KCP: Breathlessness 2

Question 1

What does FVC stand for?

Answer 1

Forced Vital Capacity

This is the total volume you can forcibly exhale after you have forcibly inhaled

Question 2

What does FEV1 stand for?

Answer 2

Forced expiritory volume after 1s

This the is the volume you can forcibly exhale in 1s

Question 3

How does a spirometry graph look different for someone with asthma and COPD?

Answer 3

Question 4

What can fractional exhaled nitric oxide tell you?

Answer 4

Nitric oxide is produced by the respiritory epithelium in response to inflammation

Asthma cause airway inflammation

Therefore by measuring nitric oxide in exhaled breath this can tell us if someone has asthma

Question 5

Asthmer treatment

Answer 5

Question 6

What is Brain-type Natriuretic Peptide (BNP)?

Answer 6

It is released from the atria in response to stretch.

Is a marker of heart failure.

Hint: Heart failure bad, BNP bad

Question 7

What is echocardiography?

Answer 7

It is an ultrasound scan used on the heart

Question 8

What is echocardiography ejection fraction?

Answer 8

This is the ratio of stroke volume to end diastolic volume

Question 9

What is finger clubbing a sign of?

Answer 9

Low blood oxygen

Presents as enlarged distal fingers, loss of nail bed angle and increased nail curvature

Question 10

What is VC, TV, ERV and IRV?

Answer 10

• Vital capacity
• Tidal volume
• Expiritory reserve volume
• Inspiritory reserve volume

Question 11

When would you be looking for troponin and performing and ECG?

VS

When would you be looking for natriuretic peptide and performing an echocardiagram?

Answer 11

1. Myocardial infarction / ischemic heart disease (heart failure due to lack of blood supply)
2. Heart failure due to other reasons

Question 12

You have listened to someones lungs and heard bilateral late inspiritory crackles in lower part of the chest. He has finger clubbing and is cyanosed. FEV1 is low however FEV1/FCV ratio is normal indicating a restricted pulmonary defecit. You perform a chest X-Ray and suspect pulmonary fibrosis. What extra investigations should you order?

Answer 12

A CT chest scan

Question 13

Please correctly label this graph:

Obstructive
Restrictive
Normal

Answer 13

• A - Normal
• B - Restrictive
• C - Obstructive

Question 14

ILD - interstitial lung disease aka fibrosis

Answer 14

Question 15

Type 1 vs Type 2 respiratory failure

Answer 15

Type 1 respiratory failure affects 1 value (PaO2 ↓)
Type 2 respiratory failure affects 2 values (PaO2 ↓ and PaCO2 ↑)

In type 1 there is V/Q missmatch, lowering oxygen and increasing co2, the hypercapnia results in an increased respiritory rate, this birng the co2 to normal however what blood is perfusing is already fully oxygenated therefore no more oxygen can get in so o2 remains low.

Examples:
Reduced ventilation and normal perfusion (e.g. pneumonia, pulmonary oedema, bronchoconstriction)
Reduced perfusion with normal ventilation (e.g. pulmonary embolism)

In type 2, either respiritory rate can not be raised (opiate induced reduced respiritory drive) or raising respiritory rate won’t result in any more air getting through (obstructive) therefore co2 can’t be expelled