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TCD Respiratory > Acute Breathlessness > Flashcards

Acute Breathlessness Flashcards

1
Q

What are the types of spontaneous pneumothorax?

A

Primary (no underlying lung disease) and secondary (lung disease or significant smoking history present).

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2
Q

What kind of pain is experienced in pulmonary embolism?

A

Pleuritic chest pain.

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3
Q

What drug should be given to a patient with suspected pulmonary embolism whilst investigations are underway?

A

Enoxaparin (clexane) to reduce and prevent blood clotting.

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4
Q

What are the cardinal features of a pulmonary embolism? (5)

A

Dyspnoea, chest pain, cough, haemoptysis, features of DVT.

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5
Q

When should the National Early Warning Score 2 (NEWS2) be used?

A

Patients over 16 for emergency, inpatient or prehospital initial assessment.

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6
Q

What pneumonics should be used to study chest x-rays?

A

Rotation
Inspiration
Picture
Exposure

Airway
Breathing
Circulation
Diaphragm
Everything else/extra tubes

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7
Q

What are the three cardinal features (signs) of anaphylaxis and what are they caused by? (3)

A

-Stridor - caused by laryngeal oedema.
-Wheeze - caused by bronchospasm due to histamine binding to H1 receptors in the lungs.
-(Pre)Syncope - caused by hypotension due to leaky capillaries.

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8
Q

What is anaphylaxis?

A

A life-threatening type 1 hypersensitivity reaction.

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9
Q

What is involved in a type 1 hypersensitivity reaction?

A

Mast cells pre-sensitised with IgE antibodies meet the antigen they have been pre-sensitised to, causing degranulation and massive histamine release.

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10
Q

What dose of adrenaline should be given to a patient in anaphylaxis?

A

Their own EpiPen dose OR 0.5mL of 1:1000.

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11
Q

Name three crystalloid fluids.

A

Saline, Hartmann’s, Plasma-Lyte.

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12
Q

What are the pharmacological treatment options for confirmed pulmonary embolism (PE)? (3)

A

-Offer DOAC (apixaban or rivaroxaban) first line.
-If these are not suitable, heparin (LMWH) for at least 5 days followed by dabigatran or edoxaban, or LMWH concurrently with a VKA (warfarin) till therapeutic anticoagulation is achieved.

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13
Q

What does a high pitch wheeze on inspiration (stridor) indicate?

A

Highly indicative of an upper airway obstruction.

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14
Q

How are smoking pack years calculated?

A

pack years = (cigarettes smoked per day/20) x no. years smoking

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15
Q

What is normal capillary refill time?

A

Blood should return to fingertip in less than 2 seconds after being pressed for 5 seconds.

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16
Q

What are blebs and bullae?

A

Blebs = small air-filled blisters that can form on surface of lung.
Bullae = pockets of air that can form within lung tissue.

17
Q

What are four respiratory diseases associated with finger clubbing?

A

Bronchiectasis
Lung cancer
Cystic fibrosis
Pulmonary fibrosis

18
Q

What are three causes of asterixis (flapping tremor)?

A

CO2 retention (i.e in COPD)
Uraemia
Hepatic encephalopathy

19
Q

What is a deep sulcus sign in a chest x-ray?

A

A deepening in the costophrenic angle as an indicator of pneumothorax.

20
Q

How are pneumothoraxes classified by size?

A

Measure the width of rim of air at level of hilum: <2cm is small, >2cm is large.

21
Q

What are the three cardinal signs of pulmonary embolism?

A

Dyspnoea, tachypnoea and pleuritic chest pain.

22
Q

What is a Wells Score?

A

A list of features that, if present, add up to a total clinical probability score stating risk of pulmonary embolism. [>5 = indicates PE].

23
Q

What immediate treatment should be given to pulmonary embolism patients in haemodynamic collapse?

A

Thrombolysis with tissue plasminogen activator (tPA).

24
Q

What is the pulmonary embolism severity index (PESI) score?

A

A risk stratification tool that has been externally validated to determine mortality and outcome of patients with newly diagnosed PE. [Low risk < 85]

25
Q

What ECG pattern is classically associated with acute pulmonary embolism?

A

S1Q3T3 - large S wave in lead I, large Q wave in lead III and inverted T wave in lead III.

TCD Respiratory (5 decks)

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