Sympathetic

54
Q

At what age can someone be diagnosed with asthma and why?

A

Over 1- asthma is to do with inflammation of the muscle in the airways, this muscle is not developed in babies under 1

55
Q

What are the 3 layers that can cause narrowing of the airway?

A

Wall of airway
Airway muscle
Mucus build up

56
Q

What does cigarette smoke inhibit in the lungs to cause loss of elasticity?

A

Alpha 1 antitrypsin

57
Q

What happens to FEV1:FVC and FVC in COPD? Explain why

A

FEV1: FVC= reduced because airway is obstructed so less air can flow out as quickly

FVC= although lungs are hyperinflated, air is trapped in the lungs which reduces capacity when a patient inhales

58
Q

What is the character of shortness of breath in COPD vs asthma?

A 
COPD= persistent and irreversible
Asthma= only during attacks/exacerbations and reversible
59
Q

What is respiratory failure?

A

Failure of the lungs to adequately carry out gas exchange- can be acute or chronic which leads to hypoxia with or without hypercapnia

60
Q

What are the types of respiratory failure and how are they defined?

A

Type I= hypoxia without hypercapnia (pO2= <8 kPa on room air at sea level)
Type II= hypoxia with hypercapnia (pCO2= >6.5 kPa on room air at sea level)

61
Q

What may someone in respiratory failure present with?

A 
Shortness of breath
Confusion
Tachypnoea 
Confusion
Cardiac dysfunction/ arrest
62
Q

What are risk factors for respiratory failure?

A

Infections like pneumonia and influenza
COPD
Young age or old age

63
Q

What are the first line investigations for respiratory failure? What other investigations might you do?

A

First line= pulse oximetry and ABG

Others= ECG, FBC, D dimer (to check for PE), CXR, serum bicarbonate

64
Q

How is respiratory failure managed?

A

Make sure their airway is cleared and patent
Give them supplemental oxygen (low flow with venturi mask, never 100% oxygen)
Give NIV if oxygen is not helping
Treat the underlying cause eg PE, infection
If they are unconscious then intubate them

65
Q

How will a patient with pneumonia present?

A

Shortness of breath
Fever/hypothermia
Cough with sputum production
Chest pain

65
Q

How will a patient with pneumonia present?

A

Shortness of breath
Fever/hypothermia
Cough with sputum production
Chest pain

66
Q

How will a patient with pneumonia present?

A

Shortness of breath
Fever/hypothermia
Cough with sputum production
Chest pain

66
Q

How will a patient with pneumonia present?

A

Shortness of breath
Fever/hypothermia
Cough with sputum production
Chest pain

67
Q

What are the types of pneumonia and how are they defined?

A

Hospital acquired= within 48 hours of admission to hospital and not incubating at the time of admission

Community acquired= acquired outside of hospital

68
Q

How is pneumonia managed?

A

Antibiotics need to be administered (within 4 hours of admission if they are in hospital)
If they are on antibiotics for 48 hours, reassess them and see if they can be switched to oral abx
Give supportive treatment eg oxygen if needed

69
Q

What investigations may be carried out for pneumonia?

A

First line= oxygen saturation and chest xray

ABG

70
Q

What is seen on chest x ray characteristically in pneumonia?

A

Shadowing of the alveoli

71
Q

What is the most commonly used SABA for asthma and how does it work?

A

Ventolin (blue inhaler)- it is a beta 2 agonist and works by relaxing the airway smooth muscle

72
Q

What do SABA, LABA and LAMA stand for?

A 
SABA= short acting beta 2 agonist
LABA= long acting beta 2 agonist
LAMA= long acting muscarinic agent
73
Q

What are some commonly used LABA for asthma?

A

Symbicort, seretide

74
Q

What is the difference between bronchitis and pneumonia and how do symptoms in each differ?

A 
Bronchitis= inflammation of the bronchi/airways
Pneumonia= inflammation of the alveoli

In pneumonia gas exchange is impaired and will cause shortness of breath but in bronchitis there will mainly only be cough present

75
Q

What are the causes of type I vs type II resp failure

A

Type I= any lung disease eg pulmonary fibrosis, pulmonary oedema, asthma, pneumonia

Type II= decreased respiratory drive (opiates, central neurological damage eg stroke/trauma) or impaired lung movement (COPD causing reduced compliance and expansion, obesity, motor neurone disease)

76
Q

What are some differentials if someone has bibasal crepitations?

A

Pneumonia, bronchiecstasis

Year 3 (104 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions