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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
Q

Exacerbation of COPD increase in frequency as FEV1 ___

A

<50% of predicted (massive decrease)

26
Q

50% of COPD exacerbations are due to what? 1/3 to what?

A

50% due to bacterial infection

1/3 to viral

27
Q

2 main complications of COPD

A

Progressive hypoxia

Respiratory failure

28
Q

In order to prevent respiratory failure during a COPD exacerbation, what measures must be taken?

A

Support w/ O2

Noninvasive positive-pressure ventilation (bipap) OR intubation and mechanical ventilation

29
Q

What kind of COPD is associated with cachexia, weight loss, bitemporal wasting, and diffuse loss of subcutaneous tissue?

A

End-Stage COPD

30
Q

Where would you admit a patient with end-stage COPD?

A

Hospice

31
Q

What symptom will patients with stable angina NOT describe?

A

Chest pain

(But they will have tight, squeezing, heavy, pressure sensations)

32
Q

Where will pts will stable angina usually indicate as the center of their symptoms? Where does it radiate?

A

Sternum

Radiates to neck, jaw, back, ulnar surface of arm (NOT TRAPEZIUS)

33
Q

What sx are anginal “equivalents”?

A

Dyspnea

Nausea

Fatigue

34
Q

Unstable angina is a harbinger for progression to what?

A

ACS

35
Q

Who is CAD more common in?

A

Men >50

Women >60

36
Q

What motions can reproduce chest pain?

A

Coughing

laughing

taking a deep breath

(anything that causes motion b/w the pleura and the chest)

37
Q

In cardiac examination, where would you auscultate to identify mitral regurgitation? What are you listening for?

A

Apex and L sternal border

Listen for S3, S4 murmurs (use the Bell)

38
Q

What supportive finding in physical examination essentially eliminates cardiovascular disease for sx cause?

A

Reproducible chest pain w/ palpation

39
Q

What do you want to make sure you evaluate in PE for possible stable angina?

A

Cardiac/Pulmonary evaluation

Palpate for PMI

Auscultate for carotid bruits

Evaluate peripheral pulses

Assess for edema

40
Q

Possible indications for stress testing of patient (4)

A
  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
Q

What is the next step for a patient with suspected IHD who is able to exercise adequately but has confounding features on EKG?

A

Imaging study to identify regional ischemia:

Echo, nuclear perfusion scan (MIBI), cardiac MRI, Cardiac PET

42
Q

A cardiac stress test may expose what findings?

A

ST depressions

(and reproduced sx of dyspnea)

43
Q

A stress echocardiogram may expose what findings?

A

Wall motion abnormalities

44
Q

Overall sensitivity of an exercise stress EKG is what percent? Negative result makes what unlikely?

A

75%

Negative result makes 3 vessel or left main CAD unlikely

45
Q

What are some contraindications to exercise stress test?

A

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
Q

What are the anterior/posterior chapman’s points for the heart?

A

Anterior - 2nd ICS along sternal border

Posterior: Intertransverse spaces b/w T2-3

47
Q

What drugs are used for short term sx management of stable angina? (3)

A

Nitroglycerin subl-lingual

Antiplatelet medication - ASA OR clopidogrel

Medication to dec demand ischemia: BBs (bisoprolol, metoprolol) or CCBs (amlodipine or diltiazem)

48
Q

What sx in stable angina is high risk for coronary events?

A

Inability to exercise <6 minutes

49
Q

Long term management of Stable Angina: Secondary prevention

A

Assess pt for other CV sx

Screen for thyroid dysfxn, anemia that increases cardiac workload and recurrence

50
Q

Long term management of Stable Angina: Tertiary prevention

A

Cardiac Rehab - encourages weight loss, exercise tolerance, control of risk factors

Smoking cessation

Tx of lipid disorders/other comorbidities

51
Q

3 main complications of Stable Angina

A

Progression to unstable angina/ACS/MI

CVA

PVD

52
Q

Why do pts with a cardiac hx who smoke e-cigarettes need cessation counseling?

A

E-cigarettes can increase frequency of angina episodes

PCM 3 Exam 1 (13 decks)

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