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79 Cards in this Set
- Front
- Back
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What are the components of the 4-stage approach to the critical patient?
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Triage (determine need for immediate action)
Primary Survey (ID life threatening problems) Initial Stabilization (address life-threatening probs) Secondary survey (full exam and therapeutic plan) |
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What are the major systems involved in triage?
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Respiratory
Cardiovascular CNS (maybe also musculoskeletal) |
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How is the CV system assessed during triage?
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MM color
CRT Pulse quality Heart rate/rhythm |
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What are tachycardia/bradycardia values for a large dog? Smaller dog? Cat?
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Large dog >160; <60
Small dog >180; <60 Cat >220, <80 |
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Which of the following are triage stat categories?
a) Toxic ingestion b) Acute blindness c) GDV d) Active seizures e) Bite wound |
c) GDV
d) Active seizures e) Bite wound |
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Which of the following are NOT high-priority triage categories (or, which are STAT cases)?
a) Urethral obstruction (cat) b) Significant active hemorrhage c) Respiratory distress d) Hypo or hyperthermia e) Pale/cyanotic/white mucous membranes |
b) Significant active hemorrhage
c) Respiratory distress e) Pale/cyanotic/white mucous membranes |
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What does ABCD stand for?
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Airway
Breathing Circulation Disability (neurologic) |
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T or F:
A blood pressure is often helpful when evaluating the cardiovascular system during triage. |
False!
This is done in the primary survey! |
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At which values do you worry about hypotension in a dog? What are some possible causes of these values?
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Dog (Systolic <90; MAP <60)
Decreased circulating volume, peripheral vasodilation, myocardial failure, spurious result |
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How can MAP be roughly calculated?
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MAP = diastolic + (1/3 (systolic-diastolic))
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What are values for hypertension in dogs? What might cause this?
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>160 systolic; >95 diastolic
Fear, pain, hyperthyroid, CRF, DM, spurious result |
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What is the goal of initial stabilization?
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OXYGENATE THE TISSUES
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What are the arterial oxygen content variables that can be modified and how can this be achieved?
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Hemoglobin (blood or oxyglobin)
Oxygen saturation (oxygen therapy; relieve constrictive/obstructive issues such as pneumothorax) |
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What are the variables of blood pressure that can be modified and how is this achieved?
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Contractility (positive inotropes)
Preload (fluid therapy) Systemic Vascular Resistance (Vasopressors) |
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Which would be an appropriate treatment for a cat with low BP, high HR, and pale MMs?
a) 4ml/kg hypertonic saline b) a 5ml/kg bolus of colloid administered rapidly c) a slowly administered bolus of crystalloid at 10ml/kg d) all of the above are appropriate e) none of them are appropriate |
a) 4ml/kg hypertonic saline
(note; colloids in cats are given SLOWLY; the crystalloid bolus should be pretty rapid, and there can be only one dose of hypertonic saline) |
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T or F:
Positive inotropes and pressors should be used during volume expansion. |
False!
Volume expand first, then use the drugz |
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What are some initial stabilization techniques for a blocked cat/dog?
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Check and rectify acid/base imbalances
Remove obstruction |
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Dogs with temperatures above _______ require active cooling while temps below _________ require active heating.
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>106 cooling; <94 heating
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What are the important elements of the secondary survey?
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Evaluate open wounds/fractures
Evaluate abdomen Abdominal/thoracic rads in ALL trauma patients Take minimum database Frequent recheck! Pain meds +/- abx |
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What are minimum database datapoints for most emergency cases?
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PCV/TS, BUN, Bilirubin, Glucose
Maybe clot times Evaluate abdominal/thoracic fluids |
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What are some indications for fluid therapy?
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Correct dehydration
Volume expansion/replacement Drug delivery Correct acid/base/electrolyte abnormalities Free water replacement |
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Which of the following are true regarding small animals?
a) ECF is 33% BW b) Interstitial volume is 75% BW c) Intracellular volume is 75% BW d) dog blood volume is 60ml/kg e) cat plasma volume is 30-40ml/kg |
a) ECF is 33% BW
e) cat plasma volume is 30-40ml/kg (note: dog blood volume is 90ml/kg, plasma volume is 60ml/kg) |
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What are the 4 variables in Starling's equation?
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Surface Area
Membrane permeability Oncotic pressure Hydrostatic pressure |
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Which of the following describe hypovolemia?
a) prolonged skin tent b) hypotension c) poor pulse strength d) pale mucous membranes e) elevated PCV |
b) hypotension
c) poor pulse strength d) pale mucous membranes (also tachycardia and prolonged CRT) |
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Which of the following describe dehydration?
a) tacky mucous membranes b) sunken eyes c) tachycardia d) prolonged CRT e) hypotension |
a) tacky mucous membranes
b) sunken eyes (also prolonged skin tent, elevated PCV) |
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Which fluid type is the most common rehydration fluid? What are examples of this?
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Isotonic fluid
(LRS, Normasol, 0.9% NaCl) |
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Which fluid type is the most common maintenance fluid? What are examples of this?
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Hypotonic fluid
0.45% NaCl |
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Which fluid types are best for intravascular fluid replacement?
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Hypertonic
Colloid |
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T or F:
Intravascular deficits must always be replaced rapidly. |
True!
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What volume of crystalloid should be given to a 30kg dog in shock and over how much time?
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600mL ASAP (use 20ml/kg)
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If bolusing an animal for shock using crystalloid, what volume of colloid can be added to the mix?
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4ml/kg colloid
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What is the crystalloid maintenance dose per day? Colloid?
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(30 x body wt) +70 = mL crystalloid per day
Colloid is 20ml/kg/d |
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Outside of physical exam parameters, how can maintenance fluid therapy be monitored?
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Blood pressure
Central venous pressure (if >10 = fluid overload) Colloid oncotic pressure PCV/TS |
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Which physical exam parameters can be used to monitor maintenance fluid therapy efficacy?
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CRT
HR MM Skin tent Body Wt Pulse Urine output |
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What are signs of fluid overload?
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Facial/conjunctival edema
serous nasal discharge peripheral edema increased resp rate/most rales CVP>10cm H2O |
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How is fluid overload treated?
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Stop fluids!
Give furosemide! Maybe dialysis (yeah right...) |
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What are the three causes of hypernatremia?
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Pure water deficit
Hypotonic fluid deficit Sodium toxicity |
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Normal Na values are usually _______. CNS effects are seen above _______.
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Normal 145 - 155 mEq/L
CNS >170 |
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When replacing water in a hyponatremic case, replacement rate should ___________ rate of development. Rate of Na replacement should be less than _________ mEq/L/hr.
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Replacement rate should parallel development rate but should not go above 0.5mEq/L/hr.
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What are causes of hyponatremia?
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Na loss/depletion
Excess water gain Pseudohypernatremia (hyperlipidemia, hyperproteinemia) |
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Which of the following result in a pure water deficit?
a) vomiting b) heavy panting c) Diabetes Mellitus d) Diabetes Insipidus e) hyperaldosteronism |
b) heavy panting
d) Diabetes Insipidus |
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What is a major sequel to HYPOnatremia? How low must the Na go to be clinically significant?
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Cerebral edema!
Na <125 is significant |
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T or F:
Na <125 mEq/L is always clinically significant. |
False!
You must take serum osmolality into account - if osmolality is low and Na is low, then it is truly hyponatremic! |
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What is the normal range for serum osmolality?
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290 - 310 mOsm/kg
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Rapidly replacing Na can lead to...
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...central pontine myelinosis
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Which of the following are causes of pseudohypochloremia?
a) Addison's b) Severe pancreatitis c) Gastric outflow obstruction d) Pleural effusion e) Vomiting |
a) Addison's
d) Pleural effusion (also congestive heart failure, peritoneal effusion) |
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Hypochloremia is characterized by metabolic _______________ while hyperchloremia is metabolic ______________.
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ALKALOSIS for hypo
ACIDOSIS for hyper |
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Which electrolyte is...
Most abundant intracellular cation? Principal anion in the body? Major extracellular osmole? Found mostly in bone? Important in ATP reactions? |
Most abundant intracellular cation - K
Principal anion in the body - Cl Major extracellular osmole - Na Found mostly in bone - Ca and P Important in ATP reactions - Mg (P is part of ATP too) |
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What are clinical signs of hypokalemia?
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Cervical ventriflexion (cats)
Weak, plantigrade stance Ileus, cramping |
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Potassium supplementation should not exceed what rate?
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0.5mEq/kg/hr
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How is hyperkalemia treated?
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Dextrose/Insulin
Ca Gluconate Bicarb |
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Which is true regarding hyperkalemia treatment?
a) In order to be the most cardioprotective, Ca gluconate should be given rapidly b) treat for hyperkalemia when K >8mEq/L c) treat for hyperkalemia when ECG changes suggest hyper K d) tall, spiky P waves are suggestive of hyper K |
b) treat for hyperkalemia when K >8mEq/L
c) treat for hyperkalemia when ECG changes suggest hyper K (note: tall, spiky T waves, are hyper K and Ca gluconate should be given slowly) |
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A deficiency of which electrolyte is associated with increased mortality?
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Hypomagnesemia
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Hypomagnesemia is associated with what other imbalances?
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Low Na, K, Ca
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What is the most common cause of hypermagnesemia?
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Oversupplementation! (iatrogenic)
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T or F:
Normal total calcium is ~10 mg/dL and normal total ionized is about half this. |
True!
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Clinical signs of hypocalcemia are generally not seen until ionized Ca is below ______.
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ionized Ca <0.8mmol/L
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Which of the following is NOT a cause of hypocalcemia?
a) hypomagnesemia b) tetany c) pancreatitis d) hypoparathyroid e) hypothyroid |
b) tetany
e) hypothyroid |
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Hypercalcemia is seen when total Ca is above ________ or ionized Ca is above ________.
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total >12mg/dL; ionized 1.3mmol/L.
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Which of the following are NOT signs of hypercalcemia?
a) tremors/twitching b) hypertension c) arrthymias d) tetany e) 3rd eyelid prolapse |
d) tetany
e) 3rd eyelid prolapse (both are HYPOcalcemia) |
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Which of the following are NOT signs of hypocalcemia?
a) PU/PD b) tremors/tetany c) stiff gait d) itchy face e) soft tissue mineralization |
a) PU/PD
e) soft tissue mineralization |
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How is hypocalcemia treated?
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Ca gluconate
CaCl2 Oral vit. D for chronic |
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How is hypercalcemia treated?
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Furosemide
IV isotonic saline Inhibit bone resorption (pred/dexameth/calcitonin) |
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What is a major clinical sign of hypophosphatemia?
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RBC lysis (occurs at <2mg/dL)
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How is hypophosphatemia treated? What else must be monitored?
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K3PO4 (monitor K)
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Which of the following is an effective phosphorous binder?
a) AlOH3 b) K3PO4 c) CaCl2 d) Ca(OH)2 e) Ca gluconate |
a) AlOH3
d) Ca(OH)2 |
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Which of the following are considered to be in the respiratory zone of the airway?
a) terminal bronchioles b) alveloar sacs c) trachea d) bronchioles e) alveolar ducts |
b) alveloar sacs
e) alveolar ducts (also respiratory bronchioles) |
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Which of the following are considered part of the upper airways?
a) bronchioles b) trachea c) larynx d) pharynx e) bronchi |
b) trachea
c) larynx d) pharynx (also nasal cavity) |
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What are the 5 causes of hypoxemia?
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V/Q mismatch
True shunt (venous admixture) Low inspired O2 fraction Diffusion impairment Hypoventilation |
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Which of the following describe an obstructive respiratory pattern?
a) edematous lungs b) fast breathing c) deep breathing d) shallow breathing e) barrier in the air passages |
c) deep breathing
e) barrier in the air passages (obstructive is deep and slow) |
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What are some differentials for tachypnea?
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Acidosis
Hyperthermia Metabolic/endocrine disorder anemia hypoxia exercise, anxiety, drugs |
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Paradoxical abdominal motion indicates which diseases?
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Pleural space dz
Upper airway obstruction Decreased lung compliance |
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Describe abnormal respiratory posturing.
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Abducted elbows, extended neck
Dogs (unwilling to sit or lie down) Cats (sternal, hold chest off ground) |
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Which of the following would result in rapid/shallow breathing patterns?
a) Upper airway obstruction b) Asthma c) Pneumonia d) Lung neoplasia e) broken ribs |
c) Pneumonia
d) Lung neoplasia e) broken ribs (also hemorrhage, fibrosis, edema, pleural space dz) |
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T or F:
Inspiratory dyspnea is usually due to an upper airway disorder. |
True!
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Which of the following is associated with inspiratory dyspnea?
a) laryngeal paralysis b) stridor c) crackles and wheezes d) paradoxical abdominal motion e) short inspiration/long expiration |
a) laryngeal paralysis
b) stridor d) paradoxical abdominal motion |
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What are examples of diseases with an expiratory dyspnea?
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COPD, Asthma, infectious bronchitis
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What are some non-airway causes of coughing?
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Pulmonary edema
Cardiac pressure on the bronchus |
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Which of the following usually require a stethescope to hear?
a) wheeze b) stertor c) coarse crackles d) stridor e) fine crackles |
a) wheeze
c) coarse crackles e) fine crackles |
