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Scientific Basis of Medicine > The case of the breathless teenager > Flashcards

The case of the breathless teenager Flashcards

1
Q

Tachypnoea

A

tachypnoea

Increased respiratory rate, usually > 20 per minute

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2
Q

dyspnoea

A

unpleasant awareness of increased respiratory effort

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3
Q

hyperpnoea

A

increased level of ventilation/increased VE

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4
Q

Minute Ventilation (VE)

A

volume of air inspired or expired per minute (l/min)

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5
Q

Hyperventilation

A

increased pulmonary ventilation in excess of metabolic demand causing decreased pCO2

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6
Q

orthopnoea

A

Shortness of breath when lying flat

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7
Q

paroxysmal nocturnal dyspnea

A

sudden awakening from sleeping with shortness of breath

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8
Q

bradypnoea

A

abnormally slow breathing

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9
Q

Cheyne-Stokes respiration

A

abnormal cycle of breathing characterized by a gradual increase of depth and sometimes rate to a maximum level, followed by a decrease, resulting in apnea

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10
Q

what controls normal breathing?

A

medulla oblongata

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11
Q

What nerve conveys sensation of breathing/dyspnoea?

A

vagus nerve

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12
Q

respiratory system receptors

A

carotid body receptors
pulmonary artery baroreceptors
central medullary chemoreceptors
lung stretch receptors

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13
Q

pulmonary causes of dyspnea

A 
COPD
fibrosis
airway obstruction
PE
asthma
pneumonia
neoplasm
anaphylaxis
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14
Q

cardiovascular causes of dyspnoea

A 
pulmonary oedema
ACS
arrhythmia
tamponade
valvular disease
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15
Q

2 infections that could cause dyspnoea

A

2 infections that could cause dyspnoea
epiglottitis
pneumonia

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16
Q

3 traumatic causes of dyspnoea

A

flail chest
pneumothorax
haemothorax

17
Q

psychiatric causes of dyspnoea

A

anxiety

hyperventilation

18
Q

metabolic causes of dyspnoea

A

metabolic acidosis
toxins
renal failure

19
Q

ascites
obesity
pregnancy

A

ascites
obesity
pregnancy

20
Q

prevalence of asthma

A

most common respiratory disease worldwide

21
Q

asthma symptoms

A

shortness of breath, wheezing, cough, chest tightness

22
Q

is there a gold standard test for asthma?

A

no

23
Q

what investigations could be done in suspected asthma?

A 
PEFR variability
spirometry
FeNO
inducible airway hyperresponsiveness
eosinophil count
atopy tests
24
Q

what FeNO is expected in someone with airway inflammation?

A

above 40ppb

25
Q

do negative investigations fully rule out asthma?

A

no as can be normal when well controlled

26
Q

When is asthma most likely?

A

when clinical features match asthma and a positive objective test

27
Q

asthma mimics

A 
airway obstruction
inducible laryngeal obstruction
cough hypersensitivity
sinus disease
exercise induced laryngeal obstruction
28
Q

Asthma triggers

A 
cold air
smoke
URTI
exercise
stress
inhaled allergens
poor treatment adherence
29
Q

criteria for moderate acute asthma

A

increasing symptoms

PEF>50-75% best

30
Q

criteria for severe acute asthma

A 
RR>25
can't complete sentences
HR >110
PEF 33-50% best
(any 1)
31
Q

criteria for life threatening asthma

A 
altered consciousness
exhaustion
cyanosis
hypotension
PEF<33% best
32
Q

when does asthma become near fatal?

A

when so severe mechanical ventilation is required or PaCO2 becomes raised

33
Q

treating acute asthma (6)

A 
nebulised salbutamol
oxygen if hypoxemic
oral prednisolone
nebulised ipratropium bromide
consider IV magnesium sulphate
consider aminophylline
34
Q

Aminophylline

A

Bronchodilator
poor data on whether actually useful in acute asthma but try with severely ill patients not responding to other therapies

35
Q

1st offered treatment for a newly diagnosed asthmatic

A

SABA e.g. salbutamol

36
Q

next step if SABA not controlling asthma

A

SABA + low dose ICS

37
Q

next step if SABA + low dose ICS not controlling asthma

A

SABA + low dose ICS + LTRA /LABA - contradicted

38
Q

treatment options if very unresponsive asthma

A

adding a LAMA or theophylline but will need specialist input

Scientific Basis of Medicine (35 decks)

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