PBL Case Flashcards
What are the characteristic symptoms of asthma?
-Wheezing
-Dyspnea
-Coughing
(these are variable both spontaneously and with therapy)
When might symptoms be worse for asthma patients?
At night - patients typically awake in the early morning hours.
What might some patients with asthma report?
- Difficulty filling their lungs with air
- Increased mucous production –> with tenacious mucus that is difficult to expectorate
- Increased ventilation and use of accessory muscles of ventilation
What are prodromal symptoms of asthma?
- Itching under the chin
- Discomfort between the scapulae
- Inexplicable fear (impending doom).
What are typical physical signs of asthma?
- Physical signs are inspiratory and to a GREATER EXTENT EXPIRATORY
- Rhonchi throughout the chest
- May be hyperinflation of the chest
When asthma is under control, what might the physical findings be?
There may be no abnormal physical findings!
What do some patients (particularly children) present with?
Predominant nonproductive cough (cough-variant asthma)
What does DVT present with?
Unilateral lower extremity swelling
What are risk factors for DVT?
- Hospitalization with confinement to bed for > 3 days
- Surgery or general anesthesia in last 3 months
- Trauma in last 3 months
- Pregnancy/recent childbirth
- Oral contraceptives (estrogen)
- Travel for more than 4 hours.
What does Pulmonary Embolism (PE) present with?
Sudden onset chest pain that is worse with inspiration, dyspnea, SOB, tachycardia.
What are the risk factors for PE?
Same at DVT:
- Hospitalization with confinement to bed for > 3 days
- Surgery or general anesthesia in last 3 months
- Trauma in last 3 months
- Pregnancy/recent childbirth
- Oral contraceptives (estrogen)
- Travel for more than 4 hours.
What does PERC rule stand for?
Pulmonary Embolism Rule-out Criteria
-It’s a “rule-out” tool and ALL variables must receive a ‘no’ to be negative
What are the criteria associated with the PERC rule?
Questions:
- Age > 50?
- HR > 100?
- O2 stat on room air
What is the pretest probability of PE if PERC rule out criteria was all answered “NO”?
What is the sensitivity and specificity of the PERC Rule-out criteria?
Sensitivity - 97%
Specificity - 23%
What is the MOST COMMON EKG finding with PE?
Sinus tachycardia
What is classically seen in EKG for 10% of PE patients?
-S1Q3T3 pattern of ACUTE COR PULMONALE
What is the McGinn-White sign?
S1Q3T3
- Large S wave in lead 1
- Q wave in lead III
- Inverted T wave in lead III
What does a large S wave in lead I signify?
Complete or incomplete RBBB
What does a Q wave in lead III signify?
Due to pressure and volume overload over right ventricle which causes repolarization abnormalities