SOB Flashcards
Categories causing SOB
Insufficient O2 getting into lungs
Insufficient blood getting into blood
Insufficient blood reaching the body
Increased resp drive
Examples of increased resp drive leading to SOB
Hyperventilation
Acidaemia eg from DKA
When is HF SOB worse
When lying down
Which ILD do drugs cause
Hypersensitivtiy pneumonitis
Which drugs cause hypersensitivity pneumonitis
Methotrexate
Amiodarone
Bleomycin
Nitrofurantonin
Why is SLE and RA relevant in SOB histories
Can lead to ILD and pleural effusions
What is relevant about sound of cough
Bovine suggests left recurrent laryngeal involvement
What is cough like in chronic bronchitis
Productive
Why is muscular weakness significant in SOB history
MND MG GBS LES Polymyositis
Why is heavy menstruation significant to SOB
Leads to anaemia
Acute causes of SOB
Bronchospasm from COPD and asthma
PE
Pneumothorax including tension
Anaphylaxis
Subacute SOB
Pneumonia HF Pleural effusion GBS MG Post operative or cancer atelectasis
Weeks to months SOB
COPD Asthma ILD Bronchiectasis Mesothelioma Cancer
How is chronic bronchitis diagnosed
Productive cough of more than 3 months in 2 consecutive years
RFs for COPD
Smoking
Occupational exposure to dust
Alpha-1-antitrypsin
Signs of COPD on examination
Hyperextended chest Accessory muscles Pursed lips Prolonged expiration Crackles Wheeze
Can asthma present with chest pain
Yes tightness or from coughing so much
How are nasal polyps relevant in SOB
Indicate asthma
Which drugs can exacerbate asthma
NSAIDS
Aspirin
Beta blockers
Which ethnicity is HF particularly prevelant in
South asian
What is best way to monitor HF
BNP
What else can BNP be elevated in
PE
Cor pulmonale
These cause further strain on the heart
Others include renal failure
What would suggest HF on ECG
Evidence of previous MI
Pathological Q waves and BBB
Why is ECG important in HF
Negative predictive value of 98%
Will see evidence of previous damage to heart
Bloods ordered in HF
FBC- anaemia
U&Es- fluid overloaded so need baselines for electrolytes and kidney if gonna get rid of a lot the fluid
TFT- can lead to tachyarrythmia
BNP
How does bronchiectasis appear on spirometry
Obstructive
What is cut off Hb1ac for diabetes
Aove 6.5 or 48mmol is diabetic
What is important thing to remember about HF
Is a syndrome not a diagnosis- causes include HTN, IHD, alcoholic cardiomyopathy
Why is SOB worse when lying down in HF
Lying down increased venous return thus increasing work of heart
Why do you get oedema in HF
Heart cant pump all of its blood so some gets backed into systemic circulation manifesting as JVP, hepatomegaly, oedema
First line HF
Bloods
ECG
CXR
Second line HF
Echo
Coronary angio
What looking for in HF echo
The ejection fraction
Areas of akinesia
Valve competency
Why do angio in HF
Look for areas where IHD
When dont you give morphine in HF
If acute as shown to be worse prognosis
Acute management of HF
Sit up
Oxygen
Vasodilators
Loop diuretic or aldosterone antagonist
Which two physiological systems arent helpful in HF
RAAS- as kidney hypoperfused so retains more fluid
Sympathetic- increased HR but heart is already struggling so damage exacerbated
What drug is given to help with sympathetic nervous system exacerbating HF sx
Beta blockers as long as no LVF
Long term management of HF
Treat the cause- angioplasty etc
Lifestyle so statins, diabetes, aspirin
If severe digoxin, ICDs, transplant
What is late finding of COPD on spirometry
FVC drops as cant inhale fully
Causes of SOB post operatively
Post operative atelectasis Pulmonary oedema Pneumonia PE Anaemia Pneumothorax
How can you get post operative atelectasis
If patients are in pain or very ill they may struggle to breath out all of the mucus in their lungs thus causing it to be blocked
How can pulmonary oedema occur post surgery
Too much fluid given
How can pneumothorax occur post operatively
Any interventions near the lung such as central line
What presents with a painful rattling cough post op
Atelectasis
How do you give oxygen in COPD exacerbations
Venturi only 24-36%
What can cause COPD exacerbations
Pneumothorax
PE
Infection
Opiate medication
How to diagnose PCP
Microscopy and cultures from sputum sample and BAL
If suspect PCP what are 2 test must do
HIV- check CD4 count, viral load if positive
TB test
How does PCP present
SOB
Dry cough
Severe desaturation on exertion
Why is a rheumatoid significant in a SOB history
On methotrexate
Can cause ILD itself
Why is a rheumatoid significant inhistory when looking at bloods
ESR and CRP elevated
Congenital disorders causing ILD
Gaucher
Neurofibromatosis
Next investigation if have patient with wt loss, lung mass and lymphadenopathy
FNA of lymph node
What is epiglottis normally caused by
Haemophillus influezae
What are terms pink puffer and blue bloater used to describe
COPD patients
Pink puffer- responds to hypoxia and hypercapnia by increasing RR therefore oxgenate well
Blue bloaters- desensitisation of the resp centre to CO2 so live off hypoxic drive therefore cyanotic
How do pink puffers appear
Barrel shaped chest
Breathe through pursed lips
How do blue bloaters appear
Bloated from widespread oedema from cor pulmonale
Differentials for bilateral creps
Pneumonia
ILD
Bronchiectasis
HF
How to differentiate creps in bronchiectasis from ILD
In bronchiectasis very varied with cough and eased by leaning forward
How does chest appear in ILD
Reduced expansion
How is atelectasis managed
Analgesia
Oxygen
Lots of physio
What is eisenmenger syndrome
When initially there is left to right cardiac shunt from VSD etc but then this develops into a right to left shunt. In left to right shifts pulmonary HTN is created from LV blood being pumped into lungs at great pressures. This pulmonary HTN can become so great it shifts blood back into a normal shunt
