pneumothorax

pulmonary embolism

inc LVEDP

when they report a recent Hx of prolonged immobilization

are on estrogen therapy

have other risk factors for DVT

or when the cause of dyspnea is not apparent

myocardial ischemia

pulmonary embolism

new onset asthma

foreign body

vocal cord dysfunction

anemia

methemoglobinemia

cyanide ingestion

CO

metabolic acidosis

panic attacks

Head and neck

Chest

Heart

Lower extremities

pursed-lip breathing

use of extrarespiratory mm

barrel-shape chest

Pulse Ox values <94% almost always represent what?

What are the exceptions?

clinically significant hypoxemia

CO toxicity and methemoglobinemia

tachycardia

systolic hypotension

JVD

Hepatojugular reflux

crackles, esp bibasilar

3rd Heart sound

LE edema

radiographic pulm vascular redistribution or cardiomegaly

recurrent PE

myocardial ischemia

RAD

Pneumonia

severe exacerbation of COPD req hospitalization

new-onset CHF

pneumothorax

PE

interstitial lung disease

Acute respiratory tract infection

asthma

AR

CHF

when the pt shows abnormal vital signs or

has a chest exam suggestive of pneumonia

postnasal drip syndrome

asthma

GERD

Chr bronchitis

Bronchiectasis

TB or other chr infection

interstitial lung diseases

bronchiogenic carcinoma

chronic bronchitis in a smoker or

bronchiectasis in pt with Hx of recurrent or complicated pneumonia

ACE inhibitor therapy

post-infectious cough

polymerase chain rxn tests and

Cx from a nasopharnygeal swab

Suspected Condition - Empiric Txt - Dx testing

Postnasal drip - __________________ - ENT referral/sinus scan

Suspected Condition - Empiric Txt - Dx testing

Asthma - B2 - _______________

Suspected Condition - Empiric Txt - Dx testing

GERD - PPI - __________________

chronic bronchitis

bronchiectasis

bronchogenic carcinoma

LVF

Mitral stenosis

pulmonary emboli

AV malformations

Pneumonia

inhalation of crack cocaine

autoimmune dz (Goodpasture's dz, Wegner's granulomatosis)

transbronchial lung biopsies

anticoagulation

pulmonary artery rupture due to distal placement of a balloon-tipped catheter

CXR

CBC w/ plt ct

renal fxn tests

UA

coagulation studies

flexible bronchoscopy

high-res CT of chest

Influenza virus

Mycoplasma Pneumonia

Chlamydia Pneumonia

Bordetella pertussis

Early phase of asthma is ____ mediated

Late phase is associated with ____________ release

IgE (assc with c histamine release from mast cells)

C cytokine

mild: expiratory wheezes

Moderate: expiratory and inspiratory wheezing

severe: diminished breath sounds and no wheezing

CHF

COPD

upper airway obstruction from foreign body

tumor

laryngeal edema

carcinoid tumors (stridor)

sxs 2 or less times a wk

asymptomatic and norm PEF btwn exacerbations

exacerbations are brief (hrs to days)

intensity may vary

Sxs >2 times/wk but < 1x/d

exacerbations may affect activity

daily sxs

daily use of inhaled short acting B2 agonist

exacerbations affect activity

exacerbations 2+ times/wk

may last days

continual symptoms

limited physical activity

frequent exacerbations

Hx of cigarette smoking

Chr cough and sputum production (in chr bronchitis)

dyspnea (in emphysema)

rhonchi, dec intensity of breath sounds

prolonged expiration on physical examination

airflow limitation on PFTs that is not fully reversible and most often progressive

excessive secretion of bronchial mucus

daily productive cough for 3+ mths in at least 2 consecutive yrs

recurrent pneumonia and hemoptysis

digital clubbing

radiographic abnormalities

1. Iprotropium bromide (preferred)

2. SAB2 agonist (albuterol, metaproterenol)

work better together (at submaximal) then either alone

severe lung dz

limited ADLs

exhaustion of medical therapy

ambulatory status

potential for pulmonary rehab

limited life expectancy w/o transplant

adequate fxn of other organs

good social support system

1. lung transplantation

2. Lung Volume Reduction surgery

3. Bullectomy

What is the median survival of pts with severe COPD

(FEV1 <1 L)?

Radiographic finding of _________________ are: dilated, thickened airways and scattered, irregular opacities

"tram-tracks" or ring-like markings

Hemoptysis

Cor pulmonale

amyloidosis

secondary visceral abscesses at distant sites

in children its usually severe and acute

in adults its usually chronic and frequently progressive

1. constructive (hypertrophy causing obstruction)

2. proliferative (polyps partially or completely obstruct bronchioles)

Dry cough, dyspnea and flu-like sxs from days to mths

fever and wt loss

crackles in most, wheezing in 1/3

aspiration

post obstructive

gram neg

staph aureus

clarithromycin

doxycyline

levofloxacin

dull to percussion

egophony

Altered mental status

altered consciousness

recent seizures (suggest aspiration pneumonia)

periodontal dz (anaerobic inf)

absent gag reflex (bacteriodes species)

encephalitis (legionella)

Nitrofurantoin

amiodarone

- Inability to take oral meds

-Multilobar involvement

-Severe vital sign abnormality(pulse>125/min, stolic BP <90, resp >30min)

-Acute mental status changes

-Arterial hypoxemia (room air O₂ <60)

-Severe acute electrolyte, metabolic, or hematologic abns (Na <130, Hct <30%, Neutrophils <1000, BUN>50, SrCreat>2.5)

-Acute comorbidities

PCN or Amoxicillin

unless it has PCN-resistance then, Vanc or ceftriaxone

2nd or 3rd gen cephalosporins or bactrim

3rd gen cephalosporin

methicillin

vancomycin

fever (50-80%)

malaise

wt loss

night sweats

wasting

hemorrhage

respiratory failure

in the morning

preferrably 3 consecutive mornings

anemia

leukocytosis

TB infection - INH qd for 9 mos

TB disease - INH, Rifampin, Pyrazinamide and ethambutol or streptomycin, one pill of each, qd, for 6 mos

NSCLC

squamous cell carcinoma, assc w/ cigarettes

adenocarcinoma, most common

large-cell carcinoma

SCLC

small-cell lung carcinoma, worst, assc with cigarettes

squamous cell -- epithelium of proximal airway

Adenocarcinoma -- goblet cells in major bronchi

small cell -- oat cell, intermediate and combined cell types

NSCLC - surgery, possible radiation

SCLC - chemo

1. a noncaseous or nonnecrotizing granuloma

2. cause is unknown

3. systemic disease

4. should have clinical consistency

dysnpea

pleuritic CP

tachypnea

hypercoagulable state

endothelial injury

local stasis

Asbestos

coal dust

silica

beryllium

1. inc production of fluid in the setting of normal caps due to inc hydrostatic or dec oncotic pressure (transudates)

2. inc production of fluid to abn cap permeability (exudates)

3. dec lymphatic clearance of fluid from pleural space (exudates)

4. infection in the pleural space (empyema)

5. bleeding into the pleural space (hemothorax)

bacterial pneumonia

CA

tension

usually a complication of mechanical ventilation or other secondary pneumothoraces

hyperresonance on percussion

diminished or absent tactile fremitus and breath sounds

tension

hydropneumothorax

hemopneumothorax

and pneumothorax with underlying pulmonary dz

pleuritic CP

tachypnea

tachycardia

dec breath sounds

hypotension

JVD

(you may also see tracheal deviation)

Doppler echocardiography is an effective way to estimate pulmonary artery pressure if ___________________is suspected

daytime somnolence

increased risk for MVA

Irritability

HA

HTN

increase in sudden death, probably from arrhythmias

enlarged tonsils

macroglossia

a long soft palate and uvula

micrognathia

overnight polysomnography

airflow, O2 sat, and respiratory, eye, chin and limb mvt are recorded

Hypothyroidism

acromegaly

amyloidosis

1. Ventilation/perfusion mismatch

2. Alveolar hypoventilation

3. right to left shunt

4. decreased inspired O2 tension

These are the 4 causes of ______________

<10 mins

rest or NTG

in the AM

in cold weather

after a large meal

or after exposure to environmental factors

vascular congestion caused by dec LV function

(the vascular congestion impairs gas exchange and results in exudation of fluid into the alveolar space)

an increase in dyspnea upon laying down

(augmented venous return that occurs assuming the recumbent position)

bicuspid aortic valve

rheumatic fever

degenerative stenosis

angina

syncope

dyspnea

CHF

bicuspid aortic valve

aortic dissection

endocarditis

rheumatic fever

aortic root dilation

dyspnea on exertion

orthopnea

paroxysmal nocturnal dyspnea

chest or head pounding

fatigue or weakness

infective endocarditis,

traumatic rupture of the aortic leaflets,

aortic root dissection and

acute dysfunction of a prosthetic valve

can all cause which type of heart valve dysfunction?

dyspnea

orthopnea

A fib

mitral valve prolapse

left ventricular dilation

posterior wall MI

rheumatic fever

endocarditis

posterior wall or papillary mm ischemia

papillary mm or chordal rupture

endocarditis

prosthetic valve dysfunction

the leaflets

the annulus

the chordae

or the papillary mm

myxomatous degeneration of the mitral valves

which progresses as the chordae become elongated and rupture

functional annular dilation

tricuspid valve prolapse

endocarditis

fatigue

abd bloating

peripheral edema

The murmur of ____________________ is a high pitched, blowing murmur best heard at the 2nd left intercostal space.

Its also called a _______________ murmur.

pulmonic regurgitation

Graham Steel

carditis

polyarthritis

chorea

erythema marginatum

subcutaneous nodules

fever

arthralgia

previous rheumatic fever

or known rheumatic heart disease

2 major

OR

1 major and 2 minor

1.2 million U of benzathine PCN monthly

OR

oral PCN or erythromycin

Obesity

HTN

DM

lipids

BP

accumulation of lipoproteins

endothelial injury and

inflammation

unstable angina

NSTEMI

STEMI

rest

gradually

hours

thrombolytics and

coronary intervention (stenting is the procedure of choice)

CBC

SrCr, BUN

electrolyte panel

PT, PTT, INR

blood typing, cardiac enzymes

ABG, CRP, homocysteine

fasting lipid panel

1. artherosclerosis

2. thrombus

3. spasm

dysnpea

weakness

diaphoresis

NVD

confusion

feeling of impending doom

angina, MVP, dissecting AA

cocaine induced CP, musculoskeletal factors

rib fracture, nerve root compression

bacterial PE, anxiety disorder, esophagitis

spontaneous pneumothorax

cholocystitis, cholelithiasis

Prolonged ischemia may produce

_______________,

_______________, or even ______.

myocardial stunning

hibernation or even MI

extensive skeletal mm injury or disease

chronic renal disease

hypothyroidism

impulse formation

and/or

impulse conduction

1. premature beats

2. bradyarrhythmias

3. tachyarrhythmias

atrial premature complexes

junctional premature complexes

ventricular premature complexes

supraventricular

ventricular

pre-excited tachycardias

palpitations

presyncope, syncope

dizziness

CP

sxs of HF

Echocardiogram

Recording devices

Head-up tilt table testing

electrophysiologic study

recur

aggressive therapy

digoxin

theophylline

anti-arrhythmic agents

certain Abx

decongestants

cocaine

hypokalemia

hypomagnesemia

hypoxia

hyperthyroidism

pacemakers

direct current cardioversion and defibrillation

radiofrequency catheter ablation and automatic implantable cardioverter-defibrillators

known heart disease

Older men

younger women who are prone to vasovagal episodes

excessive vagal tone

or

impaired control of peripheral circulation

the elderly

diabetics, or other pts with autonomic neuropathy

pts with blood loss or hypovolemia

or pts taking vasodilators, diuretics or adrenergic blockers

aortic stenosis

pulmonary stenosis

hypertrophic obstructive cardiomyopathy

congenital lesions assc with pulm HTN or L to R shunting

LA myxoma obstructing the mitral valve

disorders of automaticity like sick sinus syndrome

disorders of conduction like an AV block

tachyarrhythmias (esp VT, SVT)

1. contractile state of the myocardium

2. preload of ventricle

3. afterload applied to the ventricles

4. heart rate

thyrotoxicosis

severe anemia

AV shunting

Pagets

Thiamin deficiency

HTN

DM2

cardiomyopathies

pericardial dz

systolic/diastolic

high/low output

L/R sided

acute/chronic

hypertrophic cardiomyopathy

cardiac amyloidosis

sarcoidosis

1. asymptomatic

2. symptomatic with moderate activity

3. symptomatic with slight activity

4. symptomatic at rest

RUQ pain

loss of appetite

N

pulmonary edema

ECG

CXR

ECHO

Card Cath

CCBs

NSAIDs

Anti-arrhythmic agents

Lasix, Spironolactone

ACEI or ARBs

BB

Digitalis glycosides

Vasodilators (nitrates, nesiritide, hydralazine)

CCBs

Anticoagulation

extensive MI or severe ischemia

volume overload

arrhythmias

mitral stenosis

ventricular septal rupture

d/c of meds

excessive salt intake

tachyarrhythmias

myocardial ischemia

a viral infection

coxsackievirus B and echovirus being the more common

dec in VLDL production

secondary dec in LDL and inc in HDL

dec TGs by 1/2

hypothermia                          HA

confusion                               bizarre behavior

visual distrubances              seizures

lethargy                                  syncope

coma

those with hypopituitarism, Addison's dz, myxedema

acute alcoholism, liver failure

renal failure

1. hyperinsulinism

2. non-insulin-producing extrapancreatic tumor

sulfonylureas

insulins

quinine, quinidine

disopyramide

salicylates

ACEIs

gatifloxacin, pentamidine

What are the levels of the following in a pt with DKA?

glucose

sr bicarb

blood pH