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Year 3 > Week Three - Chronic Breathlessness > Flashcards

Week Three - Chronic Breathlessness Flashcards

1
Q

what is bronchitis

A

an inflammation of the bronchi in the lungs

this causes a narrowing of the airways due to a combination of tissue swelling and excess mucus production

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2
Q

what are the features of acute bronchitis

A

cough (chesty)
- often productive of sputum - typically clear, yellow or green coloured
- dark brown or grey coloured may be more suggestive of a true pneumonia

fever

cough lasting about two weeks

generally no treatments speed up recovery

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3
Q

what is bronchitis typically caused by

A

respiratory tract infections (usually viral), or chronic which is typically associated with COPD

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4
Q

what does pulmonary hypertension refer to

A

increased resistance and pressure in the pulmonary arteries

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5
Q

where does pulmonary hypertension cause strain

A

on the right side of the heart as it tries to pump blood through the lungs

there is back pressure through the right side of the heart and into the systemic venous system

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6
Q

what is pulmonary hypertension defined as

A

a mean pulmonary arterial pressure of more than 20mmHg

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7
Q

what are the five groups of causes of pulmonary hypertension

A

Group 1 - idiopathic pulmonary hypertension or connective tissue disease (e.g systemic lupus erythematous)

Group 2 - left heart failure usually due to myocardial infarction or systemic hypertension sion

Group 3 - chronic lung disease (COPD or pulmonary fibrosis)

Group 4 - pulmonary vascular disease (PE)

Group 5 - miscellaneous

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8
Q

what are the signs and symptoms of pulmonary hypertension

A

shortness of breath is the main presenting symptom

Syncope (loss of consciousness)
Tachycardia
Raised jugular venous pressure (JVP)
Hepatomegaly
Peripheral oedema

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9
Q

what will an ECG show in pulmonary hypertension

A

indicate right sided heart strain

  • P pulmonale (peaked P waves)
  • right ventricular hypertrophy (tall R waves in V1 and V2 and deep S waves in V5 and V6)
  • right axis deviation
  • right bundle branch block
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10
Q

what are the changes seen on CXR

A
  • dilated pulmonary arteries
  • right ventricular hypertrophy
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11
Q

what are the other investigations done for pulmonary hypertension

A

Raised NT‑proBNP blood test result indicates right ventricular failure

Echocardiogram can be used to estimate the pulmonary artery pressure

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12
Q

what is idiopathic pulmonary hypertension treated with

A

calcium channel blockers

IV prostaglandins (epoprostenol)

Endothelin receptor antagonists (macitentan)

phsophodiesterase-5 inhibitions (sildenafil)

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13
Q

what does asbestosis refer to

A

lung fibrosis related to asbestos exposure

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14
Q

what does asbestos inhalation cause

A

Lung fibrosis
Pleural thickening and pleural plaques
Adenocarcinoma
Mesothelioma

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15
Q

what is the normal pH value on ABG

A

7.35-7.45

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16
Q

what is the normal PaCO2 value in an ABG

A

4.7-6.0 kPa / 35-45 mmHg

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17
Q

what is the normal PaO2 value in an ABG

A

9.3-13.3 kPa / 80-100 mmHg

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18
Q

what is the normal HCO3- value in an ABG

A

22-28 mmol/L

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19
Q

what is the normal SaO2 in an ABG

A

92-98%

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20
Q

what is PA

A

pressure in the alveoli

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21
Q

what is Pa

A

pressure in the artery

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22
Q

what is the mechanism of respiratory compensation

A

If the concentration of Hydrogen ions increases, the pH will decrease, causing an acidosis. This causes the equation to shift to the left, and more CO2 is produced, of which some (or all) can be blown off by the lungs. This is the mechanism of respiratory compensation.w

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23
Q

what is partial respiratory compensation

A

If CO2 is not able to blown off effectively, then the concentration of CO2 increases, as thus then so will the concentration of hydrogen ions, and the pH will not be able to be resolved to normal. This is partial respiratory compensation.

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24
Q

what are most causes of acid-base disturbance due to

A

an acidosis.

25
Q

what’s metabolic compensation

A

There can also be metabolic compensation whereby the concentration of HCO3 is altered to try to keep the equilibrium in cases of respiratory dysfunction.

26
Q

what happens in respiratory alkalosis

A

In a respiratory alkalosis, CO2 is blown off too quickly, thus the curve shifts to the left, to replace the CO2, and the concentration of hydrogen ions is lowered

27
Q

what happens in metabolic alkalosis

A

In a metabolic alkalosis there is a disturbance due a loss of H+ or an excess of HCO3, causing the curve to shift.

28
Q

what chronic and acute factors in a patient’s history can affect ABG

A

renal diseases
diabetes
drugs - diuretics and aspirinw

29
Q

what is the rule of 19

A

The Rule of 19 is a way of assessing whether or not the patient was on oxygen at the time of the sample. Add the PO2 and PCO2 – if the sum of these is >19 then likely to be on inspired oxygen. If the level is lower than this, they are likely to be breathing room air.

30
Q

what are the basic ABG interpretation rules

A
  1. Look at the pH – is it acidosis, alkalosis, or normal?
    - If its acidotic, then the patient is acidotic
    If acidotic, calculate the anion gap to help differentiate the cause
    - If its alkalotic, the patient is alkalotic
    - ​If its it normal, there may be no acid-base dysfunction, or the patient could have a compensated acidosis or alkalosis. The CO2 and HCO3 values are required for further interpretation.
  2. Look at the CO2 – is it normal or abnormal? Is this change in keeping with the pH? (See table below)
  3. Look at the HCO3- – is it normal or abnormal? Is the change in keeping with the pH?
    A. Note the changes in bicarb and base excess take at least a couple of days to occur after the initial causatory event.
  4. If the changes aren’t in keeping with the levels, then it is likely to be some sort of compensation! More on how to tell this later on.
31
Q

what does
↔ CO2 ↔ pH
mean

A

normal acid base status

32
Q

what does
↔ CO2 ↓ pH
mean

A

Metabolic Acidosis

33
Q

what does
↔ CO2 ↑ pH
mean

A

metabolic alkalosis

34
Q

what does
↑ CO2 ↔ pH
mean

A

respiratory acidosis with full metabolic compensation

35
Q

what does
↑ CO2 ↓ pH
mean

A

respiratory acidosis

36
Q

what does
↑ CO2 ↑ pH
mean

A

metabolic alkalosis with partial respiratory compensation

37
Q

what does
↓ CO2 ↔ pH
mean

A

respiratory alkalosis with full metabolic compensation

38
Q

what does
↓ CO2 ↓ pH
mean

A

Metabolic Acidosis with partial respiratory compensation

39
Q

what does
↓CO2 ↑ pH
mean

A

metabolic alkalosis with partial respiratory compensation

40
Q

what is respiratory acidosis due to

A

Respiratory acidosis is very straightforward. It is always due to a retention of CO2, (Type II Respiratory failure)

41
Q

what are the causes of retention of CO2

A

COPD

Depressed respiratory drive (e.g. low GCS)
Brain Injury
Drug overdose (often opiates)
CO2retention in COPD patients causing worsening drowsiness

Hypoventilation of any other cause

42
Q

what are the signs of CO2 retention

A

Confusion – as a result of peripheral vasodilation

Asterixis (renal failure, type 2 resp failure, liver failure)

Warm extremeties

Bounding pulse

Morning headache – CO2 particularly high at these times.

43
Q

what is the 1 for 10 rule

A

ACUTE: For every rise of 10 of the PaCO2 above 40 mmHg, the bicarbonate will rise by 1

CHRONIC: For every rise of 10 of the PaCO2 above 40mmHg, the bicarbonate will rise by 4

44
Q

what is respiratory alkalosis due to

A

due to hyperventilation

45
Q

explain respiratory alkalosis and the causes associated

A

As PaCO2 lowers, so pH rises

Any cause of hyperventilation:
Anxiety
Pain
Fever
Sepsis
Hypoxia (due to acute illness (sepsis / pneumonia) or altitude)

46
Q

what is metabolic alkalosis caused by

A

Loss of hydrogen ions
- Diarrhoea (sometimes vomiting too)
- Burns

Excess Bicarbonate
- Diuretics
- Ingestion of alkaline substances

47
Q

what is the most common cause of hydrogen ion loss

A

diarrhoea

. In diarrhoea, there is a loss of K+ into the GI tract. This causes K+ to leave cells, and enter the bloodstream in an attempt to keep K+ levels normal. In order to maintain the electrical charge of the cell, H+ is then taken up by the cell.

48
Q

what is the usual cause for excess bicarbonate

A

Normal kidneys are very effective at excreting bicarbonate. Diuretics prevent the re-absorption of sodium from the renal tubule, and thus they promote sodium loss. The normal mechanism for recovering this sodium, involves an exchange with bicarbonate, and thus the ability of the renal tubule to excret bicarbonate is reduced.

49
Q

look up the variety of causes of metabolic acidosis on almost a doctor

A
50
Q

You are undertaking a medication review on one of your patients in a GP surgery who has COPD. You note that the latest spirometry shows an FEV1 of 59%. The patient is already taking salbutamol prn. What other medications should be considered at this point?

A
  • salbutamol inhaler
  • tiotropium inhaler
51
Q

what do these ABG results show?
- FiO2 35% oxygen via venturi mask
- SaO2 98%
- pH 7.31
- pCO2 7.8 kPa
- pO2 13.6 kPa
- HCO3 22.1 kPa
- BE -4.5

A

uncompensated type II respiratory failure

52
Q

What is the mechanism of action of Aminophylline?

A

phosphodiesterase inhibitor

53
Q

A 65 year old man with a 30 pack year smoking history presents to the GP complaining of persistent shortness of breath over the past 2 years. He also has a regular and productive cough. He has no fever or recent travel history. Which examination findings will most likely be seen in this patient?

A

hyper-resonant percussion note, polyphonic wheeze

54
Q

Which of the following fulfil criteria for LTOT?

A

PaO2 7.2kPa

55
Q

what is the best investigation for sarcoidosis

A

bronchoscopy with biopsy EBUS

56
Q

A 57 year old male with presents with shortness of breath and weight loss. He has finger clubbing and fine crepitations. CXR shows bilateral reticulonodular shadowing. HRCT is performed to confirm the diagnosis. What would confirm the most likely diagnosis?

A

honeycombing

57
Q

A 76 year old lady is diagnosed with pulmonary fibrosis. Her PMHx includes HTN, Afib, recurrent UTIs and osteoarthritis with bilateral hip replacements. Which drug is most likely to have contributed to her diagnosis?

A

Nitrofurantoin

methotrexate is used in rheumatoid arthritis, not osteoarthritis

58
Q
A

Year 3 (63 decks)

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