SPE3-1 HYHO

Question 1

Is dyspnea a symptom or sign?

Answer 1

Dyspnea is a SELF-REPORTED SYMPTOM

Tachypnea/accessory muscle use/intercostal retractions are OBJECTIVE SIGNS

Question 2

What is the characteristic progression of COPD?

Answer 2

Symptoms are progressive over a long period of time and the pt reports a sensation of inability to take a deep breath

Question 3

What is the progression of sx for stable angina?

Answer 3

Described as heavy, squeezing, pressure, tightness, or choking but rarely as pain.

Equivalents include dyspnea, nausea, and fatigue

It is exacerbated by activity and relieved with rest in 1-5 min

Question 4

What are some physical exam findings for COPD?

Answer 4

Barrel shaped chest, limited rib motion, generalized hyperresonance, decreased breath sounds, wheezing, prolonged expirations, transmitted voice sounds and fremitus

Question 5

In the evaluation of dyspnea, what are tests done during the H&P?

Answer 5

Walking oximetry and peak flow assessment

Question 6

If a diagnosis is still not obtained, what tests are done during phase 1?

Answer 6

CXR, spirometry, ECG, CBC, BMP

Question 7

If a diagnosis is still not obtained, what tests rae done during phase 2?

Answer 7

Chest CT, lung volumes, DLCO, tests of neuromuscular function, echocardiogram, cardiac stress testing

Question 8

If a diagnosis is still not obtained, what tests are done during phase 3?

Answer 8

Cardiopulmonary exercise testing and possible subspecialty referral

Question 9

What is an alternate DDx for COPD or stable angina when the pt is presenting with dyspnea?

Answer 9

Anemia!

Check for pulse ox, Hgb, and any pallor

Question 10

Where is the sympathetic innervation for the heart?

Answer 10

T1-T6

Question 11

Where is the sympathetic innervation for the lungs?

Answer 11

T1-T7

Question 12

What is the parasympathethic innvervation?

Answer 12

Vagus

Question 13

Where are the Chapman’s points for lungs?

Answer 13

Anterior: 2nd, 3rd, 4th ICS along sternum

Posterior: lateral T2 spinous process, intertransverse space between T2-T3, T3-T4, T4-T5

Question 14

What is the biomechanical goal of treating COPD?

Answer 14

Improve thoracic cage compliance and skeletal motion

Question 15

What is the goal of neurologic treatment of COPD?

Answer 15

Normalize autonomic tone

Question 16

What is the goal of Resp-circ treatment of COPD?

Answer 16

Maximize efficiency of the diaphragm and enhance lymphatic return

Question 17

What is the metabolic-energetic-immune goal of treating COPD?

Answer 17

Enhance self-regulatory adn self-healing mechanisms

Question 18

What is the behavioral goal of treatment of COPD?

Answer 18

Improve psychosocial components of health

Question 19

What can you rx for COPD?

Answer 19

SABA for rescue
Mantagonists to improve FEV1
LABA for persistent sx
LAMA to improve sx and reduce exacerbations (preferred over LABA)

Question 20

What is a method of primary prevention for COPD?

Answer 20

Annual flu vaccine, pneumococcal vaccine, and Tdap (to protect against Bordatella pertussis)

Question 21

What is a method of secondary prevention for COPD?

Answer 21

Avoidance of other dust and fumes (occupational or hobby exposure)

Question 22

What is a tertiary method of prevention for COPD?

Answer 22

Smoking cessation/abstinence

Pulmonary rehab (incorporates exercise, education, psychosocial and nutritional counseling)

Question 23

How is pleuritic chest pain reproduced?

Answer 23

With manuevers that cause motion between the pleura and the chest wall, such as coughing, laughing, and/or taking a deep breath

Question 24

What PE finding tyypically eliminates cardiovascular cause?

Answer 24

Reproducible chest pain with palpation

Question 25

What are some contraindications for an exercise stress test?

Answer 25

Rest angina within 48 hours, unstable rhythm, severe aortic stenosis, acute myocarditis, uncontrolled heart failure, severe pulmonary hypertension, and active infective endocarditis

Question 26

What are the goals of OMT for stable angina?

Answer 26

Not indicated

Question 27

What do you rx for stable angina?

Answer 27

Sublingual nitro, antiplatelet meds (e.g. ASA or clopidogrel), beta blockers or calcium channel blockers

Question 28

What are means of secondary prevention for stable angina?

Answer 28

Assess pt for other CV sx (like claudication) and screening for thyroid dysfunction, anemia, or anything that can increase cardiac workload

Question 29

What are tertiary methods of prevention for stable angina?

Answer 29

Cardiac rehab (an approach to encourage weight loss, increased exercise tolerance, and control risk factors)

Smoking cessation

Treatment of lipid disorders and other comorbidities that increase risk of CAD or increase cardiac workload (i.e. anemia or thyroid dysfunction)