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PCM 3 Test 1 > HYHO SPE3-1 > Flashcards

HYHO SPE3-1 Flashcards

1
Q

What is dyspnea?

A

A self-reported symptom of breathing discomfort that consists of qualitatively distinct senstaions that vary in intensity”

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2
Q

What are visible signs of increased work of breahting that can be ID’d and reported by doctors?

A
  1. Tachypnea
  2. Use of accessory muscles
  3. Intercostal retractions
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3
Q

What are causes of dyspnea?

What accounts for 85% of SOB?

A

1. CV

2. Pulmonary

3. Other: anemia or psychiatric

85% of SOB is due to: cardiac and pulmonary

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4
Q

What can help us determine what system is the CAUSE of SOB?

A

Effective history taking

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5
Q

What characteristics of dyspnea should be considered?

A

1. Acute or chronic

2. Pleuritic or non-pleuritic

3. Agg/Allev factors

4. Risk factors

ROS

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6
Q

What are risk factors for dyspnea?

A
  1. tobacco
  2. HTN/CV dz
  3. DM
  4. FH
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7
Q

COPD has a strong association with what 3 things?

How do symptoms progress and what do patients most often report?

A
  1. Smoking
  2. Occupational lung disease
  3. Medications
    • Sxs are progressive
  • - Cannot take a deep breath
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8
Q

What can indicate stable angina as the cause of dyspnea?

A

sqeezing, pressure, tightness or choking, but rarely ever pain that typically increases with activity by relieved by rest within 1-5 minutes.

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9
Q

What risk factor is associated with stable angina?

A

coronary athersclerosis

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10
Q

Common findings of COPD include (3)

A
  1. Lungs are expanded and exhalation is limited
  2. Barrel shaped chest
  3. Limited rib motion (bc lungs are hyperinflated)
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11
Q

How do we examine a patient with COPD, in order.

A
  • 1. Inspection
  • 2. Palpation
    • tenderness and see if lungs are expanded
    1. Percussion
      * side to side like a ladder
  • 4. Ausculation
    • 2 anterior/4 posterior in a ladder like pattern with mouth open to decrease sounds of upper airway
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12
Q

What special tests can you perform on a patient complaining of SOB?

A
  • 1. Tactile fremitis
  • 2. Transmitted voice sounds
  • 3. Rib motion (for pulmonary complaints)
  • 4. Assess upper airway, like oropharynx
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13
Q

What findings will you find on a person with suspected COPD upon

  • - percussion
  • - asucultation
  • - transmitted voice sounds
  • - tactile fremitis
A
  • Percussion: generalize hyperressonance bc hyperinflation
  • Ascultation: decreased breath sounds, wheezing and prolonged expirations
  • Transmitted voice sounds and tactile fremitis are decreased d/t hyperinflated lungs.
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14
Q

A patient comes in with dyspnea, after a history and physical a __________and ____________ should be performed in a patient suspected of COPD/SOB.

A
  • Walking oximetry, to assess O2 desaturation with activity and try to cause dyspnea
  • Peak flow assessment, which will be reduced in COPD
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15
Q
  • Diagnosis obtained through walking oximetry and PFA => _______
  • No Dx obtained =>
A
  • Treat
  • Further testing (phase 1):
    • CXR
    • Spirometry
    • ECG
    • CBC, BMP
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16
Q

Diagnosis obtained through phase 1 => _______

No Dx obtained =>

A
  • Treat
  • No Dx obtained=> phase 2
    • Chest CT (maybe angiography to see if thromboembolism)
    • Lung volumes, DLCO and neuromuscular function test
    • Echo and cardiac stress test
      *
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17
Q
  • Diagnosis obtained through phase 2 => _______
  • No Dx obtained =>
A
  • Treat
  • No Dx: further testing “phase 3”
    • Cardiopulmonary exercise testing
    • refer to subspecialist
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18
Q

After a patient has done walking-oximetry, repeat auscultation may show ________.

A

expiratory wheezing that wasnt there at rest

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19
Q

Peak flow assessment is ____ in COPD

COPD is diagnosed when ________.

A
  • Reduced
  • FEV1/expected FEV1 is less than or equal to 70%
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20
Q

Peak flow assessment assess the effectiveness of a treatment using what method?

A

Conduct pre and post- bronchodilator

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21
Q

A patient is has low Hb (8mg/dL), but the pulse ox reads 95% (NL), the patient is ______.

A

Anemic, because Pulse ox measures saturated Hb.

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22
Q

What findings are seen in an anemic patient?

A
  • 1. Generalized pallor
  • 2. Conjunctival pallor
  • 3. Bounding pulses
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23
Q

Because anemia can cause SOB, what lab can we run to indicate anemia?

A

CBC

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24
Q

What will we find on CXR in a patient with COPD?

A
    1. Increased AP diameter, best seen as increased spaced between sternum and mediastinum on lateral film)
    1. Flat diaphragms
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25
Q

Sympathetics for:

  • Heart
  • Lungs

Parasympathetics for:

  • Heart
  • Lungs
A
  • Heart: T1-6
  • Lungs: T1-7
  • Parasympathetics: Vagus N
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26
Q

Where are chapmans points for the lungs?

A
  • Anterior: 2nd, 3rd, 4th ICS along the sternum
  • Posterior:
    • Lateral to the T2 SP
    • Intertransverse space between
      • T2-3
      • T3-4
      • T4-5
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27
Q

What are the goals of the 5 treatment model for a COPD patient?

  • Biochemical
  • Respiratory/Circulatory
  • Neuro
  • Metabolic-Energictic-Immune
  • Behavioral
A
  • Biochemical
    • improve compliance of thoracic cage and skeletal motion
  • Respiratory/Circulatory
    • increase efficiency of diaphram and increase lymphatic return
  • Neuro
    • normalize autonomic tone
  • Metabolic-Energictic-Immune
    • enhance self-regulatory and self-healing mechanism
  • Behavioral
    • improve psychosocial components of health
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28
Q

How can we manage acute symptoms of COPD and what effect do they have on FEV1?

A
  • Short-acting bronchodilator (SABA-albuterol, SAMA-ipatropium), which improve FEV1
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29
Q

How do we manage persistant symptoms in COPD?

Which is best at improving symptoms and decreasing exacerbations?

A
  • Long acting bronchodilators (LABA-salmeterol and LAMA-tiotropium)
  • LAMA is best
30
Q

SE of B-agonists and anti-cholinergic muscarinic ANT

A
  • B-agonists: tremor or tachycardia
  • AMA: dry mouth
31
Q

What short-term treatment of COPD should we provide?

A

1. Patient education (verbal and written)

    • stop/avoid smoking
    • ID triggers
    • use inhallors
    • SE of meds
  • -OMT
    • when to seek medical atn
  • -Pulmonary referral if refractory case or complicated
32
Q

When should doc bring up smoking cessation?

A

At every visit, encourage to stop or encourage abstinence

33
Q

Cessation of smoking imrpoves rate of decline in pulmonary dysfunction to _________.

A

similar to that of non-smoking patients

34
Q

Cigarrete smoking causes _______ in FEV1 in a __________ relationship.

A

accelerated decline

dose-response

35
Q

What forms of therapy can help with smoking cessation?

A
  • Nicotene replacement
  • Bupropian (SNRI)
  • Varenicline (nictotenic acid receptor AGO/ANT)
36
Q

A primary intervention ___________.

Give examples.

A

Prevents the development of a disease

-Handwashing, immunizations

37
Q

A secondary intervention ___________.

Give examples.

A

Early detection of a existing disease to reduce the severity and complications

-Cancer screening, lipid screening in pt with HTN, pap smears

38
Q

A tertiary intervention ___________.

Give examples.

A

reduces the impact of the disease (morbidity and mortality)

  1. -rehab for MI,
  2. lipid management,
  3. smoking cessation in a patient with COPD
39
Q

Name that type of prevention:

  1. Glucose control in DM
  2. Smoking cessation in a healthy person
A
  1. Tertiary
  2. Primary
    1. ​bc no evidence of disease assx with smoking
40
Q

Longterm management of COPD involves

Primary, secondary and tertiary prevention.

What are examples of each?

A
  • Primary prevention:
    • Flu vaccine,
    • pneummonia vaccine (PCV13-prevnar, then 1 year later, PPSV23-pneumovax 1)
    • Tdap vaccine
  • Secondary
    • early detection of disease to reduce severity and complication
  • Tertiary
    • Smoking cessation/abstinance
    • Pulmonary rehab
41
Q

Progressive hypoxia is a complication of COPD that requires

A

supplimental O2

42
Q

Exacerbations is a complication of COPD are caused by __________ that increase in frequency as FEV1 ________ of predicted.

A

increased airway inflammation

FEV1 <50%

43
Q

When does respiratory failure occur in COPD?

A

During an exacerbation when a patient needs support: O2, bipap, intubation or mechanical ventilation.

44
Q

End-stage COPD is associated with _____, _____, ______, ________.

Patients will qualify for ________.

A
  1. Cachexia
  2. Weight loss
  3. Bitemporal wasting
  4. Diffuse loss of subcutaneous adipose tissue

Hospice

45
Q

SOB differentials without CP.

A

COPD

ASthma

Stable angina

46
Q

what should go under Plan in SOAP note for SOB?

A
  1. Albuteraol adminstered, well tolerated
  2. OMT performed: thoracic inlet, rib raisng
  3. talked about smoking cessation,
  4. Albuteraol MDI prescribed and instructed to correct use
  5. Labs today: CBC, BMP
47
Q

Patient with stable angina will indicate the center of synptoms as _____________.

Descriptions include:

Assx symptoms:

A
  • Fist over sternum
  • Tight, squeezing, heavy pressure but NO pain.
  • Pain DOES occur in the neck, jaw, shoulder, ulnar surface of arm but NOT trapeziums
  • Occurs with activity, but resolves at rest.
  • Dyspnea, nasuea and fatigue
48
Q

When does unstable angina occur?

Can progress into what?

A

at rest or without provocation.

ACS

49
Q

When does pleuritic chest pain occur?

A

Pleura and chest wall rub together when coughing, laughing, taking a deep breath.

50
Q

PE for stable agina includes

A
  1. Pumonary eval
  2. Cardiac eval
  • Ascultate:
    • listen to all 4 posts
    • Listen for S3/S4 murmur or mitral regurg at the apex and L sternal border by having patient lay LEFT lateral recumbant
    • Carotic bruits
  • Palpate
    • PMI
  • Look for peripheral pulses and edema
51
Q

Early in the disease process for stable angina, the PE will likely be ______.

A

NL

52
Q

What eliminates CV causes for SOB?

A

Chest pain that occurs with palation of the chest

53
Q

What findings will we likely see on ECG in a patient with IHD?

A
  1. If no symptoms, NL
  2. If sxs,
    1. changes that are consistent with previous MI (Q waves)
    2. Repolarization abnormalities (ST segment and T-wave changes)
    3. LVG and rhythm abnormalties
      1.
54
Q

When evaluating a patient with suspected ischemic heart disease, a ___________ should be performed if there aren’t already ECG changes indentified and the patient can excercise.

A

Cardiac stress test (treadmill stress test)

55
Q

Cardiac stress will show what in a person that is + for IHD?

A
  1. ST depressions during increased cardiac workoad
  2. symptoms of dyspnea may be reproduced
56
Q

What will a stress Echo show in someone who is + for IHD?

A

Wall moves weird during increased workload

57
Q

If the baseline ECG is abrnomal, what tests do we run?

A
  • Radionulclide perfusion images, CMR stress testing or PET scan to find where ischemia is located.
58
Q

Tests to run for IHD

A
    1. ECG
  • 2. Cardiac stress test, if ECG is NL & the patient can workout properly
    1. If ECG is abnormal or patient cannot exercise
      * Imaging study
      • 2D echo
      • Nuculear perfusion scan
      • Cardiac MR stress test
      • Cardiac PET scan
59
Q

Overall sensitivity of exercise stress ECG is 75%.

A (-) test ____ exclude CAD, but it makes what very unlikely

A
  • Does NOT exclude CAD
  • Makes 3-vessel or left main CAD VERY unlikely
60
Q

What are CI to excervise stres stest?

A
    1. Rest angina w/i 48 hours.
    1. Unstable rhythm
    1. Aortic stenosis
    1. Acute myocarditis
    1. Active infective endocarditis
    1. Severe pulmonary HTN
    1. Uncontrolled HF
      *
61
Q

Addtional data to retrieve is centered around what?

A

the causes of athersclerosis.

  • -Fasting glucose (assess DM)
  • -Lipid panel
    • Electrolytes (assess renal function)
62
Q

BMP includes what?

A
  1. Fasting glucose
  2. Electrolytes
63
Q

What are chapmans points of the heart?

A
  • Anterior: 2nd ICS along the sternal border
  • Posterior: intertransverse space between T2-T3
64
Q

What is the goal of OMT in stable angina?

A

OMT IS NOT INDICATED

65
Q

Short-term treatment of stable angina involves what?

A
  • Patient education
    • Modify life
      • reduce using alot of NRG early mornings or after meals
      • lose weight, stop smoking, manange cholesterol
      • Cardiology referal
66
Q

Inability to exercise for _______ puts patients at high risk for coronary events

A

Less than 6 minutes

67
Q

When should interventional catheterization and recanilization be considered?

A

Vessels are 50% or over occluded

68
Q

What should be used to manage symptoms for stable angina/IHD?

A
    1. Nitroglycerine sublingual (immediate release ) for acute angina sx; takes 1-3 minutes
    1. Antiplatelet meds (ASA or clopidogrel is intolerant or allergic to ASA)
    1. Meds to decrease demand of the <3
      * B-blockers (metaprolol or bisprolol)
      * Ca2+ channel blockers (DHP (amlodipine) or non-DHP like diltiazem)
69
Q

What are secondary preventive methods and tertiary preventative methods for stable angina?

A
  • 2
    • assess for other CV problems
    • Screen for thyroid dysfunction or anemia, which increase cardiac workload and cause sx to reoccur
  • 3
    • cardiac rehab (loose weight, increase exercise tolerance and control risk factors)
    • stop smoking
    • treat lipid disorders, etc that increase risk of athersclerosis or increased cardiac workload
70
Q

what are complications if stable angina is not managed?

A
    1. Unstable angina, ACS/MI
    1. CVA
    1. PVD
71
Q

DDx of stable angina

A

1. Stable angina

2. COPD

3. PArxysmal afib

72
Q
A

PCM 3 Test 1 (9 decks)

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