SOB and Cough/Hemoptysis

Question 1

Dyspnea

Answer 1

abnormally uncomfortable awareness of breathing

Question 2

COPD

Answer 2

disease state characterized by airflow limitation that isn’t fully reversible
progressive and associated with abnormal inflammatory response

Question 3

Chronic Bronchitis

Answer 3

chronic productive cough for 3 months for 2 years

Question 4

Emphysema

Answer 4

Pathologic term for enlargement of airspaces with destruction of bronchiole walls
CD8 T cells, macrophages, neutrophils

Question 5

Asthma

Answer 5

inflammatory disease of airways with significantly REVERSIBLE narrowing
CD4 T cells and eosinophils

Question 6

Clinical features of COPD

Answer 6

smokers, chronic cough, dyspnea, chronic sputum production
As it progresses –> chronic clear sputum, weight loss, morning headache, hypercapnia w/ hypoxemia
Classification of COPD depends on spirometry deficits
- decreased FEV/FVC ratio!!!!

Question 7

PE of COPD

Answer 7

prolonged expiration
hyperinflation (increased AP diameter)
hyperresonent to percussion
depressed diaphragm
decreased breath sounds
wheezes

Question 8

Management of COPD

Answer 8

SMOKING CESSATION!

other drugs

Question 9

Classic Triad of Asthma

Answer 9

Persistent Wheeze
Chronic Cough
Chronic Dyspnea

Question 10

Metacholine test

Answer 10

Asthma –> FEV at 80% much lower dose of metacholine than normal individual

Question 11

Asthma Severity

Answer 11

Mild Intermittent
Mild Persistent
Moderate Persistent
Severe
- the severity determines the treatment!

Question 12

Step-wise approach to treating asthma

Answer 12

Step 1 - SABA as needed
Step 2 - Low dose ICS and SABA as needed
Step 3 - Low dose ICS and LABA/medium ICS w/ SABA as needed
Step 4 - Medium dose ICS and LABA
Step 5 - High dose ICS and LABA
Step 6 - High dose ICS, LABA, oral corticosteroid

Question 13

Chronic Cough

Answer 13

defined as cough persisting for 3 wks or longer
BIG 3
- post-nasal drip (most common) - tx with ipratropium
- astham –> wheezing, use beta-agonists
- G-I reflux –> stimulates receptors in larynx and lower respiratory tract, need 24 esophageal pH monitoring

Question 14

DDx of hemoptysis

Answer 14

Airway disease
Pulmonary parenchymal disease
Pulmonary vascular disease
Miscellaneous

Question 15

Evaluation of hemoptysis

Answer 15

H&P
CXR
CBC, UA, creatinine
Bronchoscopy (won’t find much if normal CXR, but do before CT)

Question 16

Pulmonary Embolism

Answer 16

iliofemoral thrombi = source of most PE’s
Risk Factors
1. Immobilization
2. Surgery (3 months)
3. Stroke
4. History
5. Malignancy
6. Women - obesity, smoking, HTN, birth control, pregnancy
7. Air travel
Without risk factors –> factor V, high [VIII]

Question 17

Signs and Symptoms of PE

Answer 17

Dyspnea
Pleuritic chest pain
Cough
Hemoptysis
Tachypnea
Tachycardia
Crackles
Loud P2

Question 18

Workup of PE

Answer 18

ABG –> respiratory alkalosis
EKG - normal
CXR - many normal but can have slight abnormalities
D-dimer –> rules out a clot, but doesn’t rule in a clot
CT - ok sensitivity but good specificity

Question 19

Treatment of PE

Answer 19

Heparin (injection)
Warfarin (overlap Heparin for 5 days)
Massive PEs –> thrombolytics