Respiratory Core Clinical Problems Flashcards

1
Q

CO2 retention headache

A
  • characteristically a headache on wakening
  • doesn’t change with posture
  • “thick head”
  • not unlike a hangover
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2
Q

main symptoms of CO2 toxicity (hypercarbia/ hypercapnia)?

A
  • dimmed sight
  • reduced hearing
  • drowsiness
  • mild narcosis
  • dizziness
  • confusion
  • headache
  • unconsciousness
  • sweating
  • SOB
  • increased heart rate and BP
  • tremor
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3
Q

what happens to the Vt (tidal volume) in normal nocturnal ventilation?

A

It is reduced

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4
Q

What happens to the respiratory rate in normal nocturnal ventilation?

A

It is reduced

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5
Q

What happens to the pO2 and pCO2 in normal nocturnal ventilation?

A

They are maintained

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6
Q

Symptoms of sleep apnoea

A
  • episodic apnoeas
  • neurological arousal
  • fragmented sleep
  • poor quality sleep
  • daytime somnolence
  • early morning headache
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7
Q

effects of sleep deprivation

A
  • irritability
  • cognitive impairment
  • memory lapses or loss
  • impaired moral judgement
  • severe yawning
  • hallucinations
  • symptoms similar to ADHD
  • increased heart rate variability
  • risk of heart disease
  • decreased reaction time and accuracy
  • tremors
  • aches
  • impaired immune system
  • risk of type 2 diabetes
  • growth suppression
  • risk of obesity
  • decreased temperature
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8
Q

signs of obesity hypoventilation

A
  • snores little
  • Vt falls dramatically
  • pO2 falls and pCO2 rises steadily throughout the night
  • high CO2 in morning
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9
Q

any cause of chronic type 2 respiratory failure will be worsened overnight. True/ False?

A

True.

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10
Q

What are features of chest pain caused by cardiac system?

A
  • pain is central
  • heavy, dull pain
  • radiates to jaw/ arms/ back
  • autonomic symptoms
  • exertional
  • relieved by GTN spray
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11
Q

What are features of chest pain caused by respiratory system?

A
  • worse on inspiration and coughing: suggests pleural irritation
  • dull discomfort may suggest soft tissue mass, pleural mass, or local invasion
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12
Q

What are features of chest pain caused by gastrointestinal system?

A
  • indigestion
  • heartburn
  • spasms difficult to differentiate from cardiac
  • relation to posture and food
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13
Q

What are features of chest pain caused by musculoskeletal system?

A
  • history of trauma

- worse on breathing, movement, and touch

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14
Q

PE pain changes with posture, movement, and inspiration/ expiration. True/ False?

A

True

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15
Q

Ischaemic heart disease is worse in hot weather. True/ False?

A

False. It is worse in cold weather.

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16
Q

What kind of pain is ischaemic heart disease pain?

A

crushing, gets better when the person sits down for a few minutes.
Ischaemic pain occurs during heart attacks and angina

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17
Q

what is pleuritic pain like?

A

sharp, and is pain on inspiration

18
Q

what is bronchiectasis pain like?

A

it feels like someone is pushing a metal rod against your back

19
Q

what are oesophageal spasms like?

A

gripping pain

20
Q

can pain from the heart be well localised?

A

no

21
Q

what kind of pain is worse in inspiration?

A

pleuritic pain

this can occur in TB, pneumonia

22
Q

Characteristically, what is the colour of sputum in Strep pneumonia?

A

rusty coloured (due to blood)

23
Q

where could haemoptysis be coming from?

A
  • nose
  • GI (vomit, haematemesis (vomiting blood - dark and acidotic, melaena - dark sticky faeces which contain partly digested blood as a result of internal bleeding or the swallowing of blood), coffee ground vomitus (classic sign of upper GI bleeding))
  • bronchial
24
Q

what are some possible appearances of haemoptysis?

A
  • frothy
  • old
  • rusty
  • streaks
  • mixed with sputum (if not: consider infarction and trauma)
25
Q

what volume is “massive haemoptysis”?

A

more than or equal to 600ml in 24 hours

person should be admitted and may need emergency treatment

26
Q

what volume is “non-massive” haemoptysis?

A

less than 600ml in 24 hours.

27
Q

possible causes of haemoptysis?

A
  • trauma
  • infective
  • neoplastic
  • vascular
  • parenchymal
  • non-pulmonary
28
Q

what kinds of trauma could cause haemoptysis?

A
  • wounds
  • intubation
  • foreign body
29
Q

what kinds of infection could cause haemoptysis?

A
  • pneumonia
  • abscess
  • acute bronchitis
  • tuberculosis
  • bronchiectasis
  • fungi
30
Q

what kinds of neoplasia could cause haemoptysis?

A
  • primary

- secondary (lung, breast, brain, prostate, colon, other)

31
Q

what kinds of vascular problems could cause haemoptysis?

A
  • PE
  • Vasculitis (SLE, Wegener’s, RA, Osler-Weber-Rendu)
  • Arteriovenous malformation (AVM)
32
Q

What kinds of parenchymal problems could cause haemoptysis?

A
  • ILDs
  • sarcoid
  • haemosiderosis
  • Good[asture’s syndrome
  • Cystic fibrosis
33
Q

What kinds of non-pulmonary problems could cause haemoptysis?

A
  • CVS (pulmonary oedema, mitral stenosis, aortic aneurysm, Eisenmenger’s syndrome)
  • bleeding diathesis (including drug-induced)
34
Q

what are some different characters of cough?

A
  • brassy (pressure on trachea?)
  • hollow/ bovine (laryngeal nerve palsy causing vocal cord dysfunction)
  • barking (acute epiglottitis)
  • dry (GORD, drugs e.g. ACE-I)
  • change in character of a chronic cough should make you consider other pathology
35
Q

what condition should be considered when a cough is nocturnal?

A

asthma (early morning cough)

36
Q

what are some precipitating factors for an asthmatic’s cough?

A
  • emotion
  • cold, windy, wet weather
  • dust
  • allergies
  • exercise
  • drugs
37
Q

In a cough with sputum, what factors about the sputum should be considered?

A

-colour
-volume
-consistency
-pattern
Consider: infections, COPD, CF, bronchiectasis

38
Q

For a patient who has a cough, what could be some associated symptoms to consider?

A
  • breathlessness
  • sputum
  • chest pain
  • wheeze
  • hoarseness
39
Q

How can ACE inhibitors cause coughing?

A

By inhibiting the breakdown of bradykinin

40
Q

Beta blockers can worsen or precipitate underlying asthma sometimes. True/ False?

A

True