SOB and Cough/Hemoptysis Flashcards Preview

CRRAB 2 > SOB and Cough/Hemoptysis > Flashcards

Flashcards in SOB and Cough/Hemoptysis Deck (19):
1

Dyspnea

abnormally uncomfortable awareness of breathing

2

COPD

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

3

Chronic Bronchitis

chronic productive cough for 3 months for 2 years

4

Emphysema

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

5

Asthma

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

6

Clinical features of COPD

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!!!!

7

PE of COPD

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

8

Management of COPD

SMOKING CESSATION!
other drugs

9

Classic Triad of Asthma

Persistent Wheeze
Chronic Cough
Chronic Dyspnea

10

Metacholine test

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

11

Asthma Severity

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

12

Step-wise approach to treating asthma

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

13

Chronic Cough

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

14

DDx of hemoptysis

Airway disease
Pulmonary parenchymal disease
Pulmonary vascular disease
Miscellaneous

15

Evaluation of hemoptysis

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

16

Pulmonary Embolism

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]

17

Signs and Symptoms of PE

Dyspnea
Pleuritic chest pain
Cough
Hemoptysis
Tachypnea
Tachycardia
Crackles
Loud P2

18

Workup of PE

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

19

Treatment of PE

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