Approach to acute breathlessness Flashcards Preview

Internal Medicine > Approach to acute breathlessness > Flashcards

Flashcards in Approach to acute breathlessness Deck (28):
1

Causes of breathlessness categories

Respiratory airways
Parenchymal
Pulmonary circulation
Chest wall and pleura
Cardiovascular
Anemia
Non cardiorespiratory

2

Airways disease causes

COPD
Asthma
Bronchitis
Bronchiectasis
CF
Laryngeal/pharyngeal/bronchial Ca

3

Parenchymal disease

ILD
Infections
ARDS
Pneumothorax
Pneumoconiosis

4

Pulmonary ciruclation

Pulmonary embolism
Chronic thromboembolic pulmonary HTN
AV malformation

5

Chest wall and pleura

Effusion
Tumor
Fractured ribs
AS
Kyphoscolosis
NM disorders

6

Cardiac causes

LVF
MVD
Cardiomyopathy
Pericardial effusion or constrictive pericarditis

7

Non cardio-respiratory

Psychogenic
Acidosis
Hypothalmic
Thyroid
Ascites
Stoke
Normal ageing, deconditioning
GORD

8

Questions to ask breathless

How long?
Exercise?
PND/Orthopnea?
Heart or lung?
Fever?
Smoker?
Tightness in chest?
Wheezy at night
Difficulty getting breath
Painful?
Come on suddenly

9

Conditions causing life threatening acute breathlessness

PE
MI
CCF
Pneumothorax
Anaphylaxis
Pulmonary edema
Tamponade
Acute asthma

10

Subacute definitiona and causes of breathlessness

Acute asthma
Acute COPD
Pulmonary edema
Infections
Metabolic acidosis

11

Chronic definition and causes

CCF
COPD
ILD
Valvular
Anemia
Fibrosis
Pulmonary vascular/hypertensive disease

12

Associated symptoms to enquire about

Fever- infection
Central chest pain- MI, PE, pulmonary embolism, pleurisy
Palpitations-paroxysmal tachyA, PE, valvular, HA, anxiety
Syncope
Wheezing
Change in voice-pneumomediastinum, GORD, AA, lung cancer
Hemoptysis- bronchitis, bronchiectasis, malignancy, vasculitis, infection, PE
Dysphagia- laryngitis, epiglotitis
Muscle weakness, myalgia
Bone pain
Anxiety

13

Define orthopnea, platypnea, trepopnea

Orthop- dysP while supine, improves in upright
Platyp- dysP on assuming upright->typical in patent foramen ovale, abominal muscle deficiency or hepatopulmonary syndrome
TrepoP- infrequent, breathlessness in left lateral position, associated with CHF

14

What might dyspnea in pregnant patient indicate

An undiagnosed medical condition-> VHD, pulmonary HTN, alpha 1 protease deficiency, PE, pneumothoraz, AV malformation

If in recent labour- may indicate PE, sepsis/shock, amniotic fluid/trophoblastic embolism

15

Other past history important

Prgenancy
Obesity
Rheumatological disorders
Autoimmune
Malignancies
Penumonia
GORD
TB
Heart failure
Radiation

ETT/ventilation

16

Physical examination- general findings to look for

MSE changes
Sighing
Cyanosis- COPD, PE, airway obstruction, drug toxicity, Congenital heart disease, valves, tamponade
Jaundice- liver failure, lepto
Goitre
Kyphoscoliosis
Clubbing
+Abdominal girth- CHF, cirrhosis, effusions, constrictive pericarditis
Urticarial rash- anaphylaxis

17

Other components of examination for dyspnea

CV exam
- +JVP in CHF, COPD, constrictive pericarditis, pneumothorax
-S3
-edema

Respiratory examination
Neurological examination->MG, myotonic dystrophy, botulism

18

What findings when pericardial effusion and pericardial constriction

Elevated neck veins, pulsus paradoxus, pericardial knock, pericardial rub, Kussmauls

19

Investigations to order

Pulse oximetry- evaluation of hypoxemia
ABG
FBC
Sputum culture
CXR
ECG
Troponins
PEFR
UEC
LFTs
Kidney function
BNP
Echo
Pulmonary function tests
Spirometry

Highr resolution CT scan
V/Q

20

ABG purpose, findings

Hypercapnia
- COPD
-Stroke
-Airway obstruction
-Obesity hypoventilation

Hypocapnia
-Anxiety
-PE

Hypoxemia
shunting (acute respiratory distress syndrome, pneumonia, pulmonary oedema, cyanotic valvular disease),
V/Q mismatching (COPD, asthma, pulmonary embolism), diffusion impairment (interstitial lung disease), or hypoventilation (COPD exacerbation, neuromuscular disease, stroke, upper airway obstruction, or obesity-hypoventilation syndrome)

21

Hypoxemia mechanism categories

shunting (acute respiratory distress syndrome, pneumonia, pulmonary oedema, cyanotic valvular disease), V/Q mismatching (COPD, asthma, pulmonary embolism), diffusion impairment (interstitial lung disease), or hypoventilation (COPD exacerbation, neuromuscular disease, stroke, upper airway obstruction, or obesity-hypoventilation syndrome)

22

FBC findings

Leukocytosis
-Infection
-Sepsis
-Autoimmune

Eosinophilia
-parasite
-vasculitides
-asthma
-cocaine

Anemia- as primary reason

Lymphocytopenia
- Viral
-Chemotherapy

23

Electrolyte findings

Hyponatremia
-CCF
-CKD
-Liver failure
-Hypothyroid

24

LFT findings

Bilirubin +
-Liver
-CCF
-Leptospirosis

Transaminases
-Liver failure-MI
-Atypical pneumonia

25

Kidney function findings

Renal insufficiency->metabolic acidosis causing dyspnea

26

BNP

Associated with CCF

Also
-Sepsis
-CAD
-PE
-COPD w/ cor pulmonale
-Renal failure
-Liver cirrhosis
-Hyperthyroid

27

What does pulmonary function involve

Spirometry
Measuring lung volumes
Evaluating DLCO

28

Two defects on PFTs

obstructive deficit (low FEV1/FVC ratio, increased residual volume, increased total lung capacity), seen in asthma, bronchitis, and emphysema, and a restrictive deficit (symmetrical reduction of FEV1 and FVC, high FEV1/FVC ratio, low total lung capacity), seen in interstitial lung disease