SOB

Question 1

What are the pathophysiological levels, that might cause SOB?

Answer 1

1. Not enough O2 entering the Lungs
2. Not enough O2 entering the blood
3. Not enough O2 getting around the body
4. Increased resp drive

Question 2

What are possible causes for O2 not being able to enter the Lungs?

Answer 2

1. Airway obstruction
   
   1. Foreign body
   2. Bronchospsm
   3. Obstructing tumor
   4. Anaphylaxis –> airway oedema
2. Decreased lung volume
   
   1. intrathoracic: Pneumothorax, Lung collapse
   2. Extrathoracic: Trauma, Kyphosis
3. Decreased volume of functioning lung e.g. fibrosis
4. Inability to inflate lungs
   
   1. increased work (obesity)
   2. Weak resp muscles (myastenia gravis, NM-disorders
   3. Already Hyperinflated (COPD)

Question 3

What are possible causes for O2 not entering the blood?

Answer 3

1. Damage to alveolar membrane
   
   1. Emphysema
   2. Fibrosis (Intestinal Lung disease)
2. Reduced surface area
   
   1. Oedema: HF
   2. Inflammation: Pneumonia
3. Disrupted Blood supply
   
   1. PE

Question 4

What are reasons for Insufficient O2 transport in the blood?

Answer 4

1. Reduced cardia output (HF)
2. Anaemia
3. Shock

Question 5

What are possible reasons for increased respiratory rate?

Answer 5

• Hyperventilation
• Systemic acodosis (Acidemia)

Question 6

What are Specific questions you would want to consider in a Resp history (SOB)

Answer 6

1. Onset
   
   1. Sudden?
   2. Slow?
2. Alleviating/Exacerbating factors?
3. Risk factors
   
   1. Smoking
   2. Allergy/Atopy (e.g. Pets)
   3. Occupational history
   4. Medication
   5. PMH
4. Associated symptoms

Question 7

How do you calculate Pack years?

Answer 7

20 cigarettes / day for 1 year = 1 pack year

Question 8

Which jobs might put you at risk for respiratory conditions?

Which condition are you thinking of?

Answer 8

Jobs with exposure to

• asbestos
• coal dust
• silica dust

–> Might cause pneumoconioses

Question 9

Which medication are relevant for a resp. History?

Answer 9

Certain medication might cause hypersensitivity pneumonitis

• Nitrofurantoin
• Amiodarone
• Methotrexate
• Bleomycin

Question 10

What is the association between autoimmune conditions and a resp history?

Answer 10

Might predispose/cause interstitial lung disease/pleural effusions

• E.g. RA
• SLE

Question 11

What does a persistant productive for a couple of days suggest?

Answer 11

Pneumonia

Question 12

What does a persistant productive cough on most days of the past 3 months and years suggest?

Answer 12

Chronic bronichitis

Question 13

What does a dry cough, mainly present during the night with SOB suggest?

Answer 13

Asthma

Question 14

What might haemoptysis suggest?

Answer 14

Might be indicative of

• PE
• Lung cancer
• cavitating pneumonia

Question 15

What is pleuritic chest pain?

What does it indicate?

Answer 15

Pain that is worse when taking a deep breath in

Suggests

• Pneumonia
• PE
• Pneumothorax

Question 16

What are possible causes for sudden-onset SOB?

Answer 16

• Bronchospasm
  
  • COPD/Asthma exacerbation
• Anaphylaxis
• PE
• (Tension) Pneumothorayx, Hysterical hyperventilation
• Inhaled Foreign Body
• Acute epiglottitis/supraglottitis

Question 17

What are possible causes for SOB onse in hours to days?

Answer 17

1. Pneumonia
2. Hear Failure
3. Pleural effusion
4. Acute Respiratory Distress Syndrome
5. Musculoskeletal conditions
   
   1. Myastenia gravis, Guillain-Barré syndrome
6. Lung collapse
7. Altitiude sickness

Question 18

What are possible causes for SOB that starts within months - years?

Answer 18

1. COPD
2. Malignancy
3. Chronic Asthma
4. Hear failure
5. Pulmonary fibrosis
6. Anaemia
7. Bronchiectasis
8. Physical deconditioning
9. Obesity
10. etc.

Question 19

What is an ABG?

Answer 19

Medical procedure that is performed by optaining blood sample from an artery and shows Blood gases, important elctrolytes and Acid base state of patient

Question 20

What are the indications for perfoming an ABG?

Answer 20

• Control blood gases, monitor severe lung conditions
• Check effectiveness of treatement
• Consider additional oxygen or other treatment
• Check acid-base household of patient
  
  • E.g. in
  • Respiratory failure - in acute and chronic states.
  • Any severe illness which may lead to a metabolic acidosis - for example:
  • Cardiac failure.
  • Liver failure.
  • Renal failure.
  • Hyperglycaemic states associated with diabetes mellitus.
  • Multiorgan failure.
  • Sepsis.
  • Burns.
  • Poisons/toxins.
• Ventilated patients.
• Sleep studies.
• Severely unwell patients from any cause - affects prognosis.

Question 21

What are possible Complications when performing an ABG?

Answer 21

Low risk-procedure:

• bleeding or bruising at the puncture site
• feeling faint
• blood accumulating under the skin
• infection at the puncture site