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CPR 2 Exam 2 > Pulmonary Approach To Dyspnea, Palpitations, And Fatigue - Dr. Pence > Flashcards

Pulmonary Approach To Dyspnea, Palpitations, And Fatigue - Dr. Pence Flashcards

1
Q

Vital signs showing respiratory distress

A

RR > 20/min
Tachypnea

O2 < 95%

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2
Q

What can be both restrictive and obstructive

A

Bacterial and viral pneumonia

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3
Q

Pulmonary HTN dx

A

Mean pulmonary artery pressure (mPAP) >20mmHg

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4
Q

Pulmonary HTN can cause what

A

Cor pulmonae (RIGTH HF)
= JVD
= bilateral lower leg edema

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5
Q

5 groups that can get pulmonary HTN

A
  1. Pulmonary Artery HTN : CT disease, congenital, unknown usually hereditary cause
  2. Left HF : valvular dysfunction, LV problem
  3. Pulmonary Disease : ILD, COPD, OSA
  4. Chronic VTE : chronic small PE
  5. Miscellaneous : Sickle cell, sarcoidosis, tumor compression
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6
Q

SX Pulmonary HTN

A 
SOB
Fatigue 
Pre-syncope sx
CP
(JVP, edema, exertion syncope)
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7
Q

How to DX Pulmonary HTN with ECG

A
  1. RV hypertrophy
  2. Right Axis deviation : + AVF, - I
  3. RBBB : R and R’ seen in V1
  4. RA enlargement : large peaked P waves on lead II
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8
Q

Pulmonary HTN labs and imaging

A
  1. BNP : legates when heart is expanding
  2. Transthoracic Echocardiogram (TTE) : you can see chamber sizes and pulm artery systolic P (from tricuspid regurgitation gradient)
  3. Cardiac Catheterization ** GOLD
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9
Q

GOLD for Pulmonary HTN imaging

A

Swan Ganz Catheter

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10
Q

Protein C and S doe what

A

BLOCK F8 and F5

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11
Q

Antithrombin III does what

A

BLOCK : F2 and F10

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12
Q

PE sx

A

SOB, CP, Palpitations, Unilateral leg edema, can have syncope
Tachycardia, hypoxia

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13
Q

Criteria for blood clot of PE

A

Wells Criteria

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14
Q

Low probability of DVT or PE order what

A

D-Dimer

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15
Q

Higher or medium probability of DVT or PE you do what

A

Imaging study

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16
Q

D- Dimer can be + when

A

Inflammation state
High Clotting
(If - then you know there is no DVT)

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17
Q

PE EKG

A
  1. Sinus tachy + Right Axis deviation + HIGH R in V1
  2. Inverted T wave V1-V4
  3. RBBB
  4. S1Q3T3
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18
Q

Imaging for PE

A

CT Chest + CONTRAST

V/Q scan ——> no radiation

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19
Q

PE Echocardiogram

A
  1. RV is dilated

2. LV barely opening up (can show D-shaped)

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20
Q

Unstable PE is presenting how

A

Hypotension, RV strain, high cardiac enzymes

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21
Q

TX Unstable PE

A
  1. Resuscitation: Ventilation, vasopressin,
  2. Anti-coags
  3. Thrombolysis can be repeated, emboli to my, surgery thrombectomy
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22
Q

TX Stable PE

A
  1. Heparin = FAST , needs monitoring (increase antithrombin 3)
  2. Low Molecular Weight Heparin = FAST
  3. VIT K antagonist (Warfarin, Coumadin) = only when INR is 2-3 (normal)
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23
Q

Newest best anti-coags

A

Direct Oral Anticoagulants (DOACs)
= Rivaroxaban, Apixaban, Endoxaban, Dabigatran)
= inhibits F10, or dabigatran inhibits F2

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24
Q

Reversal agents for LMWH, Warfarin, DOAC

A
  1. LMWH : Protamine Sulfate
  2. W : Vit K, Prothrombin concentrate, fresh frozen plasma
  3. DOAC : 10a inhibitors = Andexanet alpha, Dabigatran = idarucizumab
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25
Q

Duration of tx for PE

A 
3 months 
(Malignancy or genetic mutation, hypercoagability disease = indefinitely)
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26
Q

OSA is what

A

OBSTRUCTIVE SLEEP APNEA
Disrupted breathing pattern when sleeping (can drops by more then 3% O2 sat, reduced breathing for 10sec or more, then gasping for air)
= tired during day

27
Q

OSA severity measured by

A

Apnea Hypopnea Index (AHI) (apnea episodes /hour)

28
Q

Sleep causes what

A

Pharyngeal muscles relax

Brain monitors CO2 levels to constrict muscle and increase breathing rate until normal

29
Q

OSA is associated with what diseases (5)

A 
HTN
DM
Atrial Fib / flutter
CAD
Occupational hazards
30
Q

OSA risks

A 
Large tongue
Obesity 
Craniofacial abnormalities 
Large tonsils
Large LN
Male
31
Q

Questionnaire used for OSA

A

STOPBANG

32
Q

DX OSA GOLD STANDARD

A

Polysomnogram
= records sleep 6-7hr (EEG, ECG, ocular movements, airflow, O2sat)
= gives you the AHI

33
Q

OSE TX 2

A
  1. Continuous Positive Airway Pressure (CPAP) : nasal or oral mast or + P ventilation (low compliance)
  2. Oral appliances: thrust mandible forward : mild osa , need frequent adjustments
34
Q

LFT of ILD

A
  1. Restrictive pattern

2. Decreased DLCO

35
Q

ILD does not have what 2 diseases

A

No primary infection of malignancy

36
Q

5 types of ILD

A
  1. Idiopathic Interstitial Pneumonia. (Idiopathic Pulmonary Fibrosis)
  2. Granulomatous ILD : Sarcoidosis, GPA, Goodpasture
  3. CT ILD : RA, SS, Dermatomyositis/Polymyositis
  4. Hypersensitivity Pneumonia: Farmers lung, bird poop, baker lung
  5. Pneumoconiosis : Coal, silicosis, asbestosis, berylliosis
37
Q

Idiopathic Pulmonary Fibrosis Prevalence, SX, PE

A
  1. Over 60yo
  2. SOB, Dry cough, fatigue, can do daily activities
  3. Velcro like crackles
38
Q

Idiopathic Pulmonary Fibrosis Imaging and LFT

A
  1. CT : fibrosis HONEYCOMBING + traction bronchiectasis

2. Restrictive pattern, low DLCO

39
Q

Idiopathic Pulmonary Fibrosis TX dont need to know drugs

A
  1. O2, Steroids
  2. Immunomodulators : Azathioprine, cyclophosphamide (moderate benefit)
  3. Anti-fibrotic therapy : Pirfenidone, Nintedanib (some benefit)
40
Q

Sarcoidosis is what and prevalence

A
  1. Non-caseating granulomas many locations (lungs most common)
  2. F, AA, 2-3rd decade + 6th decade
41
Q

Sarcoidosis sx 4

A
  1. Asymptomatic (25%)
  2. Cough, SOB,
  3. SLE, erythema nodosum
  4. Anterior uveitis
42
Q

Sarcoidosis 2 syndromes and what they include

A
  1. Lofgren’s Syndrome : Erythema nodosum, hilar LA, fever, arthritis
  2. Herefordt’s syndrome : anterior uveitis, parotitis, Cranial N 7 palsy, fever
43
Q

Sarcoidosis labs

A

High CA
High ACE
High T-cells causing this

44
Q

Sarcoidosis Radiology and LFT

A
  1. Hilar lymphadenopathy

2. Restrictive obstructive or normal

45
Q

Sarcoidosis TX

A
  1. Steroids * + SUPPORT (O2, rehab, nutrition)
  2. Methotrexate , azathioprine, cyclophosphamide
  3. Infliximab (TNF -1 inhibitors)
46
Q

GPA affects what locations and what happens and prevalence

A
  1. Lungs, kidneys, sinus
  2. Small V vasculitis , SOB, Cough, hemoptysis, saddle nose, chronic rhinitis, recurrent Otis media, fevers
  3. Caucasians middle age
47
Q

GPA labs and radiology

A
  1. C-ANCA

2. Lung nodules, patchy ground glass opacities, hilar LAD

48
Q

GPA TX

A

Steroids + Cyclophosphamide*

49
Q

Goodpasture Syndrome what happens, prevalence, sX

A
  1. Anti- Glomerular BM and Anti- Alveolar BM
  2. Peds, adults , Caucasian
  3. WL, fever, proteinuria, Hematuria, SOB, cough, Hemoptysis, hypoxemia
50
Q

Goodpasture Syndrome labs and radiology

A
  1. Anti- GBM

2. Bilateral ground glass opacities, = diffuse alveolar hemorrhage (DAH)

51
Q

Goodpasture Syndrome TX

A
  1. Plasmapheresis **

2. Steroids + cyclophosphamide**

52
Q

CT disorders that can cause ILD 3

A
  1. Systemic Sclerosis
  2. RA
  3. Dermatomyositis / Polymyositis
53
Q

Dermatomyositis / Polymyositis Labs

A

Anti- synthase ABs (myositis, reynoalds, mechanic hands, arthritis, ILD, fever)

54
Q

RA causing ILD more common in what gender

A

M ,all other RA sx more in F

55
Q

Hypersensitivity pneumonitis

A

Allergic reaction to something inhaled (alveolitis) = farmers, bird poop, woodworkers, bakers
= HISTORY IS IMPORTANT

56
Q

Hypersensitivity Pneumonitis SX, radiology , LFT

A
  1. Cough, SOB, fevers at times
  2. Diverse, focal consolidation, irregular nodules, honeycombing NOT AT BASES (like in IPF) if chronic
  3. Restrictive pattern
57
Q

Hypersensitivity Pneumonitis histology and tx

A
  1. PLASMA CELLS **, non-caseating granulomas can be seen

2. Remove Ag (to prevent chronic fibrosis)

58
Q

Pneumoconiosis is what and caused by what

A 
Inorganic dust inhaled causing inflammation and fibrosis 
= silicosis
= asbestosis
= coal workers (or navy)
= Berylliosis
59
Q

Pneumoconiosis LFT and TX

A
  1. Restrictive pattern

2. Remove exposure, immunizations, stop smoking, O2 tx

60
Q

Pneumoconiosis are at risk of what

A

TB

61
Q

Silicosis comes from what and what is it, radiology

A
  1. Crystalline quartz, miners, stone cutters,, sand blasting, quarry workers,
  2. Nodular lung disease + calcified hilar LNs + fibrosis if progressing
62
Q

Asbestosis what is it and radiology and risk of what

A
  1. Fibrous material construction, insulation, automobile worker, demolition
  2. Many nodular opacitis, pleural effusion, pleural fibrosis, blurred cardiac and diaphragm image
  3. Mesothelioma and lung cancer
63
Q

Coal miners Pneumoconiosis what is it and sx , radiology

A
  1. Coal dust, miners
  2. Asymptomatic ——> cough, SOB, sputum production
  3. Nodules usually at apex, patchy infiltrates at base , can lead to fibrosis
64
Q

Berylliosis what happens and radiology and tx

A
  1. Manufacturing alloys, electronic devises , similar to hypersensitivity reaction
  2. Hilar LAD, diffuse infiltrates
    High risk of Lung cancer
  3. Steroids *, remove Beryllium from environment

CPR 2 Exam 2 (12 decks)

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