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Clinical Prep > Cough and SOB lecture > Flashcards

Cough and SOB lecture Flashcards

1
Q

Tests to be thinking about

A 
CXR
PFT
Bronchodilator
Methacholine
Sputum test
Rapid strep
Flu test
Covid

Smoking hx?

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2
Q

COPD

A

Emphysema

Chronic Bronchitis

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3
Q

Cough

A 
COPD
Asthma
Bronchitis
PNA
Allergic rhinitis
HF exacerbation
Pulm Embolism
Lung CA
Cocci
TB
Flu
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4
Q

Whenever you have edema and sx that are seemingly heart related, remember it can be a primary respiratory problem

A

bc when lungs aren’t functioning properly, causes R side of heart to back up and be under more pressure

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5
Q

any WBC over 10 (or 11) is

A

HIGH

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6
Q

Orthopnea

A

SOB when lying down

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7
Q

Paroxysmal nocturnal dyspnea

A

SOB that awakes the patient

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8
Q

Tx for PNA:
Azithro “Z pack” or
Doxy

A

5 days

for uncomplicated CAP

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9
Q

Everyone used to get Levaquin (Levofloxacin) for PNA,

BUT now we caution with FluoroQ bc

A

life threatening Hypoglycemia/coma

Delirium, agitation, memory impairment

Tendons, retinal detachment

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10
Q

Influenza season for PNA

A

September - May

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11
Q

Clinical pearls for PNA

A 
Wet cough
Fever
SOB
Pleuritic CP
Chills
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12
Q

If you see PNA in the upper lobes

A

consider Aspiration PNA

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13
Q

Right upper lobe PNA

A

Aspiration

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14
Q

CAP important tests

A

CXR

Blood or sputum culture (sometimes)

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15
Q

Acute bronchitis

A

Cough
NO FEVER
normal lung exam

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16
Q

Tests for Acute bronchitis

A

CXR (if abnormal exam, SOB, or high fever)

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17
Q

Influenza sx

A

Sudden onset
High fever
severe Myalgia
September-May season

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18
Q

Influenza test

A

Typically Clinical dx

Can test

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19
Q

Aspiration PNA

A

Impaired mentation (dementia, prior stroke, substance abuse)

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20
Q

Test for Aspiration PNA

A

CXR: showing R upper lobe

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21
Q

TB sx

A

Long duration of sx

Risk factors for TB

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22
Q

TB testing

A

CXR w upper lobe cavitary lesions

Sputum for AFB (acid fast bacilli)

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23
Q

What is tx for COPD exacerbation?

A

ABX!!
Macrolide: Z pack

and

______

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24
Q

SOB when lying down

A

Orthopnea

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25
Q

JVD and S3 gallop

Crackles to mid lung fields

2+ pitting pedal edema bilaterally

A

Acute HF

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26
Q

CXR:

  • Blunting of costophrenic angle
  • Increased vascular marking

Sx: SOB when lying down, DOE, pitting edema

A

Acute HF

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27
Q

SOB complaint with a significant underlying Cardiac history, be thinking about

A

Heart Failure!!

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28
Q

Acute HF tx

A

Admit
Oxygen
IV Furosemide (Lasix) 20mg
Strict I and Os

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29
Q

IV dose of Furosemide is

A

DOUBLE of oral dose

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30
Q

Once pt is admitted for HF exacerbation, you can then add these thing

A

Ct diuresis, I/Os, Low salt
+
B-blockers
ACE-I if EF <40%

get a TEE (Echo cardiogram to see more about HF)

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31
Q

What were the 2 new meds that we can add in the hospital to treat Acute HF other than Lasix?

A

ACE-I

B-blocker

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32
Q

Class 1 HF:

A

sx only at activity levels that would make anyone tired

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33
Q

Class 4 HF:

A

sx of HF at REST!

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34
Q

HF meds

A

Loop diuretics
K sparing diuretic
B-blocker
ACE-I

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35
Q

B-blocker for HF

A

Metoprolol (Toprol XL)

Carvedilol (CoReg)

36
Q

ACE-I for HF

A

Lisinopril (Zestril)

37
Q

Clinical pearls for Heart Failure

A

Edema and Weight gain

38
Q

Most common cause of diastolic dysfx HF

A

HTN

39
Q

Common causes of L sided Heart Failure

A

CAD

HTN

40
Q

Common causes of R sided Heart Failure

A

Left heart failure #1!!!
or
Severe pulm dz

41
Q

Edema, JVD, and fatigue are seen in what side of HF?

A

Both!

LV or RV failure

42
Q

Pulmonary edema is seen in what side HF?

think that the ____ isn’t working correctly, so what comes before it is going to get backed up

A

Left Ventricle Heart Failure

LV isn’t working right, so as a result the Lungs are getting backed up

43
Q

Pulmonary edema

A

LV failure

44
Q

S3 gallop is pathognomic of

A

Volume overload

occurs most commonly in decompensated HF

45
Q

Pearl sx for HF

A

Hx of CAD, prior MI, HTN, PND

PE: S3 gallop, JVD, crackles

46
Q

HF tests

A

CXR
BNP
TTE (echo)

47
Q

Acute Coronary Syndrome (heart attack) important tests

A

EKG
Cardiac enzymes
Angiography

48
Q

Arrhythmia tests to consider

A

EKG
Telemetry/ Holter monitor
Event monitor

49
Q

Valvular heart dz

A

Hx of Rheumatic heart dz

50
Q

Test to get with Valvular heart dz

A

TTE (echo)

51
Q 
cc: SOB
recent surgery
O2 sat 87%
Tachycardic 
Tachypneic
A

PE?!?!

blood clot

52
Q

Remember, PE for a Pulmonary Embolism is often

A

Normal
Tachy and Tachy
BUT no adventitious breath sounds and CXR is often normal

53
Q

Why are CBC and BMP imp when ruling out PE?

A

Does she have acute Anemia?
Infection?
Platelets? need to know for anti-coag meds if warranted

54
Q

D dimer are good at

A

RULING OUT

but not confirming

55
Q

Tests to order if thinking about PE

A

EKG
CXR vs CTA chest**

Labs: CBC, BMP, cardiac markers, PT/INR, aPTT

56
Q

Best test to r/o PE

A

CTA (CT angiography)

keep in mind, this requires Contrast

Need to make sure pt’s kidneys are working well b4 giving contrast

Check Cr levels

57
Q 
Post op
Tachycardia
Tachypneic
O2 sat low
PE unrevealing
A

Pulmonary Embolism!!

58
Q

Tx for PE

A

Anti-coags

59
Q

If someone just had surgery and now has a PE, who do you need to think about calling?

A

The surgeon!!

make sure you can give the pt Anti-coags, aka make sure their recent surgical site bleeding risk isn’t too high

60
Q

Anti-coags that will work immediately

A

Heparin drip
Lovenox
DOAC

61
Q

Heparin

A

very quick acting, and quick to leave body if stopped

bleeding risk goes away in about 4 hours of stopping

62
Q

Warfarin (Coumadin)

A

takes DAYS to become therapeutic

63
Q

If you have a pt who has a blood clot and you want to be able to REVERSE the bleeding of Anti-coag if needed (i.e. they just had recent surgery), use:

A

Heparin!

64
Q

What are the only cases in which you would perform a procedure for PE?

If person is HemoDynamicalyl unstable- can do

A

Thrombolysis

Thrombectomy

65
Q

Good starting dose for Warfarin (coumadin)

A

5 mg PO daily

66
Q

What can you use as a BRIDGE when starting Warfarin (coumadin) therapy?

A

Lovenox is the bridge

67
Q

What do you need to monitor when giving Warfarin (Coumadin)?

A

INR

68
Q

Lovenox (the bridge) and DOACs have black and white dosing, BUT ______ is diff for each patient

A

Warfarin (coumadin) is highly dependent on pt

69
Q

Variable dosing per person

A

Warfarin (Coumadin)

70
Q

Black and white dosing

A

Lovenox (Enoxaparin)

DOACs

71
Q

Two DOACs used most often

A

Rivaroxaban (Xarelto)

Apixaban (Eliquis)

72
Q

Rivaroxaban

A

Xarelto

73
Q

Apixaban

A

Eliquis

74
Q

Xarelto tx

15 mg PO bidaily x3 weeks

A

then 20 mg PO daily

75
Q

Eliquis tx

10 mg PO bidaily x1 week

A

then 5 mg bidaily

76
Q

PE clinical pearls

A

If pt has PE, very good chance they also have DVT!!!

77
Q

Sudden onset SOB and leg swelling

A

favor PE

other things like fever, cough, crackles, and wheezes DO NOT

78
Q

COPD exacerbation, that is unexplained

what could be causing??

A

make sure it’s not due to an underlying PE!!

79
Q

CXR of someone with PE

A

is NORMAL

80
Q

Wells score

A

PE probability

81
Q

Gold standard for PE diagnosis

A

Angiography,

but we use CT angiography instead of traditional

82
Q

Takes time for _____ to get to therap range

A

Warfarin (coumadin)

83
Q

If pt has underlying CA, what anticoag should we use?

A

Lovenox

or apixiban (eliquis)

84
Q

How long to treat 1st PE/DVT when there was an identifiable risk factor

A

3 months

85
Q

How long to treat 1st PE/DVT when it was idiopathic- dk what caused it

A

3-6 months

86
Q

How long to treat recurring DVT/PE or inherited coagulopathy

A

Indefinitely

87
Q

Tests for Asthma

A

PFT
Peak flow
Methacholine challenge

Clinical Prep (41 decks)

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