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Medical Lectures > Pulmonary Embolism > Flashcards

Pulmonary Embolism Flashcards

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USMLE® Step 1 flashcards
1
Q

What are the clinical signs of a PE?

A 
Chest pain
Dyspnea
Cough
Apprehension
Disorientation
2/3 of patients who suffer a fatal PE do so within 30 minutes of becoming symptomatic
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2
Q

Common Signs and Symptoms of Pulmonary Disease

A 
Cough
Dyspnea
Abnormal Sputum
Chest pain
Hemoptysis
Cyanosis
Digital Clubbing
Altered Breathing Patterns
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3
Q

What is a persistent dry cough commonly caused by?

A

tumor, congestion, or hypersensitive airways (allergies)

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4
Q

What does purulent sputum indicate?

A

infection

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5
Q

A productive cough with nonpurulent sputum indicates:

A

nonspecific and just indicates irritation

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6
Q

What does dyspnea usually indicate?

A

inadequate ventilation or insufficient amounts of oxygen in the circulating blood

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7
Q

What causes dyspnea?

A

Usually caused by diffuse and extensive rather than focal pulmonary disease

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8
Q

Orthopnea

A

Dyspnea when the person is lying down
Fluid shift leads to increased fluid in the lung.
The abdominal contents also exert pressure on the diaphragm, decreasing the efficiency of the respiratory muscles

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9
Q

Factors contributing to the sensation of dyspnea

A

Increased work of breathing
Respiratory muscle fatigue
Decreased breathing reserve
Strong emotions, particularly anxiety and anger

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10
Q

Pulmonary pain patterns

A

Usually localized in the substernal or chest region over the involved lung fields
May include anterior chest, side, or back

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11
Q

Where can pulmonary pain radiate?

A

the neck, upper trapezius, costal margins, thoracic back, scapulae, or shoulder

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12
Q

What does pleural irritation result in?

A

sharp, localized pain that is aggravated with any respiratory movement

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13
Q

What relieves chest pain?

A

autosplinting (or lying on the affected side), which diminishes the movement of that side of the chest

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14
Q

Hemoptysis

A

Coughing and spitting up blood

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15
Q

What does hemoptysis indicate?

A 
Infection
Inflammation
Abscess
Tumor
Infarction
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16
Q

Cyanosis

A

A bluish discoloration of the skin and mucous

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17
Q

What can cyanosis be?

A

central

peripheral

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18
Q

Central cyanosis:

A

caused by decreased oxygen saturation of hemoglobin in arterial blood
Best observed in buccal (cheek) mucous membranes and lips

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19
Q

Peripheral cyanosis:

A

slow blood circulation in fingers and toes

Best observed in nail beds

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20
Q

Conditions that may cause clubbing:

A 
Cystic fibrosis
Lung cancer
Bronchiectasis
Pulmonary fibrosis
Congenital heart disease
Lung abscess
Can be present with disorders of the liver and GI tract
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21
Q

Altered Breathing Patterns

A

Occur in response to any condition affecting the pulmonary system

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22
Q

Apneustic breathing

A

Gasping inspiration followed by short expiration

Localizes damage to the midpons and is most commonly due to a basilar artery infarct

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23
Q

Ataxic or Biot’s breathing

A

A haphazard random distribution of deep and shallow breaths

Caused by disruption of the respiratory rhythm generator in the medulla.

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24
Q

Cheyne-Stokes respiration

A

repeated cycle of deep breathing followed by shallow breaths or cessation of breathing

25
Q

What is the most common cause of Cheyne-Stokes respiration?

A

CHF

Can occur with renal failure, meningitis, drug overdose, and increased intracranial pressure

26
Q

Kussmaul’s respiration

A

a distressing dyspnea characterized by increased respiratory rate (>20/min), increased depth of respiration, panting, and labored respiration typical of air hunger

27
Q

What condition is associated with Kussmaul’s respiration ?

A

strenuous exercise, metabolic acidosis

28
Q

What causes hyperventilation?

A

anxiety, acute head injury, blood oxygenation, fever

29
Q

What causes hypoventilation?

A

fibromyalgia syndrome, chornic fatigue syndrome, sleep apnea, muscle fatigue, muscle weakness, malnutrition, fever

30
Q

What causes apneustic breathing?

A

midpons lesion, basilar artery infarct

31
Q

What causes Biot’s breathing?

A

exercise, shock, cerebral hypoxia, heat stroke, spinal meningitis, head injury, brain abscess, encephalitis

32
Q

Hypoxemia

A

Deficient oxygenation of arterial blood, which may lead to hypoxia
Caused by respiratory alterations

33
Q

Hypoxia

A

A broad term meaning diminished availability of oxygen to the body tissues
May occur anywhere in the body

34
Q

Causes of hypoxia

A

Caused by alterations of other systems that have no relation to changes in the pulmonary system

35
Q

Pulmonary edema

A

Accumulation of fluid in the tissues and air spaces of the lung

36
Q

Causes of pulmonary edema?

A

heart disease, esp. left ventricular failure, acute HTN, or mitral valve prolapse
pulmonary disease complications
liver kidney disorder

37
Q

Later signs of pulmonary edema?

A

persistent cough, slight dyspnea, diaphoresis, and intolerance to exercise

38
Q

What is seen in pulmonary edema patients?

A

May see engorged neck and hand veins, pitting edema of the extremities, and the paroxysmal noctural dyspnea

39
Q

What may be one of the first signs of dyspnea?

A

difficulty breathing when lying down, relieved with sitting up (orthopnea)

40
Q

Preferred position of pulmonary edema patients?

A

sitting position with legs dangling over the edge of the plinth is preferred position

41
Q

Pulmonary Tuberculosis

A

An infectious, inflammatory systemic disease that affects the lungs that may disseminate to involve lymph nodes and other organs

42
Q

Cause of Pulmonary Tuberculosis

A

mycobacterium tuberculosis

43
Q

Symptoms suggestive of TB include

A 
Productive cough of more than 3 weeks duration especially when accompanied by other symptoms
Weight loss
Fever
Night sweats
Fatigue
Malaise
Anorexia
44
Q

TB patients may have:

A

Chest expansion may be decreased
Tracheal deviation may be present
Postural adaptations may have developed in late stages because of poor breathing patterns
Should also assess overall posture, gait, muscle strength, balance, and functional mobility

45
Q

Chronic Obstructive Pulmonary Disease (COPD)

A

number of disorders that affect movement of air in and out of the lungs, particularly within the small airways. The most important of these disorders are obstructive bronchitis, emphysema, and asthma

46
Q

Chronic bronchitis

A

excessive secretion of bronchial mucus and is manifested by daily productive cough for 3 months or more in at least 2 consecutive years

47
Q

Emphysema

A

pathologic diagnosis that denotes abnormal permanent enlargement of air spaces distal to the terminal bronchiole, with destruction of their walls and without obvious fibrosis

48
Q

What does exercise do for COPD patients?

A

enhance CV fitness and train skeletal muscles to function more effectively

49
Q

Asthma

A

inflammatory condition with secondary bronchospasm marked by recurrent attacks of dyspnea, with wheezing due to the spasmodic constriction of the bronchi

50
Q

Need to monitor vital signs if suspected (asthma):

A

Increasing tachypnea
Hypertensive BP readings due to hypoxemia
Auscultate the lungs for wheezing and quality of air movement

51
Q

Pleurisy

A

pleura (parietal) caused by infections, injury (rib fracture), or tumor

52
Q

Symptoms of pleurisy:

A

Sudden onset of symptoms – usually a sharp, sticking chest pain worse with inspiration, coughing, sneezing, or movement associated with deep inspiration
May have cough, fever, chills, and rapid shallow breathing (tachypnea)

53
Q

Pleural Effusion

A

Collection of fluid in the pleural space (between the membrane encasing the lung and the membrane lining the thoracic cavity)

54
Q

Infected pleural effusion

A

an accumulation of pus that occurs occasionally as a complication of pleurisy or some other respiratory disease, usually pneumonia

55
Q

Lab findings for pulmonary embolism:

A

ECG
Arterial blood gas
D-dimer

56
Q

Wells for PE

A 
S&S of DVT
Alternative diagnosis less likely
HR greater than 100
Immobilization for more than 3 days in previous 4 weeks
Previous DVT or PE
Hemoptysis
Cancer
57
Q

Wells high:

A

greater than 6

58
Q

Wells moderate:

A

2-6

59
Q

Wells low:

A

less than 2

Medical Lectures (11 decks)

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