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18 Cards in this Set
- Front
- Back
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Trigeminal, glossopharygeal, phrenic, and vagus nerves all feed into the ______ cough center. The effector nerves are the phrenic, vagus, and what?
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medullary
spinal motor - expiratory muscles |
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What are the 3 most common causes of cough?
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Postnasal drip, asthma, GI reflux... also need to consider URI's, side effect of ACE inhibitors, smoker
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Which cough medicine works better?
Codeine or Dextromethorphan |
Equal in effectiveness - better to use over the counter
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What vessels does the blood in hemoptysis come from?
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bronchial arteries - supply airways, hilar lymph nodes, visceral pleura.
They are at systemic pressure unlike the pulmonary arteries! |
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Increased risk factors for lung tumor:
Gender? Age? Smoking hx over __ pack years Hemoptysis greater than _ week(s) |
male
over 40 over 40 pack years 1 week |
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What test do you do first when a pt comes in with hemoptysis?
Which test found all tumors seen by that test, plus others? |
Bronchoscopy
Spiral CT |
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What is the source of most PE's?
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Iliofemoral thrombi (calf vein thrombi usually don't embolize)
Consider pelvic veins as a source as well |
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PE Risk factors:
Immobilization Surgery within __ months Stroke Hx of thromboembolism malignancy Air travel - over ____ miles Obesity, heavy smoking, hypertension, bc, pregnancy - only in who?? |
3 mos
3000 miles only in women |
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If someone has a PE w/o risk factors what mutation is in 40% of these cases
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Factor V Leiden
high concentrations of factor VIII occult malignancy in up to 17% |
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Most pts with PE have what 2 sx?
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Dyspnea (72%), pleuritic pain (66%)
absent sx in 26% of pts cough in 36% hemoptysis 13% |
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What PDX things do you look for in PE pt?
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Tachypnea
Crackles Tachycardia Loud P2 Fever |
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What is a loud P2?
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Pulmonary valve is louder than aortic valve in pulmonary hypertension
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Workup for PE:
ABG - usually have decreased __ __ and respiratory _____ ECG insensitive CXR - many normal, maybe effusion D-dimer - low specificity, but high _______ |
PO2, CO2, alkalosis
sensitivity |
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What type of imaging should you use for PE?
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Spiral CT - specficity of 90%, 70-87% sensitivity
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if someone has low pretest probability and normal D-dimer what do you do?
Moderate or high pretest? High pretest with normal spiral CT? |
Nothing - no need to anticoagulate
proceed with spiral CT angiography |
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Although unfractionated and low mol weight heparin have the same effectiveness, low molecular weight has these advantages:
once daily fixed dose no what needed? less likely to cause decreased _____ |
lab monitoring
platelets |
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Heparin is overlapped with warfarin for at least _ days. Warfarin for _ months.
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5 days
6 mos |
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When would you use thrombolytics?
When would you use a vena caval filter? |
in massive PE's with hypotension
In pts with PE and contraindication for anti-coagulation or recurrent PE despite anti-coags |
