Breathless Betty

Question 1

How to differentiate physiological and pathological shortness of breath from exercise

Answer 1

It can be difficult but generally it is judged by comparing yourself to your past self or those around you

Question 2

Significance of sputum colour (grey or green)

Answer 2

Grey or green generally indicates elevated WBCs; could be infection but not necessarily

But this is compared to the patient’s ‘norm’

Question 3

Causes of cough

Answer 3

Cold
Acute Bronchitis
Tracheitis
Pneumonia
COPD
Asthma
Anxiety
Foreign Body
TB
Bronchiectasis
Congestive Heart Failure
Lung Cancer

Drug-induced: e.g. ACE Inhibitors

Question 4

Pneumonia

Answer 4

Alveoli become full of fluid as a result of infection

Question 5

Bronchiectasis

Answer 5

Can be genetic or acquired

Damage to alveoli and so damage ciliary mucous so mucous stagnates and does not clear

REVISE AND ADD

Question 6

Differentiate between smoker’s cough and COPD cough

Answer 6

It is difficult to do so; smokers with a PERSISTENT smoker’s cough are suggested to present for further investigation

Question 7

Alerting symptoms regarding COPD or Lung Cancer - im not rly sure :’(

Answer 7

Cough > 3 weeks
Smoking history associated with Haemoptysis
Change in ‘smoker’s cough’

Question 8

Haemoptysis

Answer 8

Coughing up blood

Question 9

Sound heard during percussion of fluid in lungs

Answer 9

Dullness, unlike percussion of air which is more crisp

Question 10

Symptoms OE of COPD patients

Answer 10

Prolonged Exhalation
Polyphonic Wheeze (multi note breath)
Unusual dull percussion of lungs
Reduced chest movements (I THINK)

REVISE

Question 11

What does a lowered PEF Indicate

Answer 11

A lot of very different things that are hard to diagnose

Question 12

What do stained fingers on COPD indicate

Answer 12

Tar staining (indicate that they are a current smoker)

Question 13

What does no ankle swelling tell us of a COPD patient

Answer 13

It indicates that the patient likely does not have chronic congestive heart failure

Question 14

What is spirometry used for in COPD

Answer 14

It is not used to diagnose COPD but it does confirm it when other data and history is indicative of it

It also identifies those most at risk of complications

Just as a bonus, it also scares some patients straight if you tell them they have lungs of a 90 year old

Question 15

How to diagnose between COPD and Emphysema

Answer 15

COPD is an umbrella term for those with chronic bronchitis and emphysema; they are clumped together because usually one would include at least an element of the other

Question 16

Describe the FEV1:FVC in obstructive and restrictive lung disease

Answer 16

FEV1 is low in both but FVC is normal in obstructive while being lowered in restrictive

Obstructive: Low FEV1:FVC
Restrictive: Normal FEV1:FVC

Question 17

eGFR

Answer 17

Estimated Glomerular Filtration Rate

Measures Renal Function

eGFR must be kept in mind in certain prescriptions
(Declines during aging)

Question 18

Why is Haemoglobin elevated for those with COPD

Answer 18

Body’s response to hypoxia

Question 19

Polycythaemia

Answer 19

Having a high concentration of red blood cells in your blood

Question 20

Amoldipine

Answer 20

Calcium-channel blocker used for hypertension and angina

Question 21

Ramipril

Answer 21

Used for high blood pressure and congestive heart failure

Question 22

Atorvastatin

Answer 22

Statin

Question 23

Are beta blockers indicated for COPD patients with hypertension

Answer 23

Yes definitely, as long as a spirometer does not indicate asthma (but monitor their progress with spirometry)

Question 24

What are COPD patients vulnerable to

Answer 24

Winter infection and Covid

Question 25

In what way does the x-ray indicate COPD

Answer 25

idk REVISE

Question 26

Should a chest X-ray be done for COPD Patients and why

Answer 26

Yes for sure, to ensure that there are no other concurrent infections

Question 27

Fundamental Five COPD Interventions

Answer 27

Smoking Cessation (MOST IMPORTANT ASF) Pulmonary Rehabilitation (VERY IMPORTANT AS WELL) Vaccination Self Management Plan Assess Co-morbidities (including mental health)

Question 28

Recommended Vaccinations for COPD Patients

Answer 28

Covid Flu Vaccine Pneumococcal

Question 29

Dyspnoea

Answer 29

Opposite of Apnoea | Shortness of Breath

Question 30

How is tiotropium taken up

Answer 30

It is taken via inhalation

Question 31

Mucolytics

Answer 31

Medicines that make the mucus less thick and sticky and easier to cough up Often makes patients cough up copious amounts and almost feel like they're drowing from how much there is

Question 32

Should we suggest e-cigarettes for smoking cessation

Answer 32

This is up to the doctor Generally, use it *with caution* as a last resort if other methods of cessation do not work

Question 33

Fostair 100/6

Answer 33

REVISE THIS SEEMS INTERESTING

Question 34

What improvement is expected in COPD patients with medication

Answer 34

Usually the medication is not expected to solve the issue, instead just to improve lifestyle like allowing tying your shoes without breathlessness

Question 35

Pulmomary Rehabilitation

Answer 35

Getting COPD patients to do simpler movements to strengthen their lungs

Question 36

Referrals from the COPD Clinic Include:

Answer 36

``` Severe disease Frequent exacerbators Suspect genetic cause Breathelssness doesn't match up with spirometry severity Cor Pulmonale Increasing palliative care needs Paid decline ```