High Yield Handout Dyspnea

Question 1

ATS definition of dyspnea

Answer 1

subjective experience of breathing discomfort that consists of quantitatively distinct sensations that vary in intensity.

Question 2

Dyspnea is

Answer 2

a self reported symptom

Question 3

Tachypnea is

Answer 3

a sign that is characterized by accessory uscle use and intercostal retractions due to the increased work of breathing

Question 4

85% of SoB is caused by

Answer 4

cardiac and pulmonary

Question 5

COPD

Answer 5

strongly associated with smoking, occupational lung disease, or medication.

Progressive symptoms over a long period of time leading to the feeling that one is unable to take a breath

Question 6

stable angina

Answer 6

typically described as heavy, squeezing, pressure, tightness or choking but rarely as pain

angina equivalents include dyspnea, nausea, and fatigue

typically relieved with rest in 1-5 minutes

Question 7

compare side to side in lung exam in a what pattern?

Answer 7

ladder

Question 8

when listening to the lungs patient should breathe

Answer 8

with mouth open

Question 9

common findings with COPD

Answer 9

barrel chest
limited rib motion
percussion yielding generalized hyperresonance
decreased breath sounds

Question 10

rib motion is what for pulmonary complaints

Answer 10

a ‘special test’

Question 11

1st step of dyspnea diagnostics

Answer 11

walking oximetry

peak flow assessment

Question 12

2nd step of dyspnea diagnostics ‘phase 1’

Answer 12

chest x-ray
spirometry
EKG
CBC/BMP

Question 13

3rd step of dyspnea diagnostics ‘phase 2’

Answer 13

Chest CT
Lung volumes/DLCO/tests
Echocardiogram
Cardiac stress Test

Question 14

4th step of dyspnea diagnostic ‘phase 3’

Answer 14

consider cardiopulmonary exercise testing (and referral)

Question 15

COPD diagnostic requirement

Answer 15

FEV/eFEV <70%

Question 16

Typical X-ray findings of COPD

Answer 16

flattening of the diaphragm

increased AP diameter

Question 17

sympathetic to heart

Answer 17

T1-6

Question 18

sympathetic to lungs

Answer 18

T1-7

Question 19

parasympathetic to heart and lungs

Answer 19

vagus

Question 20

lungs chapmans’ points

Answer 20

anterior 2, 3, 4 ICS along sternum

posterior lateral T2 spinous process
intertransverse space between T2-3, T3-4, and T4-5

Question 21

Beta Agonist side effects

Answer 21

tremor

tachycardia

Question 22

anticholinergic muscarinic antagonist side effcts

Answer 22

dry mouth

Question 23

biomechanical OMT COPD goals

Answer 23

improve thoracic cage compliance and skeletal motion

Question 24

neurological OMT COPD goals

Answer 24

normalize autonomic tone

Question 25

resp-circ OMT COPD goals

Answer 25

maximize efficiency of the diaphragm and enhance lymphatic tone

Question 26

metabolic-energetic-immune OMT COPD goals

Answer 26

enhance self-regulatory and self-healing mechanisms

Question 27

behavioural OMT COPD goals

Answer 27

improve psychosocial components of health

Question 28

Complications of COPD

Answer 28

progressive hypoxia Eaxerbations Respiratory Failure

Question 29

progressive hypoxia complication of COPD

Answer 29

requires oxygen supplementation

Question 30

exacerbations of COPD

Answer 30

increased in frequency as FEV1<50% of predicted driven by airway inflammation and >50% are related to bacterial infection 1/3 to viral

Question 31

repiratory failure of COPD

Answer 31

during exacerbation, patients may need support with oxygen BIPAP or intubation with mechanical ventilation may be required

Question 32

Primary prevention of COPD

Answer 32

annual flu vaccine pneumococcal vaccine followed by pneumovax 1 year later TDAP to protect against bordetella pertussis

Question 33

Seconday prevention of COPD

Answer 33

avoidance of other dust and fumes

Question 34

tertiary prevention of COPD

Answer 34

Smoking Cessation/abstinence. Pulmonary Rehab is a comprehensive treatment program that incorporates exercise, education, psychosocial and nutritional counseling. Proven to improve health-related quality of life, dyspnea and exercise capacity as well as reduce rates of hospitalization.

Question 35

Will a patient express the sensation of pain with stable angina

Answer 35

no, discomfort including tight, squeezing, heavy, pressure, etc but NO pain

Question 36

anginal equivalents

Answer 36

dyspnea nausea fatigue

Question 37

CAD in men

Answer 37

>50

Question 38

CAD in women

Answer 38

>60

Question 39

physical examination for stable angina

Answer 39

Pulomary evaluation ascultation over all 4 cardiac listening posts. palpate for PMI auscultate for carotid bruits peripheral pulses assess for edema

Question 40

stable angina in stress echo

Answer 40

wall motion abnormalities

Question 41

cardiac stress test in stable angina

Answer 41

ST depressions identified during increased cardiac workload may cause dyspnea

Question 42

with stable angina who is at high risk for coronary events

Answer 42

inability to exercise <6min

Question 43

secondary prevention for stable angina

Answer 43

asses pt for other CV symptoms (claudication for example) screening for thyroid dysfunction, anemia, that can increase cardiac workload and cause symptoms to reoccur

Question 44

tertiary prevention for stable angina

Answer 44

cardiac rehab smoking cessation/abstinence treatment of lipid disorders and other comorbidities that increase risk of atherosclerosis or increase cardiac workload, such as anemia and thyroid dysfunction