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Dm pharm 1 > dyspnea > Flashcards

dyspnea Flashcards

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1
Q

What is the pathophysiology of Angioedema?

A

Mast cell mediated, bradykinin mediated vascular leakage.

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2
Q

What are the patient presentations of Angioedema?

A

Lip/tongue swelling; swelling can occur anywhere, drooling.

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3
Q

What is the evaluation method for Angioedema?

A

Clinical.

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4
Q

What is the treatment for Angioedema?

A

Monitor airway/other symptoms for anaphylaxis, watch and wait for those who are fine, consider advanced airway if worsening, prepare for cricothyrotomy, Tranexamic acid (TXA) or C1 esterase inhibitors, ICU.

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5
Q

What is Ludwig’s Angina?

A

Infection of the submandibular, submental, and sublingual spaces.

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6
Q

What are the risk factors/causes of Ludwig’s Angina?

A

Odontogenic infection.

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7
Q

What are the patient presentations of Ludwig’s Angina?

A

Bull neck (woody induration), mouth open, fevers, muffled voice, tripod position, drooling, dysphagia.

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8
Q

What is the evaluation method for Ludwig’s Angina?

A

CT neck and face with IV contrast (if airway is stable).

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9
Q

What is the management for Ludwig’s Angina?

A

Monitor airway carefully, consider advanced airway if worsening, prepare for cricothyrotomy, broad-spectrum antibiotics, admit to ICU with ENT consult.

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10
Q

What is Epiglottitis?

A

Supraglottic structures and epiglottis cellulitis.

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11
Q

What are the risk factors/causes of Epiglottitis?

A

Unimmunized/partially immunized, Hemophilus influenzae, staph, and strep.

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12
Q

What are the patient presentations of Epiglottitis?

A

Unvaccinated child, tripod position, dysphagia, drooling, distress, hot potatoes voice, severe sore throat, minimal respiratory distress.

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13
Q

What is the evaluation method for Epiglottitis?

A

Clinical, labs: CBC, CMP, lateral neck x-ray (thumbprint) but not necessary to diagnose.

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14
Q

What is the treatment for Epiglottitis?

A

Secure airway first, monitor airway closely, consult ENT and anesthesia, start antibiotics: ceftriaxone + vancomycin, PICU.

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15
Q

What is Croup?

A

Inflammation of larynx, trachea, and sometimes bronchi.

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16
Q

What are the risk factors/causes of Croup?

A

Viral, parainfluenza most common cause.

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17
Q

What are the patient presentations of Croup?

A

6mo-3yr, barking cough, inspiratory stridor, rhinorrhea.

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18
Q

What is the evaluation method for Croup?

A

Clinical, AP neck x-ray (steeple) not needed for clinical diagnosis.

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19
Q

What is the treatment for Croup?

A

Administer antipyretics, dexamethasone, nebulized epi if moderate to severe, discharge home if stable on reassessment.

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20
Q

What is a Foreign Body aspiration?

A

Right main stem and lower lobe most common.

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21
Q

What are the risk factors/causes of Foreign Body aspiration?

A

Can’t chew well, peaks in 2nd year and 8th decade. Peanuts, meat, seeds.

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22
Q

What are the patient presentations of Foreign Body aspiration?

A

Toddler, choking, stridor, bidirectional wheeze, coughing, retractions, wheezing.

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23
Q

What is the evaluation method for Foreign Body aspiration?

A

PA/lateral CXR for initial assessment, CT in stable patients.

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24
Q

What is the treatment for Foreign Body aspiration?

A

Monitor airway, intubation, Magill forceps and conscious sedation, bronchoscopy, remove object, airway support. ALL BUTTON BATTERIES NEED EMERGENT REMOVAL.

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25
What is Anaphylaxis?
Rapid onset hives, immediate, severe, type 1 (IgE) hypersensitivity.
26
What are the risk factors/causes of Anaphylaxis?
Medications, foods, Hymenoptera stings.
27
What are the patient presentations of Anaphylaxis?
Within 5-30 minutes: dyspnea, hypotension, GI symptoms, acute mucocutaneous symptoms: flushing, pruritus, urticaria, angioedema, respiratory: wheezing, stridor, hypoxia, hypotension or end-organ damage.
28
What is the evaluation method for Anaphylaxis?
Clinical.
29
What is the treatment for Anaphylaxis?
Monitor airway, IM epinephrine, repeat every 5 to 15 minutes, second line adjuncts: albuterol for bronchospasm, H1 antihistamine (Diphenhydramine) for itching and hives, H2 antihistamine (famotidine) for GI itching and hives, methylprednisolone (Solu-Medrol) to prevent rebound.
30
What is COPD Exacerbation?
Irreversible expiratory airflow limitation from excessive sputum (chronic bronchitis) or alveolar septal destruction (emphysema).
31
What are the cardinal triad symptoms of COPD Exacerbation?
1. Increased dyspnea, 2. Increased cough/wheezing, 3. Change in color/volume of sputum.
32
What are the risk factors/causes of COPD Exacerbation?
Smoking, advanced age, viral and bacterial infections (70%), environmental, PE, ACS.
33
What is the evaluation method for COPD Exacerbation?
CXR showing hyperextended lungs with flat diaphragm, labs: CBC, CMP, troponin.
34
What is the treatment for COPD Exacerbation?
Apply nasal cannula oxygen, O2 target: 88-90%, if not improving move to BiPAP, duoneb (Albuterol + Ipratropium) nebulizers, give steroids: Methylprednisolone IV or PO prednisone, antibiotics: outpatient: Azithromycin or Doxycycline, inpatient: Ceftriaxone.
35
What is Asthma Exacerbation?
Airway inflammation with intermittent airway obstruction.
36
What are the risk factors/causes of Asthma Exacerbation?
Pollens, pets, mold, smoke, exercise.
37
What are the patient presentations of Asthma Exacerbation?
Wheezing, fragmented sentences, retractions, tachypnea, altered mental status when severe.
38
What is the evaluation method for Asthma Exacerbation?
CXR, +/- additional work-up.
39
What is the treatment for Asthma Exacerbation?
Monitor airway: target SpO2 of >92%, BiPAP as needed, medications: steroids (Prednisone QD x 5 d PO, Methylprednisolone IV, Dexamethasone), Albuterol + ipratropium (Duoneb), severe cases: IV magnesium, IM epinephrine.
40
What is Acute CHF Exacerbation?
Structural or functional abnormality impairing cardiac filling or ejection.
41
What are the risk factors/causes of Acute CHF Exacerbation?
Valve disease, HTN, CAD, cardiomyopathy, medication nonadherence, MI, dietary sodium, myocarditis, alcohol, arrhythmia.
42
What are the patient presentations of Acute CHF Exacerbation?
Orthopnea, edema, dyspnea, JVD, bilateral lower extremity swelling, crackles/wheezing, diminished lung bases, S3.
43
What is the evaluation method for Acute CHF Exacerbation?
EKG, labs: CBC, CMP, troponin, +/- POCUS, CXR: cardiomegaly.
44
What is the treatment for Acute CHF Exacerbation?
Monitor airway, BiPAP, loop diuretics: IV furosemide (Lasix), nitroglycerin if HTN, admit for hypoxia.
45
What is Flash Pulmonary Edema?
Acute exacerbation of heart failure with severe pulmonary edema.
46
What are the patient presentations of Flash Pulmonary Edema?
Drowning sensation, suffocation, inspiratory and expiratory gurgling, HTN crisis, thrashing, noisy.
47
What is the evaluation method for Flash Pulmonary Edema?
CXR.
48
What is the treatment for Flash Pulmonary Edema?
Monitor airway: BiPAP, intubation, nitroglycerin or nitroprusside to reduce preload.
49
What is Pneumonia?
Infection of lung parenchyma.
50
What are the criteria for Pneumonia diagnosis?
Fever (>38C/100.4°F), leukocytosis (≥ 12,000 WBC/mm3) or leukopenia (≤4000 WBC/mm3).
51
What are the risk factors/causes of Pneumonia?
Classified based upon location/risk factors: Community-acquired, hospital-acquired, ventilator-associated.
52
What is the evaluation method for Pneumonia?
CBC, CMP, troponin, EKG, +/- BNP, +/- sepsis workup (lactate and blood cultures).
53
What is the outpatient treatment for Community-acquired Pneumonia?
Monotherapy: high dose doxycycline, amoxicillin or cefuroxime + azithromycin or doxycycline, levaquin is second or third line.
54
What is the inpatient treatment for Community-acquired Pneumonia?
Ceftriaxone + azithromycin or doxycycline, levaquin second line.
55
What is the treatment for Pediatric Pneumonia?
Hospitalize all infants 0 - 6 months or severe pneumonia, antibiotics: ampicillin if inpatient, amoxicillin if outpatient, augmentin if not fully immunized.
56
What is PE?
Pathophysiology: Blood clot in pulmonary artery.
57
What is Virchow's triad?
1. Venous stasis, 2. Endothelial injury, 3. Hypercoagulable state.
58
What are the risk factors/causes of PE?
Surgery/trauma last 3 months, travel >4 hours in last month, prior history of DVT/PE or family history, immobilization, malignancy (active), heart failure (due to low flow state), smoking, hormone use/pregnancy.
59
What is the evaluation method for PE?
POCUS, labs: CBC, CMP, TN, BNP, D-dimer.
60
What is the treatment for PE?
Heparin drip, then transition to direct oral anticoagulants (DOAC) or warfarin.
61
What are the risk factors for PE or DVT?
1. Clinical signs and symptoms of DVT 2. PE is #1 diagnosis OR Equally likely 3. Heart rate >100 4. Immobilization at least 3 days OR surgery in the previous 4 weeks 5. Previously objectively diagnosed PE or DVT 6. Hemoptysis 7. Malignancy w/ treatment within 6 months or palliative
62
What is the Two Tier Model for PE risk assessment?
"PE unlikely" 0-4 points (12.1% incidence of PE): Consider D-dimer to rule out PE - D-dimer negative: stop work up - D-dimer positive: consider CTA "PE likely" >4 points (37.1% incidence of PE): Consider CTA
63
What imaging is recommended for PE?
CTPA (CT pulmonary arteries) is #1 Ventilation-perfusion (VQ) scan is second line
64
What is the most common EKG abnormality in PE?
Sinus tachycardia ## Footnote S1Q3T3
65
What is the role of CXR in PE diagnosis?
CXR is for alternate causes, not for PE diagnosis. ## Footnote Normal CXR does not rule out PE.
66
What special considerations are there for PE diagnosis in pregnancy?
Can't use PERC or Wells. Pregnancy increases D-dimer. Use YEARS algorithm to increase D-dimer threshold if low risk.
67
What is the age-adjusted calculation for D-dimer threshold?
Age (years) x 10 ug/L - Negative: No further work up - Positive: CTPA
68
What are the symptoms of a tension pneumothorax?
Unilateral decreased breath sounds, hypotension, dyspnea, and pleuritic chest pain.
69
What is the first step in managing a tension pneumothorax?
Needle Thoracostomy FIRST
70
What are the placement details for a needle thoracostomy?
Size: 14-gauge needle Placement: Fifth intercostal space midaxillary line or midclavicular line at second intercostal space just above rib
71
What is the indication for a large/medium bore chest tube?
Indication: Large air leak, bleeding, thick pus
72
What is the size and placement for a large bore chest tube?
Size: 24-36 Fr Placement: Anterior axillary line at the nipple for men and inframammary crease in women corresponding with the fifth intercostal space
73
What are the symptoms of a panic attack?
Symptoms develop rapidly: chest pain, sweating, palpitations, shaking, sense of smothering, numbness/tingling.
74
What is the management for a panic attack?
Anxiolytics: Lorazepam (Ativan) or Hydroxyzine.

Dm pharm 1 (2 decks)

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