DOB + Flashcards
1
Q
question
A
answer
2
Q
pulmonary etiologies of DOB
A
COPD asthma restrictive lung disorder hereditary lung disorder pneumonia pneumo-thorax
3
Q
cardiac etiologies of DOB
A
CHF Coronary artery disease (CAD) MI cardiomyopathy valvular dysfunction left ventricular hypertrophy pericarditis arrythmias
4
Q
mixed cardiac/pulmonary etiology of DOB
A
chronic pulmonary emboli
pleural effusion
deconditioning
COPD with HTN and/or cor pulmonale
5
Q
noncardiac or nonpulmonary etiology of DOB
A
metabolic disorders pain trauma neuromuscular disorders functional cheminal exposure
6
Q
< 20 yo
asthma
COPD
A
asthma
7
Q
worse during night or early morning
asthma
COPD
A
asthma
8
Q
lung function normal between symptoms
asthma
COPD
A
asthma
9
Q
variable airflow limitation
asthma
COPD
A
asthma
10
Q
CXR normal
asthma
COPD
A
asthma
11
Q
> 40 yo
asthma
COPD
A
COPD
12
Q
daily symptoms and exertional dyspnea
asthma
COPD
A
COPD
13
Q
persistent airflow limitation
asthma
COPD
A
COPD
14
Q
lung function abnormal between symptoms
asthma
COPD
A
COPD
15
Q
CXR shows severe hyperinflation
asthma
COPD
A
COPD
16
Q
possible clinical features of severe asthma
A
tachypnea tachycardia silent chest cyanosis accesssory muscle use altered consciouness
17
Q
Why use PEF for asthma dx
A
more convinient and cheaper than FEV1
18
Q
What SpO2 level do you seek to maintain withoxygen therapy
A
92% O2
19
Q
When is ABG necessary for DOB?
A
patients with SpO2 <92% or features of life threatening asthma
20
Q
Management of asthma accronym
A
ASTHMA
Adrenergics (beta 2 agonists - Albuterol) Streoids Theophylline Hydration (IV) Mask O2 Anticholinergics
21
Q
digital clubbing + DOB
A
COPD
22
Q
pursing of lips + DOB
A
COPD
23
Q
COPD airflow obstruction level
A
FEV1/FVC ratio <0.7 post-bronchodilator
24
Q
What is performed to diagnose COPD
A
spirometry, post-bronchodilator
25
COPD spirometry is performed (pre/post) bronchodilator
post bronchodilator
26
COPD exacerbations mangement
```
O2
bronchodilators (SABA with or without short-acting anticholinergics)
systemic corticosteroids (40 mg prednisone per day for 5 days)
```
27
Type 1 pneumonias (2)
lobar and bronchopneumonia
28
Type 2 pneumonia (2)
CAP and HAP
29
patch consolidation usually in bases of both lungs
what type of pneumonia?
bronchopneumonia
30
What is the point criteria for treatment of penumonia? Acryonym and scoring
CURB 65
```
Confusion
Uremia
Respiratory Rate >30
Blood pressure low
65 yo or greater
```
31
Uses structure for classification
ACCF/AHA stages of HF
NYHA functional
ACCF/AHA stages of HF
32
Cardiogenic shock. Hypotension, peripheral vasoconstriction
Kilip classification Stage I
Stage II
Stage III
Stage IV
Stage IV
33
Severe HF. Frank pulmonary edema with rales
Kilip classification Stage I
Stage II
Stage III
Stage IV
Stage III
34
HF. Rales, S3 gallop and pulmonary venous hypertention
Kilip classification Stage I
Stage II
Stage III
Stage IV
Stage II
35
Acute HF management
SpO2 95-98%
patent airway and FiO2 can be increased
diuretics (secondary to fluid retension)
36
MC cause of dyspnea in AHF
pulmonary edema
37
In AHF, morphine induced the following
venodilation
mild aterial dilation
redude HR
38
In AHF, what is a potential adverse effect?
increasing need for inasive ventilation
39
reduce LV-preload and after-load wo imparing tissue perfusion
nitrates
sodium nitroprusside
nesiritide
inotropes
nitrates
40
hypertensive HF or MR, severe HR with predominantly increased after-load
nitrates
sodium nitroprusside
nesiritide
inotropes
sodium nitroprusside
41
reduce preload and after-load, increase CO wo direct inotropic effects
nitrates
sodium nitroprusside
nesiritide
inotropes
nesiritide
42
Pts with severely reduced cardic output compromised vital organ perfusion
nitrates
sodium nitroprusside
nesiritide
inotropes
inotropes
43
When are vasopressors indicated?
combination inotropic agent and fluid challenge fails to restore adequate arterial pressure and organ perfusion
44
HVS causes (increase/decrease) pCO2 which leads to (metabolic/respiratory) (alkalosis/acidosis)
HVS causes DECREASE pCO2 which leads to RESPIRATORY alkalosis
45
common ddx for HVS
acute coronary syndrome
pulmonary embolism
CO2 poisoning
46
HVS has (abnormal/normal) pH with (high/low) PaCO2 and a (high/low) bicarbonate level
HVS has NORMAL pH with LOW PaCO2 and a LOW bicarbonate level
47
Pharmaco therapies for HVS
benzodiazepines
lorazepam (ativan)
diazepam (valium)
paroxetine (paxil)
48
define tachypnea
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
normal RR for newborn
44 cycles/min
50
normal RR for adult
14 to 18 cycles/min
51
central control
- medulla
oblongata
- chemoreceptors
- medulla
| oblongata
52
peripheral control
- medulla
oblongata
- chemoreceptors
- chemoreceptors
53
where are the chemoreceptors that control breathing peripherally
located near the carotid bodies, and
| mechanoreceptors in the diaphragm and skeletal muscles
54
what causes the perception of dyspnea
imbalance in either central or peripheral control of breathing
55
differential diagnoses for acute dyspnea
- pulmonary
- cardiac
- abdominal
- psychogenic
- metabolic or endocrine
- infectious
- traumatic
- hematalogic
- neuromuscular
56
acute dyspnea associated with normal or increased respiratory effort
- abdominal
- psychogenic
- metabolic or endocrine
- infectious
- traumatic
- hematalogic
57
neuromuscular etiology is primarily associated with (increased/decreased) respiratory effort
neuromuscular etiology is primarily associated with DECREASED respiratory effort
58
most common causes of dyspnea in ER (5)
1. obstructive airway disease (asthma, COPD)
2. decompensated heart failure
3. ischemic heart disease
4. pneumonia
5. psychogenic
59
most immediately life-threatening causes of dyspnea in ER (5)
1. upper airway obstruction
2. tension pneumothorax
3. pulmonary embolism
4. neuromuscular weakness
5. fat embolism
