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Clin Med 4 > Approach to Cough + SOB > Flashcards

Approach to Cough + SOB Flashcards

1
Q

w/ PFTs for COPD, what is low and what is high

A

low- FEV1, FVC, DLCO

high- TLC, residual volumes

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2
Q

what lab do you need to know before prescribing abx

A

Cr so you can know if their renal function in case you need to renally dose

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3
Q

PNA common presenting sxs

A

productive cough

fever

SOB

pleuritic CP

chills

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4
Q

impaired mentation + cough

presumptive dx + what tests do you do?

A

aspiration PNA

CXR

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5
Q

dyspnea

cough

sputum production

A

COPD

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6
Q

COPD stage 3 (severe) FEV1

A

30% to 49%

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7
Q

daily sxs

sxs more than 1 night/ week (not nightly)

some limitation in activity

FEV1 60-80%

A

moderate persistent asthma

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8
Q

PFT diagnostic for COPD

A

FEV1/FVC less than 70% and non reversible

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9
Q

when and why do you do a F/U CXR for CAP

A

6 weeks later

to exclude underlying mass

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10
Q

causes of L sided HF

A

CAD

HTN

alcoholic cardiomyopathy

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11
Q

sxs 2 or less times/ week

sxs 2 or less nights/ month

normal PFTs in between sxs

exacerbations are brief

FEV1 > 80%

A

intermittent asthma

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12
Q

causes of R sided HF

A

LV failure

severe pulmonary dz

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13
Q

CAD/ prior MI

HTN

paroxysmal nocturnal dyspnea

S3 gallop

JVD

crackles

A

HF

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14
Q

important tests for valvular dz

A

TTE (transthoracic echo)

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15
Q

what is the most common cause of diastolic dysfunction

A

HTN

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16
Q

sxs throughout the day

sxs often nightly

extremely limited physical activity

FEV1 < 60%

A

severe persistent asthma

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17
Q

what do patients w/ VTE + CA get

A

LMW heparin > direct oral anticoags or VKA antagonists

direct oral anticoags = dabigatran/ rivaroxaban/ apixaban/ edoxaban

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18
Q

NYHA class 1 HF

A

sxs only at levels that would limit normal people

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19
Q

how long do you give heparin for after a PE

A

at least 5 days

plus

when INR has been therapeutic for 2 consecutive days

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20
Q

what abx for CAP

A

x 5 days:

resp. FLQ- levofloxacin/ moxifloxacin

macrolide- aztihromycin/ clarithromycin/erythromycin

augmentin

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21
Q

how long do pts w/ their 1st PE/DVT + a provoked/ limited time risk factor take anticoags?

A

3 months

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22
Q

most common PNA pathogens

A

strep pneumoniae

mycoplasma pneumonia

H. flu

chlamydia

influenza/ other viruses

legionella

staph aureus

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23
Q

NYHA class 2 HF

A

sxs of HF w/ ordinary exertion

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24
Q

CAP important tests

A

CXR

blood/ sputum cx

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25
Q

in patients w/ underlying malignancy, ___ is better than ___ (PE)

A

in patients w/ underlying malignancy, lovenox is better than coumadin

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26
Q

cough + SOB + febrile + crackles/ dullness

presumptive dx + what tests do you do?

A

CAP

egophony, CXR, BCX, sputum gram stain and cx

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27
Q

gold standard for dx of PE

A

angiography

28
Q

what scoring system do you use to determine the likelihood of a PE

what test do you use to r/o a PE

A

Wells- determines likelihood

D-Dimer R/O PE

29
Q

sudden onset

high fever

severe myalgias

september-May

A

influenza

30
Q

what heart sound is pathognomonic for volume overload

in what situation does it occur most commonly

A

S3 gallop

occurs most commonly in decompensated HF

31
Q

important tests for asthma

A

peak flow

PFTs

methacholine challenge

32
Q

how long do pts w/ their 1st idiopathic PE/DVT take anticoags?

A

3 to 6 months

33
Q

how old does someone have to be to do PFTs

A

over 5

34
Q

COPD stage 1 (mild) FEV1

A

80% or greater

35
Q

what accounts for 66% of HF cases

A

CAD

36
Q

dyspnea

cough that is worse at night

wheezing

chest tightness

sxs worse w/ exercise, URI, allergens, emotions, irritants

A

asthma

37
Q

PE meds

A
  • heparin
    • factor Xa monitoring
  • enoxaparin (lovenox)
  • warfarin QHS
  • factor Xa inhibitor
    • rivaroxaban
    • apixaban
    • edoxaban
  • direct thrombin inhibitor
    • dabigatran
38
Q

rarely affects upper lobes

commonly affects upper lobes

A

rarely- CAP

commonly- aspiration PNA, TB

39
Q

cough + NO fever + normal lung exam

presumptive dx + what tests do you do?

A

acute bronchitis

do a CXR

40
Q

TB important tests

A

CXR- cavitary or upper lobe lesions

sputum for AFB

41
Q

HF meds

A
  1. loop diuretics- furosemide/ bumetanide/ torsemide
  2. K sparing diuretics- spironolactone
  3. B Blocker- metoprolol/ carvedilol
  4. ACE/ARB- lisinopril
42
Q

how long do pts w/ recurrent VTEs take anticoags?

A

indefinitely

43
Q

sxs more than 2 times/ week but not daily

sxs 3-4 nights/ month

minor limitation in activity

FEV1 > 80%

A

mild persistent asthma

44
Q

cough

SOB

high fever

crackles

dullness on exam

A

CAP

45
Q

what do patients w/ VTE + NO CA get

A

direct oral anticoags > VKA antagonists > LMW heparin

direct oral anticoags = dabigatran/ rivaroxaban/ apixaban/ edoxaban

46
Q

NYHA class 4 HF

A

sxs of HF at rest

47
Q

sudden onset SOB

leg swelling

A

PE

48
Q

pleuritic CP

surgery

cough

SOB

sitting for a long time

A

PE

49
Q

cough worsens w/ cold/ exercise/ pets/ mold

wheezing

chest tightness

A

asthma

50
Q

asthma dx

A

PFT with improved FEV1 of more than 12% (200 mL) with a SABA

methacholine challenge test decreases FEV1 by 20%

51
Q

chronic airway inflammation

intermittent obstruction

airway hyper-reactivity

+/- progressive

A

asthma

52
Q

risk factors:

smoking/ 2nd hand smoke

occupational dust/ chemicals

bronchial hyperreactivity

alpha-1 antitrypsin deficiency

A

COPD

53
Q

important tests for HF

A

CXR

BNP or NT-proBNP

TTE (Transthroacic Echo)

54
Q

NYHA class 3 HF

A

sxs of HF w/ less than ordinary exertion

55
Q

COPD stage 4 (very severe) FEV1

A

less than 30%

56
Q

common sxs of both LV and RV failure

distinguishing sxs of LV vs RV failure

A

common- edema, JVD, fatigue

only LV- pulmonary edema

57
Q

PNA complications

A

resp failure

death

empyema

58
Q

imporant tests for Acute Coronary Syndrome

A

EKG

cardiac enzymes

angiography

59
Q

PE important tests

A

*** CTA ***

D-Dimer

LE US

VQ scan

pulmonary angiography

60
Q

risk factors:

hx of allergy

tobacco exposure

GERD

vocal cord dysfunction

RSV

maternal smoking

A

asthma

61
Q

a massive PE may cause

A

RV failure and death

62
Q

rhematic heart dz

murmur

A

valvular dz

63
Q

asthma meds

A

SABA- albuterol/ levalbuterol

LABA- salmeterol/ formeterol

ICS- fluticasone/ budesonide/ beclomethasone/ memetasone

mast cell stabilizer-cromolyn

leukotriene receptor antagonist- montekulast

oral systemic steroids- prednisone

MAB- omalizumab

64
Q

sudden onset + high fever + severe myalgias + December-May

presumptive dx + what tests do you do?

A

influenza

clinical dx, direct immunofluorescence/ ELISA

65
Q

cough

afebrile

normal lung exam

A

acute bronchitis

66
Q

COPD stage 2 (moderate) FEV1

A

50% to 79%

67
Q

COPD meds

A

SABA- albuterol/ levaolbuterol

LABA- salmeterol/ formeterol

SAMA- ipatropium bromide

LAMA- tiotropium

oral steroids- prednisone

SABA/SAMA combo- combivent

LABA/ICS combo- advair/ symbicort/ dulera

Clin Med 4 (9 decks)

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