SPE3-1 HYHO Flashcards
Is dyspnea a symptom or sign?
Dyspnea is a SELF-REPORTED SYMPTOM
Tachypnea/accessory muscle use/intercostal retractions are OBJECTIVE SIGNS
What is the characteristic progression of COPD?
Symptoms are progressive over a long period of time and the pt reports a sensation of inability to take a deep breath
What is the progression of sx for stable angina?
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
What are some physical exam findings for COPD?
Barrel shaped chest, limited rib motion, generalized hyperresonance, decreased breath sounds, wheezing, prolonged expirations, transmitted voice sounds and fremitus
In the evaluation of dyspnea, what are tests done during the H&P?
Walking oximetry and peak flow assessment
If a diagnosis is still not obtained, what tests are done during phase 1?
CXR, spirometry, ECG, CBC, BMP
If a diagnosis is still not obtained, what tests rae done during phase 2?
Chest CT, lung volumes, DLCO, tests of neuromuscular function, echocardiogram, cardiac stress testing
If a diagnosis is still not obtained, what tests are done during phase 3?
Cardiopulmonary exercise testing and possible subspecialty referral
What is an alternate DDx for COPD or stable angina when the pt is presenting with dyspnea?
Anemia!
Check for pulse ox, Hgb, and any pallor
Where is the sympathetic innervation for the heart?
T1-T6
Where is the sympathetic innervation for the lungs?
T1-T7
What is the parasympathethic innvervation?
Vagus
Where are the Chapman’s points for lungs?
Anterior: 2nd, 3rd, 4th ICS along sternum
Posterior: lateral T2 spinous process, intertransverse space between T2-T3, T3-T4, T4-T5
What is the biomechanical goal of treating COPD?
Improve thoracic cage compliance and skeletal motion
What is the goal of neurologic treatment of COPD?
Normalize autonomic tone
What is the goal of Resp-circ treatment of COPD?
Maximize efficiency of the diaphragm and enhance lymphatic return
What is the metabolic-energetic-immune goal of treating COPD?
Enhance self-regulatory adn self-healing mechanisms
What is the behavioral goal of treatment of COPD?
Improve psychosocial components of health
What can you rx for COPD?
SABA for rescue
Mantagonists to improve FEV1
LABA for persistent sx
LAMA to improve sx and reduce exacerbations (preferred over LABA)
What is a method of primary prevention for COPD?
Annual flu vaccine, pneumococcal vaccine, and Tdap (to protect against Bordatella pertussis)
What is a method of secondary prevention for COPD?
Avoidance of other dust and fumes (occupational or hobby exposure)
What is a tertiary method of prevention for COPD?
Smoking cessation/abstinence
Pulmonary rehab (incorporates exercise, education, psychosocial and nutritional counseling)
How is pleuritic chest pain reproduced?
With manuevers that cause motion between the pleura and the chest wall, such as coughing, laughing, and/or taking a deep breath
What PE finding tyypically eliminates cardiovascular cause?
Reproducible chest pain with palpation
What are some contraindications for an exercise stress test?
Rest angina within 48 hours, unstable rhythm, severe aortic stenosis, acute myocarditis, uncontrolled heart failure, severe pulmonary hypertension, and active infective endocarditis
What are the goals of OMT for stable angina?
Not indicated
What do you rx for stable angina?
Sublingual nitro, antiplatelet meds (e.g. ASA or clopidogrel), beta blockers or calcium channel blockers
What are means of secondary prevention for stable angina?
Assess pt for other CV sx (like claudication) and screening for thyroid dysfunction, anemia, or anything that can increase cardiac workload
What are tertiary methods of prevention for stable angina?
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)
