Pence Dyspnea Palpitations and Fatigue Flashcards
(45 cards)
1
Q
How will an EKG look in a person with a PE?
A
- Sinus tach
- Inverted T waves (V1-4) due to RV strain
- Incomplete or complete RBBB
-
S1, Q3, T3
- deep S in 1
- Q wave in 3
- Inverted T wave in 3
2
Q
Gold standard imaging for PE?
A
- CT chest with contrast
3
Q
What symptoms make up an unstable PE?
A
- Hypotension
- RV strain
- Elevated cardiac enzymes
4
Q
Treatment for unstable PE
A
- Resuscitation
- ventilation or hemmodynamic support
- Thrombolytic therapy
- If systemic thrombolysis fails:
- repeat thrombolysis
- attempt catheter thrombolysis
- proceed to surgery for thrombectomy
5
Q
How do you treat Stable PE?
A
- Heparin
- Low molecular weight heparin
- enoxaparin or lovenox
- Vitamin K antagonist
- Warfarin or Coumadin
- DOACs
- rivaroxaban apixaban dabigatran endoxaban
6
Q
What is the reversal agent for LMWH?
A
Protamine Sulfate
7
Q
What is the reversal agent for DOACs?
A
- Xa inhibitors
- Andexanet alpha
- Dabigatran idarucizumab
8
Q
What is reversal agent for Warfrin?
A
- Vitamin K
- Prothrombin complex concentrate
- fresh frozen plasma
9
Q
What is the minimum length of treatment of a PE for all patients?
A
Three months
10
Q
Who gets indefinite anticoagulation after a PE?
A
Those with underlying disease with high risk of VTE recurrence such as malignancies or genetic mutations
11
Q
What is obstructive sleep apnea?
A
- Disruption in breathing pattern while sleeping that results in excessive daytime somnolence despite adequate sleep periods and not explained by other causes
12
Q
What is apnea?
A
Reduction in breathing for ten seconds with a noted drop in SpO2 by >3%
13
Q
What are the two issues of OSA?
A
- Obstruction:
- soft tissue or anatomical abnormalities that lead to a patient having a more difficult time keeping airway open during sleep
- Ventilatory drive:
- The body’s sensitivity to CO2
14
Q
What is OSA associated with?
A
- Htn
- A.fib/ flutter
- CAD
- Type II diabetes
- At higher risk for occupational hazards
15
Q
Risk factors for OSA?
A
- Obesity #1 cause/predictor
- Large tongue
- Craniofacial abnormalities
- Enlarged tonsils
- Enlarged lymph nodes
- Males
16
Q
Symptoms of OSA?
A
- Excessive daytime sleepiness
- Partner witnesses gasping episodes
- STOPBANG
17
Q
What is STOPBANG?
A
- Snoring
- Tired
- Observed episode
- Pressure
- BMI
- Age >50
- Neck size
- Gender
18
Q
How do you diagnose OSA? Describe the process.
A
- Polysomnogram (PSG)
- Gold standard
- Occurs at home or sleep lab
- Records sleep activity for 6-7 hrs
- Monitors EEG, ECG, ocular movement, airflow and O2 saturation
19
Q
How do you treat OSA?
A
- Continuous Positive Airway Pressure (CPAP)
- provides pressure to overcome obstruction
- 30-50% non compliance
- Now is a nasal mask but also have oral nasal mask
20
Q
Who does idippathic pulmonary fibrosis occur in?
A
M=F age >60 yo
21
Q
Symptoms of Idiiopathic pulmonary fibrosis?
A
- Progressive dyspnea
- Dry cough
- Fatigue
- Inability to perform daily activities
- Prominent inspiratory crackles “Velcro Lung”
22
Q
what will a CT show in a patient with IPF?
A
- Significant fibrosis bilaterally “honeycombing” with traction bronchiectasis
23
Q
What will PFT and DLCO show in a patient with IPF?
A
Restrictive pattern and decreased DLCO
24
Q
How do you treat Idiopathic Pulmonary Fibrosis? Survival rate?
A
- Supportive care
- Steroids
- Immunomodulators
- Anti fibrotic therapy
- 50% 3-5 yrs after diagnosis
25
What is sarcoidosis?
* non caseating granuloma
* Can affect most organ systems lungs are most common
* Heterogenous prognosis
26
Clinical presentation of Sarcoidosis?
* cough dyspnea of insidous onset
* Cutaneous involvement
* lupus pernio
* erythema nodosum
* maculopapular rash
* Anterior uveitis
* Lofgren's syndrome
* Heerfordt's syndrome
* Asx in 20-3-%
27
What is Lofgren's syndrome?
* Seen in sarcoidosis
* Erythema nodosum
* Hilar lymphadenopathy
* fever
* arthritis
28
What is Heerfordt's syndrome?
* Seen in sarcoidosis
* anterior uveitis
* Parotitis
* Cranial nerve VII palsy
* Fever
29
What do you see on sarcoidosis radiology?
* hilar lymphadenopathy
* minimal dz findings to diffuse fibrosis
30
Sarcoidosis PFTs?
* normal, restrictive, or obstructive pattern
* +/- reduced DLCO
31
Treatment of sarcoidosis?
* Supportive care
* Immunosuppression
* steroids are first line
* methotrexate, asathipprine, cyclophosphamide
* Biologics
32
What are the staages of sarcoidosis?
1. Hilar LAD
2. Hilar LAD + infiltrates
3. Infiltrates only
4. Fibrosis
*not a progression of disease*
33
What dose Granulomatosis with Polyangiitis cause?
* systemic small vessel vasculitis affecting sinuses kidneys and lungs
* results in destruction of lung parenchyma, diffuse alveolar hemorrhage, ulceration in the tracheobronchial tree and glomerulonephritis
34
Clinical presentation of GPA? Labs?
* Dyspnea
* Cough
* Hemoptysis
* Fever
* Saddle nose
* Chronic sinusitis/rhinitis
* Recurrent otitis media
* +C-ANCA
35
Treatment of GPA?
* steroids and cyclophosphamide
36
Radiology of GPA?
* lung nodules
* patchy ground glass opacities
* hilar LAD
37
What is goodpasture syndrome?
* AI condition against the glomerular and alveolar basement membrane
* results in destruction of lung parenchyma diffuse alveolar hemorrhage and glomerulonephritis
38
Clinical presentation of goodpastures syndrome and labs?
* Weight loss
* fever
* proteinuria
* hematuria
* dyspnea
* hemoptysis
* cough
* hypoxemia
* + anti-GBM
39
Treatment of Goodpasture's?
Plasmapheresis + steroids + cyclophosphamide
40
What is hypersensitivity pneumonitis
* extrinsic allergic alveolitis caused by repeated exposure to Ag of environmental or occupational nature in a sensitized individual
41
History of hypersensitivity pneumonitis?
* cough dyspnea low fever
* Recent or chronic exposure to allergen
* gets better when outside of the environment
42
Histoloogy of Hsn pneumonitis?
* Plasma cells
* +/- non caseating granulomas
43
PFT's of hsn pneumonitis?
* Restrictive pattern
* +/- DLCO
44
Pneumoconiosis?
* Inflammation from inhaling inorganic dust
* results in fibrosis
45
Silicosis risks?
* miners
* stone cutters
* sand blasting
* quarry workers
