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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
**Sympathetics** for: * Heart * Lungs **Parasympathetics** for: * Heart * Lungs
* **Heart**: T1-6 * **Lungs**: T1-7 * **Parasympathetics**: Vagus N
26
Where are **chapmans points** for the **lungs**?
* Anterior: 2nd, 3rd, 4th ICS along the sternum * Posterior: * **Lateral to the T2 SP** * **Intertransverse space** between * **T2-3** * **T3-4** * **T4-5**
27
What are the goals of the 5 treatment model for a **COPD** patient? * Biochemical * Respiratory/Circulatory * Neuro * Metabolic-Energictic-Immune * Behavioral
* **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
28
How can we manage **acute symptoms of COPD** and what effect do they have on **FEV1**?
* **Short-acting bronchodilator** (**SABA**-albuterol, **SAMA**-ipatropium), which **improve FEV1**
29
How do we manage **persistant symptoms** in COPD? Which is best at improving symptoms and decreasing exacerbations?
* **Long acting bronchodilators** (**LABA**-salmeterol and **LAMA**-tiotropium) * **LAMA** is best
30
SE of **B-agonists** and **anti-cholinergic muscarinic ANT**
* **B-agonists:** tremor or tachycardia * **AMA**: dry mouth
31
What **short-term treatment of COPD** should we provide?
**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
When should doc bring up **smoking cessation?**
At every visit, encourage to stop or encourage abstinence
33
**Cessation of smoking** imrpoves rate of decline in pulmonary dysfunction to \_\_\_\_\_\_\_\_\_.
**similar to that of non-smoking patients**
34
**Cigarrete smoking** causes _______ in FEV1 in a __________ relationship.
**accelerated decline** **dose-response**
35
What forms of therapy can help with **smoking cessation?**
* **Nicotene replacement** * **Bupropian (SNRI)** * **Varenicline (nictotenic acid receptor AGO/ANT)**
36
A **primary intervention** \_\_\_\_\_\_\_\_\_\_\_. Give examples.
Prevents the development of a disease -Handwashing, immunizations
37
A **secondary intervention** \_\_\_\_\_\_\_\_\_\_\_. Give examples.
**Early detection** of a *existing* disease to **reduce the severity and complications** -Cancer screening, lipid screening in pt with HTN, pap smears
38
A **tertiary intervention** \_\_\_\_\_\_\_\_\_\_\_. Give examples.
**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
**Name that type of prevention:** 1. Glucose control in DM 2. Smoking cessation in a healthy person
1. **Tertiary** 2. **Primary** 1. ​bc no evidence of disease assx with smoking
40
**Longterm management** of COPD involves **Primary, secondary and tertiary prevention.** What are examples of each?
* **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
**Progressive hypoxia** is a complication of COPD that requires
supplimental O2
42
**Exacerbations** is a _complication of COPD_ are caused by __________ that increase in frequency as **FEV1** ________ of predicted.
**increased airway inflammation** FEV1 **\<50%**
43
When does **respiratory failure** occur in COPD?
During an exacerbation when a patient **needs support:** O2, bipap, intubation or mechanical ventilation.
44
**End-stage COPD** is associated with \_\_\_\_\_, \_\_\_\_\_, \_\_\_\_\_\_, \_\_\_\_\_\_\_\_. Patients will qualify for \_\_\_\_\_\_\_\_.
1. Cachexia 2. Weight loss 3. Bitemporal wasting 4. Diffuse loss of subcutaneous adipose tissue **Hospice**
45
SOB differentials without CP.
**COPD** **ASthma** **Stable angina**
46
what should go under Plan in SOAP note for SOB?
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
Patient with **stable angina** will indicate the center of synptoms as \_\_\_\_\_\_\_\_\_\_\_\_\_. Descriptions include: Assx symptoms:
* 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
When does **unstable angina** occur? Can progress into what?
**at rest or without provocation.** **ACS**
49
When does **pleuritic chest pain** occur?
**Pleura** and **chest wall rub together** when ***coughing***, **laughing**, taking a d**eep breath.**
50
PE for **stable agina i**ncludes
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
**Early** in the disease process for **stable angina,** the PE will likely be \_\_\_\_\_\_.
**NL**
52
What eliminates **CV** causes for SOB?
**Chest pain** **that occurs with palation** of the chest
53
What findings will we likely see on **ECG** in a patient with IHD?
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
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.
Cardiac stress test (treadmill stress test)
55
**Cardiac stress** will show what in a person that is + for IHD?
1. **ST depressions** during increased cardiac workoad 2. **symptoms of dyspnea** may be reproduced
56
What will a **stress Echo** show in someone who is + for IHD?
**Wall moves weird** during increased workload
57
If the baseline **ECG** is **abrnomal**, what tests do we run?
* **Radionulclide perfusion images**, **CMR stress testing** or **PET scan** to find where ischemia is located.
58
**Tests** to run for **IHD**
* 1. **ECG** * 2**. Cardiac stress test,** _if ECG is NL_ & the _patient can workout properly_ * 3. If ECG is abnormal or patient cannot exercise * Imaging study * **2D echo** * **Nuculear perfusion scan** * **Cardiac MR stress test** * **Cardiac PET scan**
59
Overall sensitivity of **exercise stress ECG** is 75%. A **(-)** test ____ exclude CAD, but it makes what very unlikely
* Does NOT exclude CAD * Makes 3-vessel or left main CAD VERY unlikely
60
What are CI to **excervise stres stest?**
* 1. Rest angina w/i 48 hours. * 2. Unstable rhythm * 3. Aortic stenosis * 4. Acute myocarditis * 5. Active infective endocarditis * 6. Severe pulmonary HTN * 7. Uncontrolled HF *
61
Addtional data to retrieve is centered around what?
the **causes of athersclerosis.** * -Fasting glucose (assess DM) * -Lipid panel * - Electrolytes (assess renal function)
62
**BMP** includes what?
1. **Fasting glucose** 2. **Electrolytes**
63
What are chapmans points of the **heart**?
* **Anterior**: 2nd ICS along the sternal border * **Posterior**: intertransverse space between T2-T3
64
What is the goal of OMT in **stable angina?**
**_OMT IS NOT INDICATED_**
65
**Short-term** treatment of stable angina involves what?
* **Patient education** * Modify life * reduce using alot of NRG early mornings or after meals * lose weight, stop smoking, manange cholesterol * Cardiology referal
66
Inability to exercise for _______ puts patients at **high risk for coronary events**
**Less than 6 minutes**
67
When should **interventional catheterization** and **recanilization** be considered?
**Vessels are 50% or over occluded**
68
What should be used to manage symptoms for stable angina/IHD?
* 1. **Nitroglycerine sublingual** (immediate release ) for **acute angina sx;** takes 1-3 minutes * 2. **Antiplatelet meds** (**ASA** or **clopidogrel** is intolerant or allergic to ASA) * 3. Meds to decrease demand of the \<3 * **B-blockers (metaprolol or bisprolol)** * **Ca2+ channel blockers** (DHP (amlodipine) or non-DHP like diltiazem)
69
What are secondary preventive methods and tertiary preventative methods for ***stable angina?***
* 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
what are complications if **stable angina** is not managed?
* 1. **Unstable angina, ACS/MI** * 2. **CVA** * 3. **PVD**
71
DDx of stable angina
**1. Stable angina** **2. COPD** **3. PArxysmal afib**
72

PCM 3 Test 1 (9 decks)

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