HYHO COPD/Angina

Question 1

What is a key difference between dyspnea and tachypnea?

Answer 1

Dyspnea is a “subjective experience” that is a self-reported symptom.

Tachypnea, accessory muscle use, and intercostal retractions are visible signs of increased work of breathing

Question 2

What are common findings on physical exam of a patient with COPD?

Answer 2

• Barrel shaped chest, limited rib motion, and lung expansion w/limited exhalation
• Generalized hyper-resonance on percussion due to hyperinflation
• Decreased breath sounds, wheezing and prolonged expirations are common in COPD
• Transmitted voice sounds and fremitus are decreased due to hyperinflation

Question 3

What spirometry results may suggest a COPD diagnosis?

Answer 3

FEV1/expected FEV1 is less than 70%

Question 4

If a diagnosis is not reached after two “phases” of testing, what should be done in Phase 3 to obtain a diagnosis?

Answer 4

Consider Cardiopulmonary Exercise Testing (and subspecialty referral)

Question 5

Describe common X-Ray findings you might find on a patient with COPD?

Answer 5

Flattening of the diaphragms and increased AP diameter (best appreciated by increased space between sternum and mediastinum on lateral film)

Question 6

Goals of OMT for COPD

Answer 6

Biomechanical: Improve thoracic cage compliance and skeletal motion

Neurological: Normalize autonomic tone

Resp-Circ: Maximize efficiency of the diaphragm and enhance lymphatic return

Metabolic-Energetic-Immune: enhance self-regulatory and self healing mechanisms

Behavioral: Improve psychosocial components of health

Question 7

Along with medication, what is another important part of the treatment plan?

Answer 7

Patient education. Provide them with written material as well as discussion of diagnosis. Smoking cessation should be addressed at every visit to encourage cessation and continued abstinence.

Question 8

What steps must be taken for the Long-Term Management of COPD

Answer 8

Primary Prevention: Annual flu vaccine, TDAP to protect against Pertussis

Secondary Prevention: Avoidance of other dust and fumes

Tertiary Prevention: Smoking cessation/abstinence. Pulmonary Rehab

Question 9

Lung Chapman’s Points

Answer 9

Anterior: 2nd, 3rd, 4th ICS along sternum

Posterior: Lateral T2 Spinous process, Intertransverse space
between T2-3, T3-4 & T4-5

Question 10

What findings may you see on an ECG done on a patient complaining of angina?

Answer 10

likely normal in the absence of symptoms. However, findings may include changes consistent with previous MI (Q- waves), repolarization abnormalities (ST-segment and T-wave changes), LVH or rhythm abnormalities

Question 11

If confounding features are not present on resting ECG, what is the next step that must be taken when evaluating a patient with IHD?

Answer 11

Perform treadmill exercise test

Question 12

What are contraindications to exercise stress tests?

Answer 12

Rest angina withing 48 hours, unstable rhythm, severe aortic stenosis, acute myocarditis, uncontrolled heart failure, severe pulmonary hypertension, and active infective endocarditis

Question 13

What symptoms may warrant a referral to Cardiology and/or cardiac catheterization?

Answer 13

inability to exercise < 6 minutes

Strong consideration for interventional cardiac catheterization and recanalization of vessels ≥50% occlusion