Resp Flashcards
What are the 2 most common causes of acute cough
Upper respiratory tract infections (URI) and acute bronchitis are the most common causes of acute cough.
What are the 2 most common causes of sub-acute cough
Subacute cough is often a sequela of a URI (postinfectious cough) but can also be due to
1) chronic bronchitis
2) pneumonia.
What are the 2 most common causes of chronic cough
Chronic cough is often caused by rhinitis/sinusitis (upper airway cough syndrome), asthma, GERD, and ACE inhibitors.
Red flag symptoms of cough
SOB
Blood
Weight-loss
Fever
Which conditions can you see a nocturnal cough
Asthma and GERD
DDX for productive cough
pneumonia bronchitis bronchiectasis pulmonary edema tuberculosis
DDX for non-productive cough
asthma interstitial lung disease viral pneumonia (e.g., adenovirus. RSV, influenza virus)
What is the 3rd most common cause of cough
GERD
State some clinical features of PE
Acute onset of symptoms, often triggered by a specific event (e.g., on rising in the morning, sudden physical strain/exercise)
Dyspnea and tachypnea (> 50% of cases)
Sudden chest pain (∼ 50% of cases), worse with inspiration
Cough and hemoptysis
Possibly decreased breath sounds, dullness on percussion, split-second heart sound audible in some cases
Tachycardia (∼ 25% of cases), hypotension
Jugular venous distension
Low-grade fever
Syncope and shock with circulatory collapse in massive PE (e.g., due to a saddle thrombus)
Symptoms of DVT: unilaterally painful leg swelling
State 4 causes of pulmonary hypertension
1) COPD
2) Valvular heart disease-Mitral valve disease
3) chronic sleep apnea
4) idiopathic
What is the difference between cor pulmonale and pulmonary HTN
Pulmonary hypertension: chronically elevated mean pulmonary arterial pressure (mPAP) at rest ≥ 25 mm Hg (normal: 10–14 mm Hg) due to chronic pulmonary and/or cardiac disease or unknown reasons (idiopathic form)
Cor pulmonale: altered structure (hypertrophy, dilation) or impaired function of the right ventricle caused by pulmonary hypertension resulting from a primary disorder of the respiratory or pulmonary artery system
basically when Chronic lung disease CAUSES right-sided heart failure(it is called) cor pulmonale
State some signs you will see on physical examination for someone with pulmonary hypertension
Loud and palpable second heart sound (often split) Parasternal heave Nail clubbing Jugular vein distention Symptoms of right heart failure
What is the treatment for pulmonary hypertension
Treatment of the underlying cause
E.g., bronchodilators and inhalation corticosteroids for patients with COPD, CPAP for patients with obstructive sleep apnea
State some causes of heart failure-systolic or diastolic
Coronary artery disease, myocardial infarction
Arterial hypertension
Valvular heart disease
Diabetes mellitus (diabetic cardiomyopathy)
Renal disease
Infiltrative diseases (e.g., hemochromatosis, amyloidosis)
Cardiac arrhythmias
Dilated cardiomyopathy (e.g., Chagas disease, chronic alcohol use, idiopathic)
Myocarditis
Constrictive pericarditis
Restrictive or hypertrophic cardiomyopathy
Pericardial tamponade
Obesity
Smoking
COPD
Heavy drug (recreational and prescription) and alcohol abuse
The three major causes of heart failure are coronary artery disease, hypertension, and diabetes mellitus. Patients typically have multiple risk factors that contribute to the development of CHF.
Outline the management of PE patient
- go through stable patient
- unstable patient
Follow flow char on AMBOSS
PE ECG signs are:
Sinus tachycardia most commonly seen
Signs of right ventricular pressure overload
SIQIIITIII -pattern
New right bundle branch block
Bradycardia < 50 or tachycardia > 100 bpm
Right or extreme right axis deviation (30% of cases)
T negativity in leads V2and V3 (∼ 30%)
1st line treatment for PE-acute treatment
first line for haemodynamically stable PE/DVT Treatment- Apixaban (Direct Xa inhibitor) - remember do not use NOAC in renal impairment
eTG-Oral factor Xa inhibitors (eg apixaban, rivaroxaban) are preferred to dabigatran or warfarin to treat proximal DVT and PE because they do not require parenteral anticoagulation for initiation. Apixaban and rivaroxaban do not require routine anticoagulation monitoring; however, using the correct dose is vital because underdosing may not provide adequate anticoagulation.
What is the long term prophylaxis for PE
Long term anti-coagulation
- First-line- Apixaban
- DVT or PE provoking factor that is no longer present- anticoagulant therapy for 3 months
- Otherwise, assess risks and benefit.
Pregnancy VTE is
LMWH
Bronchial breath sounds in the lung parenchyma
Pneumonia
Bronchodilator reversibility/post-bronchodilator test
What findings need to be there in the test that allows differentiating between reversible obstruction from irreversible destruction
An increase in FEV1 by 200ml or 15% of the initial value indicates reversible airway obstruction(bronchial asthma)