Breathless Betty (REVISE)

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

Coryza
Acute Bronchitis
Tracheitis
Pneumonia
COPD
Asthma
Anxiety
Foreign Body
TB
Bronchiectasis
CHD
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 bronchiole/alveoli sacs and so damage ciliary mucous elevator so mucous stagnates and does not clear

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

Percussion of COPD

Answer 7

Dull Percussion

Question 8

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

Answer 8

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

Question 9

Haemoptysis

Answer 9

Coughing up blood

Question 10

Sound heard during percussion of fluid in lungs

Answer 10

Dullness, unlike percussion of air which is more crisp

Question 11

Symptoms OE of COPD patients

Answer 11

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

REVISE

Question 12

Polyphonic Wheeze

Answer 12

Whistling Like Breath Sound

Due to the varying changes in breathing of COPD

Question 13

Monophonic Wheeze

Answer 13

Indicates tumour or something

Question 14

What does a lowered PEF Indicate

Answer 14

A lot of very different things that are hard to diagnose

Question 15

What do stained fingers on COPD indicate

Answer 15

Tar staining (indicate that they are a current smoker)

Question 16

What does no ankle swelling tell us of a COPD patient

Answer 16

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

Question 17

What is spirometry used for in COPD

Answer 17

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 18

How to diagnose between COPD and Emphysema

Answer 18

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 19

Describe the FEV1:FVC in obstructive and restrictive lung disease

Answer 19

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 20

eGFR

Answer 20

Estimated Glomerular Filtration Rate

Measures Renal Function

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

Question 21

Why is Haemoglobin elevated for those with COPD

Answer 21

Body’s response to hypoxia

Question 22

Polycythaemia

Answer 22

Having a high concentration of red blood cells in your blood

Question 23

Amoldipine

Answer 23

Calcium-channel blocker used for hypertension and angina

Question 24

Ramipril

Answer 24

Used for high blood pressure and congestive heart failure

Question 25

Atorvastatin

Answer 25

Statin

Question 26

Are beta blockers indicated for COPD patients with hypertension

Answer 26

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

Question 27

What are COPD patients vulnerable to

Answer 27

Winter infection and Covid

Question 28

In what way does the x-ray indicate COPD

Answer 28

Not really much - does not diagnose other things though

Question 29

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

Answer 29

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

Question 30

Fundamental Five COPD Interventions

Answer 30

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

Question 31

Recommended Vaccinations for COPD Patients

Answer 31

Covid Flu Vaccine Pneumococcal

Question 32

Dyspnoea

Answer 32

Shortness of Breath

Question 33

How is tiotropium taken up

Answer 33

It is taken via inhalation to prevent systemic muscarinic inhibition

Question 34

Mucolytics

Answer 34

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 35

Should we suggest e-cigarettes for smoking cessation

Answer 35

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

Question 36

Fostair 100/6

Answer 36

LABA and Inhaled Steroid (Beclamethasone)

Question 37

What improvement is expected in COPD patients with medication

Answer 37

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

Question 38

Pulmomary Rehabilitation

Answer 38

Getting COPD patients to do simpler movements to strengthen their lungs

Question 39

Referrals from the COPD Clinic Include:

Answer 39

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

Question 40

Polyphonic Wheeze

Answer 40

Whistling Like Breath Sound Due to the varying changes in breathing