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Flashcards in 10. Shortness of Breath Deck (27)
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1

How can you classify the causes of SOB by timing?

Sudden: Bronchospasm, anaphylaxis, PE, Pneumothorax, foreign body
Days: pneumonia, HF + pleural effusion
Weeks: COPD, Lung cancer, pulmonary fibrosis

2

What are 5 risk factors to ask about in someone with SOB?

Smoking
Pets
Occupation e.g. exposure to asbestos
Drugs: hypersensitivity pneumonitis
PMH: AI conditions e.g. RA + SLE can cause interstitial lung disease + pleural effusions

3

What 5 associated symptoms should you ask someone with SOB about?

Chest pain
Cough
Muscle weakness/ fatigue
Tender limbs
FLAWS
Blood loss

4

What is COPD?

Bracket term covering chronic bronchitis + emphysema

5

List 3 causes COPD

Smoking: >20 pack years
Occupational exposure to lung irritants
Alpha 1 antitrypsin deficiency

6

What are 5 signs of COPD?

Hyperexpanded chest
Breathing through pursed lips
Reduced air entry/ chest expansion
Prolonged expiratory phase
Hyper-resonant percussion

7

What are 5 key features in the HPC for asthma?

Wheeze
Chest tightness +/ cough
Worse at night/ mornings/ during exercise
Hx or FHx of other atopies
Symptoms worse with NSAIDs, aspirin, beta blockers

8

What 3 signs might you see on examination in someone with interstitial lung disease?

Clubbing
Reduced chest expansion
Late inspiratory fine crackles

9

What are 6 key features in the HPC for heart failure?

SOB OE
Orthopnea
Paroxysmal nocturnal dyspnoea
Swollen ankles
Sleeping with multiples pillows
Pink frothy sputum

10

What are 5 symptoms of congestive heart failure and the reasoning behind them?

SOB: not pumping enough blood. Back pressure forces fluid from the pulmonary vasculature into the alveoli.

Orthopnoea: lying down increases venous return to the heart while it is already struggling to pump. Increases congestion in pulmonary vaculature, forcing fluid into the lungs.

Displaced apex beat due to dilation of the heart.

Crackles in lungs due to build up of blood in pulmonary vessels, forcing fluid into alveoli + causing collapse

Peripheral oedema due to back pressure in the venous system and salt + water retention due to activation of RAAS by a low cardiac output.

11

What are the 4 broad causes of SOB?

Insufficient O2 getting into the lungs
Insufficient O2 getting into the blood
Insufficient O2 getting around the body
Increased respiratory drive

12

List 4 causes of insufficient O2 getting into the lungs

Obstructed airways: COPD
Decreased lung volume: Pneumothorax
Decreased volume of functioning lung: Cystic disease
Inability to inflate lungs: Obesity

13

List 3 causes of insufficient O2 getting into the blood

Damage to alveolar membrane: Emphysema
Fluid between alveolar wall + capillary: oedema (HF)
Disrupted blood supply: PE

14

List 3 causes of insufficient O2 getting around the body

Reduced CO: Aortic stenosis
Anaemia
Shock

15

List 2 causes of increased respiratory drive

Hysterical hyperventilation
Acidaemia: DKA

16

What is suggested by pleuritic chest pain? What about non pleuritic?

P: Pneumonia, PE, Pneumothorax
NP: CVS pathology

17

What 6 characteristics about a cough must be established?

Productive?
Colour of sputum?
Blood?
When does cough occur?
Sound?
Persistent/ episodic?

18

What may be the cause of SOB if associated with muscle weakness?

Neuromuscular disease e.g. GBS, MG, MND

19

What cause of SOB is associated with tender limbs?

PE caused by DVT

20

Why may blood loss contribute to SOB?

SOB can be caused by anaemia

21

What history may make you suspect interstitial lung disease as cause of SOB?

Exposure to asbestos, silica or coal
Exposure to drugs e.g. methotrexate, Amiodarone

22

List 5 risk factors suggesting a cause for heart failure

IHD (smoking, DM, hypercholesterolaemia)
Other atherosclerotic disease (Stroke, TIA)
HTN
Valvular disease
Cardiomyopathy

23

List 4 signs of heart failure on examination

Raised JVP, hepatomegaly, peripheral oedema
Displaced apex beat
Crackles in both lung bases
3rd + 4th heart sounds

24

What bloods would you request in a patient SOB? What are you looking for in each?

FBC: anaemia
Cholesterol, glucose, HbA1c: IHD
TFTs: Hyperthyroidism
U+E's: electrolyte baseline before diuretic usage
BNP: HF

25

What is Atelectasis?

Alveoli become deflated or possibly filled with alveolar fluid.
Leads to complete or partial collapse of entire lung/ lobe).

26

What is type 1 respiratory failure caused by? List 3 diseases that cause this

Disease affecting amount of O2 able to get into pulmonary blood
Due to problems with gas exchange at the pulmonary membrane or ventilation of the lungs
COPD, Pneumonia, Pulmonary fibrosis

27

What is type 2 respiratory failure caused by? List 3 diseases that cause this

Ventilatory failure resulting in alveolar hypoventilation
Air not being shifted in + out of the lungs adequately
Decreased expiratory drive e.g. Opiates
Impaired lung movements e.g. COPD