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1
Q

List the categories of acute dyspnoea causes

A
  • Upper airway obstruction
  • Lower airway disease
  • Parenchymal lung disease
  • Non specific resp causes
  • Cardio causes
  • Metabolic acidosis
  • Anxiety
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2
Q

List parenchymal lung diseases that can cause acute breathlessness

A
  • Pneumonia
  • Lobar collapse
  • ARDS: acute resp distress syndrome
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3
Q

What are the symptoms of pneumonia? (8)

A
  • Cough
  • Wheeze
  • Green productive sputum
  • Pleuritic chest pain (towards bottom of lung)
  • Sepsis: sweats, fevers
  • SOB
  • Worse lying down
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4
Q

Pneumonia signs (7)

A
  • Tachypnoea
  • Intercostal muscle movement
  • Wheeze
  • Dull percussion
  • Bronchial breathing
  • Coarse crackles
  • Raised CRP
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5
Q

What are the complications of pneumonia? (3)

A
  • Pleural effusion
  • Empyema: pus in cavity
  • Pulmonary cavity
  • Recurrence if patient immunocompromised/partially treated first infection
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6
Q

What are the symptoms of a progression to an empyema/pulmonary cavity?

A

H

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7
Q

How is a diagnosis of puenmonia made?

A

On chest x ray NOT just signs and symptoms

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8
Q

What is the duration of pneumonia symptoms without further complications?

A

Short hours to a few days

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9
Q

Lobar collapse (3)

A

Not obvious

  • Difficulty breathing/rapid and shallow
  • Wheeze
  • Cough
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10
Q

List non specific resp conditions that can cause acute dyspnoea (4)

A
  • Pneumothorax (simple/tension)
  • Pleural effusion
  • PE
  • Acute chest wall injury
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11
Q

What are the most common conditions that can progress to a pleural effusion? (3)

A
  • Heart failure
  • Pneumonia (paraneumonic effusion/pleural infection)
  • Malignancy
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12
Q

What are the signs of a progression to a pleural effusion on the affected side?

A
  • Reduced chest expansion
  • Mediastinal displacement
  • Stony dull percussion
  • Reduced/absent breath sounds
  • Reduced/absent vocal resonance
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13
Q

When are the signs of a pleural effusion present?

A

When greater than 500 ml

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14
Q

What are the symptoms of a simple puenmothorax? (4)

A
  • At rest and sudden onset
  • Pleuritic chest pain on 1 side
  • SOB
  • Proportionate to size and stable
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15
Q

How are the symptoms and signs of a tension puenmothorax different to simple? (5)

A
  • Worsening signs and symptoms
  • Unstable haemodynamically: hypotensive/tachycardic/high resp rate
  • Tracheal deviation from side of PTX
  • More obvious lung collapse
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16
Q

What can a tension puemonothorax progress to?

A

Cardiac arrest

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17
Q

What are the signs of a simple puenmothorax? (7)

A
  • No tracheal deviation
  • Subtle lung collapse = decreased peripheral lung markings CXray
  • Sats normal
  • Unilateral hyperresonant
  • Unilateral stony dull percussion
  • Unilateral
    reduced/no breath sounds
  • Unilateral reduced vocal resonace
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18
Q

List the resp causes of chronic dyspnoea

A
  • Asthma
  • COPD
  • Lung cancer
  • ILD (interstitial lung diseases) e.g sarcoidosis, idiopathic pulmonary fibrosis, extrinsic allergic alveolitis/pneumocitosis
  • Pleural effusion
  • Chronic pulmonary thromboembolism
  • Bronchiectasis
  • Cystic fibrosis
  • Pulmonary hypertension (primary/secondary)
  • Pulmonary vasculitis
  • TB
  • Laryngeal/tracheal stenosis - extrinsic compression/malignancy
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19
Q

What are the symptoms of asthma? (11)

A
  • Wheezing
  • Cough
  • Periodic dyspnoea
  • Tachypnoea
  • Chest tightness
  • Recurrent
  • Episodic
  • Diurnal (worse at night/in early morning)
  • Triggered by: cold, exercise, viruses, allergens, medications
  • Atrophy family history
  • Recorded episode
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20
Q

What are the triggers for asthma? (5)

A
  • Cold
  • Exercise
  • Viruses
  • Allergens
  • Medications (betablockers/ NSAIDs)
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21
Q

Give examples of medications that trigger asthma (2)

A
  • Betablockers

- NSAIDs

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22
Q

What are the signs of asthma?

A
  • Obstructive lung disease PFTs on spirometer
  • NO levels raised
  • 15% improvement in FEV1 or PEF following the inhalation of a bronchodilator
  • Expiratory wheeze
  • Silent chest=serious
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23
Q

What is the presentation of acute asthma? (2)

A
  • Worsening of normal symptoms (e.g wheeze/dyspnoea)

- Recorded episode: wheeze/variable PEFR/FEV1

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24
Q

How does atopic asthma present? (2)

A
  • Triggered by environmental agent

- Skin test: wheal and flare reaction

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25
How does occupational asthma present? (2)
Adult onset asthma with worse at work
26
What are the symptoms of COPD? (5)
- Progressive dyspnoea, persistent - Worsens with exercise - Chronic cough - Dry/regular sputum production - Recurrent winter bronchitus
27
What are the patient risk factors associated with COPD?
- Smoking | - Over 35 year olds
28
What are the red flags for breathlessness? (5)
- Acutely breathless - Haemoptysis - Hoarse voice - Chest pain - Rapid weight loss
29
What are the signs of COPD? And which indiate a progression to cor pulmonale? (12)
- Tachypnoea - Hyperinflated chest - Wheeze - Use of accessory muscles - Poor chest expansion - Hyperresonant chest - Pursing of lips on expiration - Cyanosis * - Peripheral oedema * - Raised JVP * - Cachexia - Prolonged expiration * = cor pulmonale
30
How does an exacerbation of COPD present? (5)
- Acute onset - Worsening of COPD patient symptoms from usual stable state - Fever/systemic infection symptoms - Cyanosis symptoms: confusion, blue, severe SOB - Triggers: viral/bacterial resp tract infection
31
What confirms a diagnosis of COPD?
History with post bronchodilator FEV1/FVC =<0.70
32
What are the symptoms of acute bronchitus? (4)
- Dry then later productive (any colour inc. red) cough - Systemically unwell: fever - Dyspnoea - Wheezing
33
Presentation of ARDS? (Acute resp distress syndrome)
- Acute onset - Wide pulmonary pressure (so not HF) - Dyspnoea - Tachycardia - Tachypnoea - Bilateral basal crackles - Chest pain
34
What are the causes of ARDS?
Acute lung inflammation - Sepsis - Pneumonia - Trauma - Aspiration - Shock : ischaemiac damage/liver failure/pancreatitus/drug overdose
35
What are the symptoms of pulmonary oedema? (11)
- Sig breathing probs (SOB) - Cough w/pink frothy sputum (haemoptysis) - SOB - Resp distress - Tachypnoea - Excessive sweating - Suffocation feeling - Pale skin - Wheezing - Palpitations - Chest pain
36
Pleural effusion (7)
- Chest pain - Dry cough - Dyspnoea/orthopnea - Reduced chest expansion - Tracheal deviation from affected side - Stony dull percussion - Reduced/absent breath sounds/vocal resonance
37
Signs of pulmonary oedema (3)
- Decreased O2 sats - Raised JVP + peripheral oedema (fluid overload) - Basal creps
38
What is pulmonary oedema secondary to? And what conditions is this state associated with? (5)
FLUID OVERLOAD - Kidney failure - IV therapy - Heart failure - Hypoalbuminaemia (liver failure) - Pericarditus
39
What are the differences between asthma and COPD clinically? (4)
- A=better quality of life - A=dinural, C=daytime externtional - A=reversible, C=irreversibe - A=allergy history, C=no allergy, more smoking
40
What are the symptoms of acute extrinsic allergic alveolitis? (5)
- Acute dyspnoea - Cough - Fever - Rash/swelling - Onset: a few hours after antigen exposure and resolving on cessation
41
What are the symptoms of bronchal carcinoma? (9)
- Chest pain : fullness to severe persistent pain. Maybe pleuritic - Cough: dry/ (purelent if infection) - change in smoker's cough - Several episodes of small haemoptysis without infection - Recurrent pneumonia – same site/slow to treatment response - SOB: if large tumour - Voice hoarseness - Resp symptoms not responding to treatment - Weight loss - Anorexia
42
What is a sign that a COPD patient has progressed to a bronchial carcinoma?
Change in character of smoker's cough
43
What suggests pneumonia is associated with malignancy? (3)
- Slow to heal - Same site - Slow response to treatment
44
What signs are found in bronchial carcinoma? (2)
- Phrenic involvement - diaphragm raising = absent breath sounds and dull percussion - Pleural rub/pleural effusion signs if pleura involvement
45
List the interstitial lung diseases causing breathlessness (7)
- Chronic extrinsic allergic alveolitis - Idiopathic pulmonary fibrosis - Sarcoidosis - Simple coal workers pneumoconiosis - Complicated coal workers’ pneumoconiosis/progressive massive fibrosis - Asbestosis - Silicosis
46
What are the symptoms of simple coal workers pneumoconiosis? (2)
- Asymptomatic | - Or some bronchitis
47
What are the symptoms of complicated coal workers’ pneumoconiosis/progressive massive fibrosis? (3)
- Cough - Dyspnoea - Black sputum - Progressing despite dust exposure cessation
48
What can progressive massive fibrosis eventually lead to? (2)
- Pulmonary hypotension | - Cor pulmonale
49
What are the symptoms and signs of chronic extrinsic allergic alveolitus? (7)
- Insidous onset - Cough - Progressive dyspnea - Fatigue - Weight loss - Clubbing - Acute episodes: fever and SOB after antigen exposure
50
What are the signs of chronic extrinsic allergic alveolitus? (5)
- Type 1 resp failure - Hypoxemia at rest, desat with exercise - Resp distress - Tachypnoea - Inspiratory crackles on lower lung fields
51
Symptoms of idiopathic pulmonary fibrosis (8)
- 45-65 years - Progressive breathlessness - Weight loss - Malaise - Type 1 resp failure/cor pulmonale - Clubbing - End insp crackles - Reduced chest expansion
52
Bronchiectasis presentation (5)
``` Decreased FEV1 Decreased FEV1/VC ratio (less than 0.7) Cough Fever Foul smelling purulent sputum ```
53
What lung cancer is associated with kidney stones? And why? (2)
- Squamous cell = hypercalcaemia | - Ectopic PTH secretion
54
Acute asthma signs 3
- Expiration wheeze - Silent chest=emergency! - Hypokalaemia
55
What can progress to lobar collapse? (4)
- Blockage of bronchiole/bronchus=within airway e.g foregin body/mucus plug in asthma - From wall blockage= tumour - Compressing from outside .g tumour - Pneumothorax/pleural effusion
56
Effusion vs consolidation clinical signs
- Effusion: stony dull vs consolidation dull | - Effusion: vocal resonance is decreased/absent + consolidation: increased VR
57
Acute LVF heart failure signs (4)
- Tachypnoea - Cold hands - Tachycardia - Crackles/wheeze
58
Lung cancer (8)
- Hoarse voice - Blood in sputum - Progressive SOB - Anaemia (palpitations/tiredness) - Night sweats - Cough - Chest pain - Horner's syndrome: ptosis/myosis/adenlyclosis
59
Acute COPD exercabation (2)
- Acutely SOB | - Sputum colour change
60
TB (8)
- Young and travel - Cough (+/haemptosis) - Night sweats - Fever/chills - SOB - Fatigue - Weight loss - Systemic infections e.g menignitus/pericarditus)
61
TB vs lung cancer (5)
- Age: young vs old - Smoking: non vs yes - Weight loss: slow vs sudden - Chest pain: not present vs present - Hoarseness: not present vs present
62
Drugs with clottiing risks? (2)
- HRT | - Contraceptive pill
63
Puemonthorax risk factors (9)
- Cystic fibrosis - Marfan's syndrome - Male - Tall - Young (20s) - Smoking - COPD - Asthma - Cystic fibrosis
64
What sign can be found particularly in patients with lower lobe pneumonia?
Upper abdo tenderness
65
Heart failure (9)
- Pink frothy sputum - PND - Orthopnoea - Tachycardia - Lung crackles - Raised JVP - S3 gallop - Displaced apex beat - Wheeze - Fluid overload: acites
66
Asbestosis (5)
- Persistent dry cough - Wheezing - Fatigue - Joint pain (hand and foot) - Clubbing
67
How does lesions in the lung predispose to infections?
Obstruction decreases lung clearance of secretions

Breathlessness (9 decks)

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