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48 Cards in this Set

  • Front
  • Back

What is the course of asthma

Fluctuating course

What are the symptoms of asthma



Chest tightness


What causes exacerbations

1. Allergen (LMW penicillin, Organic Dander)

2. Non specific stimuli (cold air)

3. No identifiable source

Which mediators cause bronchoconstriction

1. Histamine

2. Methacholine

Which drugs cause bronchoconstriction

1. Beta antagonists (propranolol, metoprolol is Beta 1 selective but is still contraindicated)


Which physicochemical agents cause bronchoconstriction


Sulfer Dioxide

Nitrogen Dioxide

What kind of response does an allergen cause

Cytokine/inflammatory mediator release causing mucus hypersecretion

Is asthma predictable of unpredictable

Unpredictable disease

Which immunoglobulin is formed in an allergic reaction of asthma


What is the early response in asthma

Within 10-15 minutes of exposure

What is the late response in asthma

6-10 hours after exposure by "late formed" mediators

What time of the day are the symptoms of asthma bad

Night time

Why does a wheeze occur in asthma

Intrathoracic pressure > intra-airway pressure (worth with forced attempts)

What causes the dyspnea

early = greater muscle effort

later = hypoxemic effect from chemoreceptor

What causes chest tightness

Increased muscle effort and bronchocontriction

What are the clinical signs of asthma

1. Tachycardia

2. Tachypnea

3. Pulsus Parodoxus (not common)(drop in systolic blood pressure in inspiration of greater than 10 mmHg)

4. Hypoxemia (V/Q mismatch)

5. Decreased PCO2

6. Decreased FEV1; FEV1/FVC;peak flow (common to obstructive defects)

7. Bronchial Hyper-responsiveness (greater than normal drop in FEV1 with methacholine test)

What does a rising PC02 in asthma suggest

Decompensating asthma

What are the Ddx for asthma


2. CHF


4. Pneumonia

5. Pneumothorax

What is the outpatient treatment of asthma

Step 1: beta 2 agonist prn

Step 2: add daily ICS

Step 3: Add long acting beta 2 agonist and leukotriene agonist

Step 4: Add sustained released theophylline and oral corticosteroid

What is the Emergency department treatment for Asthma

First: assess ABC (any concern get MD)

Consider assessing with spiro as treatment begins



Ipratropium amount empiric but often 3 doses

IV or oral corticosteroids

Consider antibiotic (if infection), aminophlline, magnesium

Which patient with Asthma do you admit

FEV1 < 40%; post treatment FEV1 < 60%

They just don't look well

Does a normal O2 saturation mean the asthmatic patient is stable


What are some things you should keep tract of an asthmatic patient that means things are going wrong

1. Normal or elevating PCO2

2. Not working as hard

3. No more wheezing

4. Dont mist pneumonia

5. Premature discharge

6. Do not under treat asthma

7. Be careful of beta blocker and NSAID/ASA

What analogy can you use to describe ventolin

Fire extinguisher

What is the most common cause of COPD


What happens in COPD

1. Persistent inflammation of airway

2. Parenchymal destruction (less support of small air ways)

3. Expiratory airway collapse and air trapping (because of the destruction of the surrounding tissue i.d. parenchyma)

4. Hyperinflation

5. Increased lung compliance

When is the cross sectional area the greatest and smallest in the bronchioles

Greatest = inspiration

Smallest = expiration (lumen gets supper small)

What are the results of emphysema

1. Decreased alveolar surface area

2. Decreased elastic recoil

3. Increased alveolar gas volume

4. Fewer capillaries

What does pursed airway breathing allow

Increase intra air way pressure to prevent collapse of the alveoli

Which gender is COPD more common in

More common in women than men EXCEPT older than 75

What are the symptoms of COPD

1. Dyspnea

2. Cough

3. Sputum

4. Fever

5. Exercise Tolerance

What causes the majority of COPD exacerbations


What can cause COPD exacerbation without an infection

1. CHF

2. MI

3. PE

4. Pneumothorax

What are the clinical signs of COPD exacerbation

1. Visible Dyspnic

2. Cough

3. Flaired nasal

4. Pursed lip breathing

5. Accessory muscle use

6. Barrel chest

7. Intercostal withdrawing

8. Hyperresonant to percussion

9. Wheeze

10. Altered LOC

11. ABG: hypoxemic, hypercapnic, acidosis

12. Obstructive pattern pulmonary function test

How do you manage COPD

1. ABC

2. Consider intubation if unstable

3. Consider BiPAP


If hypoxemic DO NOT withhold for fear of CO2 retention (afraid they won't be breathing out CO2 anymore)

Deliver in controlled manner

If a patients O2 sat is low should you ever withhold oxygen

NO, always give oxygen in an acute setting because no oxygen will kill the patient. You can always titrate the oxygen downward to maintain sats in the low 90's if you are concerned about CO2

What is the management of COPD

1. Salbutamol Nebulized

2. Ipratroprium Nebulized

3. Antibiotics

4. Systemic steroids

In DVT what is Virchows Triad

1. Venous stasis (immobile person)

2. Endothelial Disruption (prior DVT's, orthopedic injury)

3. Hypercoagulable state (Drugs, malignancies)

Which tests do you consider for DVT

1. D-dimer

2. Ultrasound

3. Contrast venogram

What is the treatment for DVT

Anticoagulant (Wafarin, UFH, LMWH, NOAC)

What is in the physical examine for DVT

1. Increase temp in limb

2. Increase limb size

3. Low grade fever

4. Calf tenderness

5. Palpable cord

6. Homan's sign

7. Signs of pulmonary embolism

What are the Signs and symptoms of Pulmonary Embolism

1. Dyspnea

2. Tachypnea

3. Wheezing

4. Tacyhcardia

5. Pleuritic chest pain

6. Hemoptysis

Where does pulmonary embolisms arise from

DVT (thrombosis embolised into lungs)

What is vital in regards to testing in PE

Need to rule PE in or out

What are the test for PE

1. D-dimer (highly sensitive test to rule out PE)(not specific)(therefore can be positive without having a PE)

2. CXR (non sensitive)

3. ECG (non sensitive)

4. ABG (non sensitive)

5. V/Q scan (some what sensitive and specific)

6. CT-PE study (This is the gold standard)(Most sensitive and specific)

What is the treatment for PE

1. Prevention (get person walking right after surgery)

2. Oxygen

3. Anticoagulation

4. Thrombolytics (only to pt you think my code, or have a high risk)

5. IV filter

What is high, moderate, and low probability for wells DVT score

3 = high

1-2 = moderate

0 = low

What is high, moderate, and low probability for Wells PE criteria

High > 6

Moderate 3-6

Low < 2