PBL 3.04 Breathing Difficulties

A patient develops complete heart block in hospital after suffering from a myocardial infarction. His ECG shows a heart rate of 37 beats per minute and desynchronisation of atrial and ventricular contraction. Heart block in a myocardial infarction suggests damage to the atrioventricular (AV) node and occlusion of a particular coronary artery.

• Right coronary artery

• Left coronary artery

• Left anterior descending

• Circumflex

• None of these

What are the major pathologic changes caused by Emphysema?

• Mucous gland hypertrophy, hyperplasia and hypersecretion

• Airway dilation and scarring

• Damage to alveolar walls, air space enlargement

• Smooth muscle hypertrophy, hyperplasia, excessive mucus

Hypertrophy and hyperplasia of mucous glands in bronchi, hypersecretion of mucous is pathogenesis of which disease?

• Asthma

• Emphysema

• Chronic Bronchitis

• Bronchiectasis

• Otitis externa

A 16-year-old girl is brought in with difficulty breathing. She is unable to talk in full sentences and is panicking. She is known to have asthma. On examination she has a respiratory rate of 28 breaths/minute, a heart rate of 105 beats/minute and her chest is silent. Which of the features in this girl's history is most concerning?

• Unable to talk in full sentences

• Panicking

• Respiratory rate of 28 breaths/minute

• Heart rate of 105 beats/minute

• Silent chest

What is the cardiac output (Q)?

• Q = Heart Rate x Stroke Volume

• Q = Heart Rate x End Diastole Volume

• Q = Heart Rate x End Systole Volume

• Q = Ejection fraction + End Diastole Volume

• Q = Stroke Volume + End Diastole Volume

An elderly lady with long-standing chronic obstructive pulmonary disease (COPD) presents to the hospital with increasing breathlessness and a chesty cough. A chest X-ray is ordered as part of the initial assessment. Which characteristic signs would you expect to see on her chest X-ray?

• Pleural effusion

• Lobar collapse

• Empyema

• Flattened diaphragm

• Hyperinflated lungs

What is mitral stenosis?

• Valve does not open completely, causing narrowing.

• Valve does not close completely, causing leakage

A 70-year-old man is seen by his GP complaining of breathlessness and lower limb swelling. His GP measures his B-type natriuretic peptide to aid in the diagnosis of his condition. Which of the following would stimulate the body to produce B-type natriuretic peptide in heart failure?

• Increased ventricular filling pressure

• Use of ACE inhibitors

• Decreased stroke volume

• Increased activation of the renin-angiotensin-aldosterone system

• Peripheral oedema

Which of the following is not an age related change impacting breathing difficulties?

• Rib cage becomes stiffer/rigid

• Intercostal muscles weaken

• Alveoli can lose their shape and elasticity

• Reversible constricting of airways (caused by asthma)

Centriacinar and _ are two types of emphysema. Fill in the blank.