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Year 3 Conditions > SOB > Flashcards

SOB Flashcards

1
Q

Categories causing SOB

A

Insufficient O2 getting into lungs
Insufficient blood getting into blood
Insufficient blood reaching the body
Increased resp drive

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2
Q

Examples of increased resp drive leading to SOB

A

Hyperventilation

Acidaemia eg from DKA

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3
Q

When is HF SOB worse

A

When lying down

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4
Q

Which ILD do drugs cause

A

Hypersensitivtiy pneumonitis

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5
Q

Which drugs cause hypersensitivity pneumonitis

A

Methotrexate
Amiodarone
Bleomycin
Nitrofurantonin

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6
Q

Why is SLE and RA relevant in SOB histories

A

Can lead to ILD and pleural effusions

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7
Q

What is relevant about sound of cough

A

Bovine suggests left recurrent laryngeal involvement

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8
Q

What is cough like in chronic bronchitis

A

Productive

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9
Q

Why is muscular weakness significant in SOB history

A 
MND
MG
GBS
LES
Polymyositis
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10
Q

Why is heavy menstruation significant to SOB

A

Leads to anaemia

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11
Q

Acute causes of SOB

A

Bronchospasm from COPD and asthma
PE
Pneumothorax including tension
Anaphylaxis

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12
Q

Subacute SOB

A 
Pneumonia
HF
Pleural effusion
GBS
MG
Post operative or cancer atelectasis
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13
Q

Weeks to months SOB

A 
COPD
Asthma
ILD
Bronchiectasis
Mesothelioma
Cancer
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14
Q

How is chronic bronchitis diagnosed

A

Productive cough of more than 3 months in 2 consecutive years

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15
Q

RFs for COPD

A

Smoking
Occupational exposure to dust
Alpha-1-antitrypsin

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16
Q

Signs of COPD on examination

A 
Hyperextended chest
Accessory muscles
Pursed lips
Prolonged expiration
Crackles 
Wheeze
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17
Q

Can asthma present with chest pain

A

Yes tightness or from coughing so much

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18
Q

How are nasal polyps relevant in SOB

A

Indicate asthma

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19
Q

Which drugs can exacerbate asthma

A

NSAIDS
Aspirin
Beta blockers

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20
Q

Which ethnicity is HF particularly prevelant in

A

South asian

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21
Q

What is best way to monitor HF

A

BNP

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22
Q

What else can BNP be elevated in

A

PE
Cor pulmonale
These cause further strain on the heart
Others include renal failure

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23
Q

What would suggest HF on ECG

A

Evidence of previous MI

Pathological Q waves and BBB

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24
Q

Why is ECG important in HF

A

Negative predictive value of 98%

Will see evidence of previous damage to heart

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25
Bloods ordered in HF
FBC- anaemia U&Es- fluid overloaded so need baselines for electrolytes and kidney if gonna get rid of a lot the fluid TFT- can lead to tachyarrythmia BNP
26
How does bronchiectasis appear on spirometry
Obstructive
27
What is cut off Hb1ac for diabetes
Aove 6.5 or 48mmol is diabetic
28
What is important thing to remember about HF
Is a syndrome not a diagnosis- causes include HTN, IHD, alcoholic cardiomyopathy
29
Why is SOB worse when lying down in HF
Lying down increased venous return thus increasing work of heart
30
Why do you get oedema in HF
Heart cant pump all of its blood so some gets backed into systemic circulation manifesting as JVP, hepatomegaly, oedema
31
First line HF
Bloods ECG CXR
32
Second line HF
Echo | Coronary angio
33
What looking for in HF echo
The ejection fraction Areas of akinesia Valve competency
34
Why do angio in HF
Look for areas where IHD
35
When dont you give morphine in HF
If acute as shown to be worse prognosis
36
Acute management of HF
Sit up Oxygen Vasodilators Loop diuretic or aldosterone antagonist
37
Which two physiological systems arent helpful in HF
RAAS- as kidney hypoperfused so retains more fluid | Sympathetic- increased HR but heart is already struggling so damage exacerbated
38
What drug is given to help with sympathetic nervous system exacerbating HF sx
Beta blockers as long as no LVF
39
Long term management of HF
Treat the cause- angioplasty etc Lifestyle so statins, diabetes, aspirin If severe digoxin, ICDs, transplant
40
What is late finding of COPD on spirometry
FVC drops as cant inhale fully
41
Causes of SOB post operatively
``` Post operative atelectasis Pulmonary oedema Pneumonia PE Anaemia Pneumothorax ```
42
How can you get post operative atelectasis
If patients are in pain or very ill they may struggle to breath out all of the mucus in their lungs thus causing it to be blocked
43
How can pulmonary oedema occur post surgery
Too much fluid given
44
How can pneumothorax occur post operatively
Any interventions near the lung such as central line
45
What presents with a painful rattling cough post op
Atelectasis
46
How do you give oxygen in COPD exacerbations
Venturi only 24-36%
47
What can cause COPD exacerbations
Pneumothorax PE Infection Opiate medication
48
How to diagnose PCP
Microscopy and cultures from sputum sample and BAL
49
If suspect PCP what are 2 test must do
HIV- check CD4 count, viral load if positive | TB test
50
How does PCP present
SOB Dry cough Severe desaturation on exertion
51
Why is a rheumatoid significant in a SOB history
On methotrexate | Can cause ILD itself
52
Why is a rheumatoid significant inhistory when looking at bloods
ESR and CRP elevated
53
Congenital disorders causing ILD
Gaucher | Neurofibromatosis
54
Next investigation if have patient with wt loss, lung mass and lymphadenopathy
FNA of lymph node
55
What is epiglottis normally caused by
Haemophillus influezae
56
What are terms pink puffer and blue bloater used to describe
COPD patients Pink puffer- responds to hypoxia and hypercapnia by increasing RR therefore oxgenate well Blue bloaters- desensitisation of the resp centre to CO2 so live off hypoxic drive therefore cyanotic
57
How do pink puffers appear
Barrel shaped chest | Breathe through pursed lips
58
How do blue bloaters appear
Bloated from widespread oedema from cor pulmonale
59
Differentials for bilateral creps
Pneumonia ILD Bronchiectasis HF
60
How to differentiate creps in bronchiectasis from ILD
In bronchiectasis very varied with cough and eased by leaning forward
61
How does chest appear in ILD
Reduced expansion
62
How is atelectasis managed
Analgesia Oxygen Lots of physio
63
What is eisenmenger syndrome
When initially there is left to right cardiac shunt from VSD etc but then this develops into a right to left shunt. In left to right shifts pulmonary HTN is created from LV blood being pumped into lungs at great pressures. This pulmonary HTN can become so great it shifts blood back into a normal shunt

Year 3 Conditions (33 decks)

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