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PCM 3 Exam 1 > [HYHO] SPE 1 Dyspnea > Flashcards

[HYHO] SPE 1 Dyspnea Flashcards

1
Q

How is dyspnea often reported?

A

Self-reported by the pt

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2
Q

What etiologies account for 85% of cases of SOA?

A

Cardiac and pulmonary

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3
Q

What is the order of physical exam for a thoracic examination?

A

IPPA

Inspect

Palpate

Percuss (ladder pattern)

Auscultate (ladder pattern)

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4
Q

What common special tests can be done when evaluating for COPD? What are the findings for each test?

A

Tactile fremitus (typically decreased)

Transmitted voice sounds (typically decreased)

Rib motion (limited expansion)

Assessment of oropharynx

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5
Q

After history, physical examination, and obtaining a differential diagnosis for dyspnea, what is the next step in making a diagnosis?

A

Walking pulse oximetry

Peak flow assessment

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6
Q

To make a COPD diagnosis, the FEV1/expected FEV1 ratio must be ___

A

Less than or equal to 70%

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7
Q

What is a walking oximetry test?

A

Pt walks with a pulse-oximeter to assess O2 desaturation with activity and to replicate dyspnea

May administer pre and post-bronchodilator to assess effectiveness of treatment

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8
Q

If no dx made with history and PE, what diagnostic data is gathered in phase 1 testing of dyspnea?

A

CXR

spirometry

ECG

CBC, BMP

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9
Q

If no dx is made in phase 1, what diagnostic data is gathered in phase 2 testing of dyspnea?

A 
Chest CT (consider angio for thromboembolic dz)
Lung volume, DLCO, tests of neuromuscular fxn

Echocardiogram, cardiac stress testing

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10
Q

If no information is gathered in phase 2, what diagnostic data is gathered in phase 3 of dyspnea testing?

A

Consider cardiopulmonary exercise testing

Consider subspecialty referral

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11
Q

Why would anemia be considered as an alternative ddx for dyspnea? What test would you obtain to evaluate for anemia?

A

Pulse ox only reads saturated hemoglobin, but pt may have a low hemoglobin level (hypoxic)

Order a CBC

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12
Q

Typical CXR findings for COPD

A

Flattened diaphragm

Increased AP diameter

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13
Q

What are the levels for sympathetic innervation to the heart? Lungs?

A

Heart: T1-6

Lungs: T1-7

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14
Q

What is the parasympathetic innervation to the heart and lungs?

A

Vagus

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15
Q

Anterior Chapman’s points for lungs?

A

2, 3, 4 ICS along sternum

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16
Q

Posterior Chapman’s points for lungs?

A

Lateral T2 SP

intertransverse space b/w:

T2-3

T3-4

T4-5

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17
Q

Goals of OMT COPD (5 models)

A

Biomechanical: Improve thoracic cage compliance, skeletal motion

Neurological: Normalize autonomic tone

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

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

Behavioral: Improve psychosocial components of health

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18
Q

What rescue/short-acting medications are prescribed for COPD?

A

Short acting inhaled bronchodilators:

B-agonists (albuterol)

Anticholinergic muscarinic antagonists (ipratropium); improve FEV1

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19
Q

What long acting medications are prescribed to COPD pts with persistent sx?

A

B agonists (salmeterol)

Anticholinergic musclarinic antagonists (tiotropium) - better for improving sx and reducing exacerbations

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20
Q

When should smoking cessation be addressed in pts with COPD?

A

Every visit

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21
Q

What pharmacologic therapies are provided for pts interested in smoking cessation?

A

Nicotine replacement

Bupropion (SNRI)

Varenicline (nicotinic acid receptor agonist/antagonist)

22
Q

Long term management of COPD: Primary prevention

A

Annual flu vaccine - PCV13/Prevnar followed by PPSV23 the next year

Tdap to protect against Bordatella pertussis

23
Q

Long term management of COPD: Secondary prevention

A

Avoidance of dust and fumes (occupational or hobby exposure)

24
Q

Long term prevention of COPD: Tertiary prevention

A

Smoking cessation/abstinence

Pulmonary rehabilitation (tx program w/ exercise, education, psychosocial and nutritional counseling to improve quality of life and reduce hospitalization)

25
Exacerbation of COPD increase in frequency as FEV1 \_\_\_
\<50% of predicted (massive decrease)
26
50% of COPD exacerbations are due to what? 1/3 to what?
50% due to bacterial infection 1/3 to viral
27
2 main complications of COPD
Progressive hypoxia Respiratory failure
28
In order to prevent respiratory failure during a COPD exacerbation, what measures must be taken?
Support w/ O2 Noninvasive positive-pressure ventilation (bipap) OR intubation and mechanical ventilation
29
What kind of COPD is associated with cachexia, weight loss, bitemporal wasting, and diffuse loss of subcutaneous tissue?
End-Stage COPD
30
Where would you admit a patient with end-stage COPD?
Hospice
31
What symptom will patients with stable angina NOT describe?
Chest pain (But they will have tight, squeezing, heavy, pressure sensations)
32
Where will pts will stable angina usually indicate as the center of their symptoms? Where does it radiate?
Sternum Radiates to neck, jaw, back, ulnar surface of arm (NOT TRAPEZIUS)
33
What sx are anginal "equivalents"?
Dyspnea Nausea Fatigue
34
Unstable angina is a harbinger for progression to what?
ACS
35
Who is CAD more common in?
Men \>50 Women \>60
36
What motions can reproduce chest pain?
Coughing laughing taking a deep breath (anything that causes motion b/w the pleura and the chest)
37
In cardiac examination, where would you auscultate to identify mitral regurgitation? What are you listening for?
Apex and L sternal border Listen for S3, S4 murmurs (*use the Bell)*
38
What supportive finding in physical examination essentially eliminates cardiovascular disease for sx cause?
Reproducible chest pain w/ palpation
39
What do you want to make sure you evaluate in PE for possible stable angina?
Cardiac/Pulmonary evaluation Palpate for PMI Auscultate for carotid bruits Evaluate peripheral pulses Assess for edema
40
Possible indications for stress testing of patient (4)
1. Dx of ischemic heart disease uncertain 2. Assess functional capacity of pt 3. Assess adequacy of tx program for IHD 4. Markedly abnormal calcium score on EBCT
41
What is the next step for a patient with suspected IHD who is able to exercise adequately but has confounding features on EKG?
Imaging study to identify regional ischemia: Echo, nuclear perfusion scan (MIBI), cardiac MRI, Cardiac PET
42
A cardiac stress test may expose what findings?
ST depressions | (and reproduced sx of dyspnea)
43
A stress echocardiogram may expose what findings?
Wall motion abnormalities
44
Overall sensitivity of an exercise stress EKG is what percent? Negative result makes what unlikely?
75% Negative result makes 3 vessel or left main CAD unlikely
45
What are some contraindications to exercise stress test?
*Basically any recent, unstable heart condition* Rest angina w/in 48 hrs Unstable rhythm Severe aortic stenosis Acute myocarditis Uncontrolled heart failure Severe pulmonary HTN Active infective endocarditis
46
What are the anterior/posterior chapman's points for the heart?
Anterior - 2nd ICS along sternal border Posterior: Intertransverse spaces b/w T2-3
47
What drugs are used for short term sx management of stable angina? (3)
**Nitroglycerin** subl-lingual Antiplatelet medication - **ASA** OR **clopidogrel** Medication to dec demand ischemia: BBs (**bisoprolol, metoprolol**) or CCBs (**amlodipine** or **diltiazem**)
48
What sx in stable angina is high risk for coronary events?
Inability to exercise \<6 minutes
49
Long term management of Stable Angina: Secondary prevention
Assess pt for other CV sx Screen for thyroid dysfxn, anemia that increases cardiac workload and recurrence
50
Long term management of Stable Angina: Tertiary prevention
Cardiac Rehab - encourages weight loss, exercise tolerance, control of risk factors Smoking cessation Tx of lipid disorders/other comorbidities
51
3 main complications of Stable Angina
Progression to unstable angina/ACS/MI CVA PVD
52
Why do pts with a cardiac hx who smoke e-cigarettes need cessation counseling?
E-cigarettes can increase frequency of angina episodes

PCM 3 Exam 1 (13 decks)

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