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Year 3 Conditions > SOB > Flashcards

SOB Flashcards

1
Q

Categories causing SOB

A

Insufficient O2 getting into lungs
Insufficient blood getting into blood
Insufficient blood reaching the body
Increased resp drive

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2
Q

Examples of increased resp drive leading to SOB

A

Hyperventilation

Acidaemia eg from DKA

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3
Q

When is HF SOB worse

A

When lying down

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4
Q

Which ILD do drugs cause

A

Hypersensitivtiy pneumonitis

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5
Q

Which drugs cause hypersensitivity pneumonitis

A

Methotrexate
Amiodarone
Bleomycin
Nitrofurantonin

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6
Q

Why is SLE and RA relevant in SOB histories

A

Can lead to ILD and pleural effusions

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7
Q

What is relevant about sound of cough

A

Bovine suggests left recurrent laryngeal involvement

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8
Q

What is cough like in chronic bronchitis

A

Productive

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9
Q

Why is muscular weakness significant in SOB history

A 
MND
MG
GBS
LES
Polymyositis
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10
Q

Why is heavy menstruation significant to SOB

A

Leads to anaemia

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11
Q

Acute causes of SOB

A

Bronchospasm from COPD and asthma
PE
Pneumothorax including tension
Anaphylaxis

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12
Q

Subacute SOB

A 
Pneumonia
HF
Pleural effusion
GBS
MG
Post operative or cancer atelectasis
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13
Q

Weeks to months SOB

A 
COPD
Asthma
ILD
Bronchiectasis
Mesothelioma
Cancer
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14
Q

How is chronic bronchitis diagnosed

A

Productive cough of more than 3 months in 2 consecutive years

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15
Q

RFs for COPD

A

Smoking
Occupational exposure to dust
Alpha-1-antitrypsin

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16
Q

Signs of COPD on examination

A 
Hyperextended chest
Accessory muscles
Pursed lips
Prolonged expiration
Crackles 
Wheeze
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17
Q

Can asthma present with chest pain

A

Yes tightness or from coughing so much

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18
Q

How are nasal polyps relevant in SOB

A

Indicate asthma

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19
Q

Which drugs can exacerbate asthma

A

NSAIDS
Aspirin
Beta blockers

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20
Q

Which ethnicity is HF particularly prevelant in

A

South asian

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21
Q

What is best way to monitor HF

A

BNP

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22
Q

What else can BNP be elevated in

A

PE
Cor pulmonale
These cause further strain on the heart
Others include renal failure

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23
Q

What would suggest HF on ECG

A

Evidence of previous MI

Pathological Q waves and BBB

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24
Q

Why is ECG important in HF

A

Negative predictive value of 98%

Will see evidence of previous damage to heart

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25
Q

Bloods ordered in HF

A

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

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26
Q

How does bronchiectasis appear on spirometry

A

Obstructive

27
Q

What is cut off Hb1ac for diabetes

A

Aove 6.5 or 48mmol is diabetic

28
Q

What is important thing to remember about HF

A

Is a syndrome not a diagnosis- causes include HTN, IHD, alcoholic cardiomyopathy

29
Q

Why is SOB worse when lying down in HF

A

Lying down increased venous return thus increasing work of heart

30
Q

Why do you get oedema in HF

A

Heart cant pump all of its blood so some gets backed into systemic circulation manifesting as JVP, hepatomegaly, oedema

31
Q

First line HF

A

Bloods
ECG
CXR

32
Q

Second line HF

A

Echo

Coronary angio

33
Q

What looking for in HF echo

A

The ejection fraction
Areas of akinesia
Valve competency

34
Q

Why do angio in HF

A

Look for areas where IHD

35
Q

When dont you give morphine in HF

A

If acute as shown to be worse prognosis

36
Q

Acute management of HF

A

Sit up
Oxygen
Vasodilators
Loop diuretic or aldosterone antagonist

37
Q

Which two physiological systems arent helpful in HF

A

RAAS- as kidney hypoperfused so retains more fluid

Sympathetic- increased HR but heart is already struggling so damage exacerbated

38
Q

What drug is given to help with sympathetic nervous system exacerbating HF sx

A

Beta blockers as long as no LVF

39
Q

Long term management of HF

A

Treat the cause- angioplasty etc
Lifestyle so statins, diabetes, aspirin
If severe digoxin, ICDs, transplant

40
Q

What is late finding of COPD on spirometry

A

FVC drops as cant inhale fully

41
Q

Causes of SOB post operatively

A 
Post operative atelectasis
Pulmonary oedema
Pneumonia
PE 
Anaemia
Pneumothorax
42
Q

How can you get post operative atelectasis

A

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

43
Q

How can pulmonary oedema occur post surgery

A

Too much fluid given

44
Q

How can pneumothorax occur post operatively

A

Any interventions near the lung such as central line

45
Q

What presents with a painful rattling cough post op

A

Atelectasis

46
Q

How do you give oxygen in COPD exacerbations

A

Venturi only 24-36%

47
Q

What can cause COPD exacerbations

A

Pneumothorax
PE
Infection
Opiate medication

48
Q

How to diagnose PCP

A

Microscopy and cultures from sputum sample and BAL

49
Q

If suspect PCP what are 2 test must do

A

HIV- check CD4 count, viral load if positive

TB test

50
Q

How does PCP present

A

SOB
Dry cough
Severe desaturation on exertion

51
Q

Why is a rheumatoid significant in a SOB history

A

On methotrexate

Can cause ILD itself

52
Q

Why is a rheumatoid significant inhistory when looking at bloods

A

ESR and CRP elevated

53
Q

Congenital disorders causing ILD

A

Gaucher

Neurofibromatosis

54
Q

Next investigation if have patient with wt loss, lung mass and lymphadenopathy

A

FNA of lymph node

55
Q

What is epiglottis normally caused by

A

Haemophillus influezae

56
Q

What are terms pink puffer and blue bloater used to describe

A

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

57
Q

How do pink puffers appear

A

Barrel shaped chest

Breathe through pursed lips

58
Q

How do blue bloaters appear

A

Bloated from widespread oedema from cor pulmonale

59
Q

Differentials for bilateral creps

A

Pneumonia
ILD
Bronchiectasis
HF

60
Q

How to differentiate creps in bronchiectasis from ILD

A

In bronchiectasis very varied with cough and eased by leaning forward

61
Q

How does chest appear in ILD

A

Reduced expansion

62
Q

How is atelectasis managed

A

Analgesia
Oxygen
Lots of physio

63
Q

What is eisenmenger syndrome

A

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

Year 3 Conditions (33 decks)

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