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Year 3 > Week Two - Sub-Acute Breathlessness > Flashcards

Week Two - Sub-Acute Breathlessness Flashcards

1
Q

what are the cardiac causes of breathlessness

A

heart failure
angina/ischaemic heart failure
valvular heart disease
cardiac arrhythmias

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2
Q

what are the respiratory causes of breathlessness

A

COPD
asthma
interstitial lung disease
breathing pattern disorder
lung cancer
pulmonary vascular disease

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3
Q

what are the mental health causes of breathlessness

A

anxiety
depression

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4
Q

what are the other causes of breathlessness

A

obesity
physical deconditioning
anaemia
long COVID

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5
Q

what is Eisenmenger’s syndrome

A

describes the reversal of a left-to-right shunt in a congenital heart defect due to pulmonary hypertension

this occurs when an uncorrected left-to-right leads to remodelling of the pulmonary microvasculature, eventually causing obstruction to pulmonary blood and pulmonary hypertension

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6
Q

what is central cyanosis

A

Central cyanosis is a generalized bluish discoloration of the body and the visible mucous membranes, which occurs due to inadequate oxygenation secondary to conditions that lead to an increase in deoxygenated hemoglobin or presence of abnormal hemoglobin.

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7
Q

what is peripheral cyanosis

A

Peripheral cyanosis is the bluish discoloration of the distal extremities (hands, fingertips, toes), and can sometimes involve circumoral and periorbital areas. Mucous membranes are generally not involved. Peripheral cyanosis is rarely a life-threatening medical emergency. However, it is essential to determine the underlying cause and its timely management to prevent potential complications.

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8
Q

what is differential cyanosis

A

Differential cyanosis is the asymmetrical bluish discoloration between the upper and lower extremities. It usually indicates serious underlying cardiopulmonary conditions.[3]

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9
Q

what is pseudo cyanosis

A

The bluish discoloration despite adequate oxygenation is sometimes seen due to the ingestion of drugs, toxins, or metals. This is called ‘Pseudocyanosis.’

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10
Q

what are the causes of central cyanosis

A

Hypoventilation due to conditions affecting the central nervous system, such as intracranial hemorrhage, tonic-clonic seizures, and heroin overdose.

Pulmonary causes leading to ventilation-perfusion mismatch and impaired alveolar-arterial diffusion, for instance, bronchospasm (asthma), pulmonary embolism, pneumonia, bronchiolitis, pulmonary hypertension, hypoventilation, and COPD[6][7][8]

Cardiovascular causes include heart failure, congenital heart diseases (right to left shunting), and valvular heart diseases.

Hemoglobinopathies including methemoglobinemia, sulfhemoglobinemia

Polycythemia

High altitude

Hypothermia

Obstructive sleep apnea

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11
Q

what are the causes of peripheral cyanosis

A

Reduced cardiac output secondary to heart failure or shock

Local vasoconstriction due to cold exposure, hypothermia, acrocyanosis, and Raynaud phenomenon

Vasomotor instability

Arterial obstruction causing regional ischemia secondary to peripheral vascular disease. Causes include atherosclerosis, Buerger disease, atheroembolism

Venous stasis or obstruction, such as in deep vein thrombosis

Hyperviscosity attributable to multiple myelomas, polycythemia, and macroglobulinemia

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12
Q

what is generalised reduced blood flow due to

A

congestive heart failure

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13
Q

how is peripheral cyanosis characterised

A

Localized cyanosis affecting only extremities

Pink tongue as mucous membranes are almost never involved

Cold extremities as compared to warm extremities in central cyanosis

Clubbing is absent

Pulse volume usually low

Capillary refill time more than 2 sec

Disappears with massage and warming

Dyspnea usually absent

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14
Q

what drugs should be considered for heart failure

A

diuretics, ACE inhibitors, inotropic drugs

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15
Q

what is the range of fever

A

anything over 38 degrees is high

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16
Q

what infections causes fever

A

respiratory tract infections and colds

flu

infection of the gut (gastroenteritis)

ear infections

infections of the tonsils

UTI and kidney infections

DVT and PE

rheumatoid arthritis and lupus

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17
Q

what is the main lower respiratory tract infection

A

pneumonia

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18
Q

what can an upper respiratory tract infection include

A

ears, nose, throat and sinuses

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19
Q

what is important differential in a child under 12 months with respiratory infections

A

bronchiolitis

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20
Q

what are the six main URTI

A

common cold

sore throat

tonsilitis

acute otitis media

otitis media with effusion

acute sinusitis

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21
Q

what is the cause of the common cold

A

Viral. Most commonly rhinovirus, but may also be coronavirus and RSV.

22
Q

what is the normal presentation of the common cold

A

colourless nasal discharge and a blocked nose

23
Q

what is the treatment for the common cold

A

It is a self limiting infection

antibiotics are of no use due to viral nature of the infection

24
Q

what is the cause of a sore throat - pharyngitis

A

usually viral

B-haemolytic streptococcus may be present

25
Q

what are the causes of tonsillitis

A

2/3 of cases are viral (e.g. EBV) and 1/3 are bacterial (e.g. β-haemolytic streptococcus).

26
Q

what are the symptoms of tonsillitis

A

May have tonsilar exudates
Headache
Abdominal pain
Fever
Cervical lymphadenopathy
Lethargy

27
Q

what should be avoided in tonsillitis treatment and why

A

amoxicillin should be avoided - as can cause macuopapular rash if tonsillitis is due to infectious mononucleosis (EBV)

28
Q

what are the causes of acute otitis media

A

Many cases are viral, including RSV and rhinovirus. Bacterial causes are usually haemophilus influenzae and Moraxella catarrhais.

29
Q

what are the symptoms of acute otitis media

A

Fever
Ear pain
Child may tug at affected ear
Otoscopic findings: red, inflamed tympanic membrane. Loss of light reflex

30
Q

what is the recommended antibiotic for acute otitis media

A

amoxicillin

31
Q

what is OME - glue ear

A

Caused by recurrent otitis media. Very common at <1 years age. Persists up to around 10 years of age.

32
Q

what are the symptoms of OME

A

Hearing loss on affected side
Other symptoms (e.g. pain) are rare
Tympanic membrane may be dull and retracted. Flud level may be visible

33
Q

what is the cause of acute sinusitis

A

usually viral, occasionally bacterial

34
Q

what are the symptoms of sinusitis

A

Pain
Swelling
Tenderness
(all over zygomatic/cheek region)

35
Q

how is sinusitis treatment

A

symptom relief with paracetamol and ibuprofen

36
Q

what is ARDS

A

acute respiratory distress syndrome

37
Q

what is ARDS a result of

A

essentially acute lung inflammation as a result of sepsis, pneumonia, trauma or aspiration

38
Q

what is the pathology behind ARDS

A

results from local or systematic inflammatory processes. cytokines and other inflammatory mediators recruit macrophages and neutrophils to the area

these WC’s then release other inflammatory agents, and there is a disruption of the boundary between lung tissue and normal capillaries.

there is reduced lung compliance and disruption of surfactant leading to collapse of airways

39
Q

how can you differentiate between ARDS and acute heart failure

A

by taking a pulmonary wedge pressure measurement

40
Q

what are the signs and symptoms of ARDS

A

Dyspnoea
Tachycardia
Tachypnoea
Bilateral Basal crepitations / other abnormal breath sounds
Chest pain
Peripheral vasodilation

41
Q

what is the diagnostic criteria for ARDS

A

Acute onset
PCWP – pulmonary capillary wedge pressure – <19mmHg
CXR – demonstrating bilateral diffuse infiltrates
Refractory hypoxaemia – PO2:FiO2 <200
(Total thoracic compliance <30ml/cm H2O) – helpful but not necessary to fulfil diagnostic criteria

42
Q

what are the bloods done for ARDS

A

amylase, FBC, U+E, CRP

ESR is not generally useful as it measures chronic inflammation

43
Q

what would an ABG show

A

Low O2 – often does not respond well to prescribed O2
pH – can be low initially (due to respiratory acidosis), or may be high in the presence of sepsis, or as a result of the underlying cause of ARDS

44
Q

what pressure is required in pulmonary capillary wedge pressure to consider ARDS as a diagnosis

A

<19mmHg

45
Q

what combats high intrapulmonary pressures

A

inhaled nitric oxide

46
Q

what is the other name for salbutamol

A

Ventolin

47
Q

what is the other names for formoterol

A

Oxis, foradile, foradil, atock

48
Q

how much of an inhaled dose actually makes it into the lungs

A

15%

49
Q

what are the unwanted effects of inhalers

A

Fine tremor – this may be present if a patient is on a high dose of these for a long period. It is unlikely that inhaler use alone will cause this, and it most common occurs in patients who are taking nebulized forms of the drugs. This results from β2 stimulation

Tachycardia and arrhythmia can result when high doses are taken. This is a result of β1 and β2 stimulation

Headache

Bronchospasm can sometimes occur the first time the drug is taken.

Oral candidiasis can occur when the drugs are used long term. Some practicioners recommend to rinse the mouth and spit after the inhaler is used to reduce the likelihood of this.

Acute metabolic responses – these will not persist long-term, but initially can include hypokalaemia, hypomagnesaemia and hyperglycaemia.

Tolerance can occur if you overuse them. Protein kinase A (one of the proteins activated in the 2nd messenger system) attacks the β2 receptor and uncouples it from its G-protein, meaning that activation of the receptor will not result in activation of the 2nd messenger system.

50
Q

what is the usual inhaled dose of salbutamol

A

100ug

51
Q

what is the main symptomatic difference between lower and upper Respiratory tract infections

A

People who have lower respiratory tract infections will experience coughing as the primary symptom. People with upper respiratory tract infections will feel the symptoms mainly above the neck, such as sneezing, headaches, and sore throats. They may also experience body aches, especially if they have a fever

52
Q
A

Year 3 (63 decks)

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