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E Med > DOB + > Flashcards

DOB + Flashcards

1
Q

question

A

answer

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2
Q

pulmonary etiologies of DOB

A 
COPD
asthma
restrictive lung disorder
hereditary lung disorder
pneumonia
pneumo-thorax
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3
Q

cardiac etiologies of DOB

A 
CHF
Coronary artery disease (CAD)
MI
cardiomyopathy
valvular dysfunction
left ventricular hypertrophy
pericarditis
arrythmias
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4
Q

mixed cardiac/pulmonary etiology of DOB

A

chronic pulmonary emboli
pleural effusion
deconditioning
COPD with HTN and/or cor pulmonale

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5
Q

noncardiac or nonpulmonary etiology of DOB

A 
metabolic disorders
pain
trauma
neuromuscular disorders
functional
cheminal exposure
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6
Q

< 20 yo

asthma
COPD

A

asthma

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7
Q

worse during night or early morning

asthma
COPD

A

asthma

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8
Q

lung function normal between symptoms

asthma
COPD

A

asthma

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9
Q

variable airflow limitation

asthma
COPD

A

asthma

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10
Q

CXR normal

asthma
COPD

A

asthma

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11
Q

> 40 yo

asthma
COPD

A

COPD

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12
Q

daily symptoms and exertional dyspnea

asthma
COPD

A

COPD

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13
Q

persistent airflow limitation

asthma
COPD

A

COPD

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14
Q

lung function abnormal between symptoms

asthma
COPD

A

COPD

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15
Q

CXR shows severe hyperinflation

asthma
COPD

A

COPD

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16
Q

possible clinical features of severe asthma

A 
tachypnea
tachycardia
silent chest
cyanosis
accesssory muscle use
altered consciouness
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17
Q

Why use PEF for asthma dx

A

more convinient and cheaper than FEV1

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18
Q

What SpO2 level do you seek to maintain withoxygen therapy

A

92% O2

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19
Q

When is ABG necessary for DOB?

A

patients with SpO2 <92% or features of life threatening asthma

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20
Q

Management of asthma accronym

A

ASTHMA

Adrenergics (beta 2 agonists - Albuterol)
Streoids
Theophylline
Hydration (IV)
Mask O2
Anticholinergics
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21
Q

digital clubbing + DOB

A

COPD

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22
Q

pursing of lips + DOB

A

COPD

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23
Q

COPD airflow obstruction level

A

FEV1/FVC ratio <0.7 post-bronchodilator

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24
Q

What is performed to diagnose COPD

A

spirometry, post-bronchodilator

25
Q

COPD spirometry is performed (pre/post) bronchodilator

A

post bronchodilator

26
Q

COPD exacerbations mangement

A 
O2
bronchodilators (SABA with or without short-acting anticholinergics)
systemic corticosteroids (40 mg prednisone per day for 5 days)
27
Q

Type 1 pneumonias (2)

A

lobar and bronchopneumonia

28
Q

Type 2 pneumonia (2)

A

CAP and HAP

29
Q

patch consolidation usually in bases of both lungs

what type of pneumonia?

A

bronchopneumonia

30
Q

What is the point criteria for treatment of penumonia? Acryonym and scoring

A

CURB 65

Confusion
Uremia
Respiratory Rate >30
Blood pressure low
65 yo or greater
31
Q

Uses structure for classification

ACCF/AHA stages of HF
NYHA functional

A

ACCF/AHA stages of HF

32
Q

Cardiogenic shock. Hypotension, peripheral vasoconstriction

Kilip classification Stage I
Stage II
Stage III
Stage IV

A

Stage IV

33
Q

Severe HF. Frank pulmonary edema with rales

Kilip classification Stage I
Stage II
Stage III
Stage IV

A

Stage III

34
Q

HF. Rales, S3 gallop and pulmonary venous hypertention

Kilip classification Stage I
Stage II
Stage III
Stage IV

A

Stage II

35
Q

Acute HF management

A

SpO2 95-98%
patent airway and FiO2 can be increased
diuretics (secondary to fluid retension)

36
Q

MC cause of dyspnea in AHF

A

pulmonary edema

37
Q

In AHF, morphine induced the following

A

venodilation
mild aterial dilation
redude HR

38
Q

In AHF, what is a potential adverse effect?

A

increasing need for inasive ventilation

39
Q

reduce LV-preload and after-load wo imparing tissue perfusion

nitrates
sodium nitroprusside
nesiritide
inotropes

A

nitrates

40
Q

hypertensive HF or MR, severe HR with predominantly increased after-load

nitrates
sodium nitroprusside
nesiritide
inotropes

A

sodium nitroprusside

41
Q

reduce preload and after-load, increase CO wo direct inotropic effects

nitrates
sodium nitroprusside
nesiritide
inotropes

A

nesiritide

42
Q

Pts with severely reduced cardic output compromised vital organ perfusion

nitrates
sodium nitroprusside
nesiritide
inotropes

A

inotropes

43
Q

When are vasopressors indicated?

A

combination inotropic agent and fluid challenge fails to restore adequate arterial pressure and organ perfusion

44
Q

HVS causes (increase/decrease) pCO2 which leads to (metabolic/respiratory) (alkalosis/acidosis)

A

HVS causes DECREASE pCO2 which leads to RESPIRATORY alkalosis

45
Q

common ddx for HVS

A

acute coronary syndrome
pulmonary embolism
CO2 poisoning

46
Q

HVS has (abnormal/normal) pH with (high/low) PaCO2 and a (high/low) bicarbonate level

A

HVS has NORMAL pH with LOW PaCO2 and a LOW bicarbonate level

47
Q

Pharmaco therapies for HVS

A

benzodiazepines
lorazepam (ativan)
diazepam (valium)
paroxetine (paxil)

48
Q

define tachypnea

A

A respiratory rate greater than
normal.

Normal rates range from 44 cycles/min
in a newborn to 14 to 18 cycles/min in adults

49
Q

normal RR for newborn

A

44 cycles/min

50
Q

normal RR for adult

A

14 to 18 cycles/min

51
Q

central control

  • medulla
    oblongata
  • chemoreceptors
A
  • medulla

oblongata

52
Q

peripheral control

  • medulla
    oblongata
  • chemoreceptors
A
  • chemoreceptors
53
Q

where are the chemoreceptors that control breathing peripherally

A

located near the carotid bodies, and

mechanoreceptors in the diaphragm and skeletal muscles

54
Q

what causes the perception of dyspnea

A

imbalance in either central or peripheral control of breathing

55
Q

differential diagnoses for acute dyspnea

A
  • pulmonary
  • cardiac
  • abdominal
  • psychogenic
  • metabolic or endocrine
  • infectious
  • traumatic
  • hematalogic
  • neuromuscular
56
Q

acute dyspnea associated with normal or increased respiratory effort

A
  • abdominal
  • psychogenic
  • metabolic or endocrine
  • infectious
  • traumatic
  • hematalogic
57
Q

neuromuscular etiology is primarily associated with (increased/decreased) respiratory effort

A

neuromuscular etiology is primarily associated with DECREASED respiratory effort

58
Q

most common causes of dyspnea in ER (5)

A
  1. obstructive airway disease (asthma, COPD)
  2. decompensated heart failure
  3. ischemic heart disease
  4. pneumonia
  5. psychogenic
59
Q

most immediately life-threatening causes of dyspnea in ER (5)

A
  1. upper airway obstruction
  2. tension pneumothorax
  3. pulmonary embolism
  4. neuromuscular weakness
  5. fat embolism

E Med (13 decks)

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