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Cardioresp differentials Flashcards

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1
Q

What is a key question to ask in a palpitations history and what are the red flags?

A

Presenting complaint: palpitations
(1) essential to establish a timeline!
- has the patient kept a record?
NB: also if the patient is having palpitations in the consultation: ask them to tap it out on the table
Red Flags:
(2) chest pain?
(3) collapse?
(4) FHx of sudden cardiac death

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2
Q

What conditions should be considered as Ddx for palpitations?

A

1) ventricular tachycardia
2) Atrial fibrillation
3) Supraventricular tachycardia
4) ventricular ectopics
5) Anxiety
6) Thyrotoxicosis
7) Phaeochromacytoma

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3
Q

What are the S&Sx and HPC associated with ventricular tachycardia?

A

“Ventricular Tachy:
• Dizziness/ sweating/ pain
• Paroxysmal noct dyspnoea
• Symptoms of acute HF/ shock/ chest pain/ syncope may be a medical emergency → A to E assessment and CPR (however, less likely as OSCE)
• Broad QRS complex ECG”

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4
Q

What are the risk factors and Ddx associated with ventricular tachycardia?

A

• Recent MI
• Any ischaemic changes to the heart
• Normal cardiac RFs
Ddx:
• Any other palpitation

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5
Q

What investigations should be done if palpitations are suspected?

A

“• Bedside:
full exam and hx, basic obs, ECG, BM
• Labs:
FBC, U+E, Lipid screen, Mg2+, Ca2+, TSH
• Imaging:
consider 24hr ECG, consider ECHO for structural changes “

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6
Q

What would the signs and symptoms/HPC of AF be?

A

“AF
• Irregularly irregular
• Consider type (first episode, paroxysmal, persistent, permanent)
• Dizziness/ faintness
• Consider in a HF pt”

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7
Q

What are the risk factors and DDx for AF?

A

“• Normal cardiac RF
• Cardiac: HF, mitral stenosis, HTN
• Infectious: pneumonia
• Metabolic: hyperthyroidism
• Stimulants: alcohol, caffeine”
DDx= any other palpitation

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8
Q

What investigations should be done in palpitations?

A

“• Bedside: full exam and hx, basic obs, ECG, BM
• Labs: FBC, U+E, Lipid screen, Mg2+, Ca2+, TSH
• Imaging: consider 24hr ECG, consider ECHO for structural changes “

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9
Q

What are the S/Sx and HPC associated with supraventricular tachycardia?

A

“SVT
• Paroxysmal palpitations
• Possible syncope
• Dizziness/ sweating”

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10
Q

What are the risk factors for SVT?
what is the DDx?

A

“• Recent MI
• Any ischaemic changes to the heart
• Normal cardiac RF”
ddx: any other palpitation

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11
Q

What are the S/Sx associated with ventricular ectopics?

A

“Ventricular ectopics
• Pts feel a skipped beat then an uncomfortable lurch in their chest
• Associated sympathetic actvity (sweating, dizziness)
• Positional association: laying down
• On ECG the QRS complexes are wide”

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12
Q

What are the RF for ventricular ectopics?
What DDx are there for ventricular ectopics?

A

“• Recent MI
• Any ischaemic changes to the heart
• Normal cardiac RF”
Ddx: any other palpitation

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13
Q

What are the S/Sx and HPC of Anxiety?

A

“Anxiety
• Associated with a trigger
• Paroxysmal
• Tingling around lips, tingling in fingertips
• Make a big point of talking about social Hx for this one
• Associated nausea/ sweating/ dry mouth

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14
Q

What are the risk factors associated with anxiety?
What Ddx are there for anxiety?

A

RF:
• Make a point about SHx

DDx:
• Any of palpitations
• Anxiety precipitated by hyperthyroidism
[do HAD10 score]

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15
Q

What are S/Sx and HPC for thyrotoxicosis?

A

Thyrotoxicosis
• Classic thyroid symptoms
• ?Thyroid storm (delerium/ diarhhoea/ nausea/ vomiting with possible precipitating factors ie. recent illness/ stress/ trauma)

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16
Q

What are the RF and ddx for thyrotoxicosis?

A

RF: FHx
DDx: Anxiety [do anxiety screen e.g. HAD10 score] & AF

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17
Q

What are the S/Sx and HPC for phaeochromacytoma?

A

5 P’s
Pain, pallor, pressure (raised BP), pain (headache), perspiration

These Sx will occur in episodes and at the same time

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18
Q

What are the RF and DDx for phaeochromacytoma?

A

RF: Fhx
DDx: any of palpitations

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19
Q

What are the DDx for dyspnoea as a PC?

A

Dyspnoea
Acute:
• Asthma
• Pneumonia
• Acute pulmonary oedema
• ACS
• PE
• Tension pneumothorax

Chronic
• Lung malignancy
• COPD (excluding IECOPD)
• Pulmonary fibrosis
• HF”

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20
Q

What are the red flags for a dyspnoea PC?

A

• Chest pain (MI)
• Haemoptysis
(PE/ lung ca)
• Weightloss
(lung ca/ COPD/ pulmonary fibrosis)
• Heavy smoking history
(lung ca/ COPD)
• Asbestos
(lung cancer> mesothelioma)
• Unilateral leg swelling
(PE)

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21
Q

What are the S/Sx & HPC for asthma?

A

“Asthma
• Wheezing and breathlessness
• Trigger (cold air/ exercise/ aspirin)
• Night time worst
• Consider background eczema/ allergy”

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22
Q

What are the RF and DDx for asthma?

A

RF:
“• Atopic triad
• Triggers
• Care for aspirin induced”
DDx:
“• Acute pulmonary oedema
• Foreign body obstruction”

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23
Q

What investigations should be done for a PC ?asthma in a Hx of dyspnoea?

A

• Bedside: full exam and Hx, peak flow, basic obs
• Labs: FBC, U+E, CRP, ESR, ABG
• Imaging: consider CXR (especially to rule out a foreign body obstruction)
• Special: spirometry, methacholine reversal test”

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24
Q

What are the S/Sx & HPC for pneumonia?

A

“Pneumonia
• Cough with green sputum (maybe haemoptysis)
• Fevers
• Pleuritc chest pain
• Possible background of COPD (H.Influenzae)
• It is essential to determine whether community/ hospital acquired”
e.g. have they been in hospital recently

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25
What are the RF and Ddx for pneumonia
RF: "• Immunocompromised patients • HAP: care home/ hospital stay • ""Is anyone else around you experiencing similar symptoms)" DDx: "• Flu • Infective exac COPD (in smokers) • Asthma"
26
What investigations should be done for dyspnoea?
"• Bedside: full exam and Hx, peak flow, basic obs • Labs: FBC, U+E, CRP, ESR, ABG, sputum culture, from results you would like to assess CURB65 • Imaging: CXR • Special: spirometry, methacholine reversal test
27
What are the S/Sx of acute pulmonary oedema?
"Acute pulmonary oedema • Severe breathlesness • On background of ACS/ arrhythmia/ HF/ CRF • Orthopnoea and PND • ""Pink frothy sputum"" • ?silent MI in elderly pt"
28
What are the RF & Ddx for acute pulmonary oedema?
RF: • Recent: HF/ MI/ ChronicRenalFailure/ liver failure Ddx: • Asthma • COPD • Pneumonia
29
What investigations should be done for ?acute pulmonary oedema in dyspnoea hx?
• A to E assessment but keeping the patient as up right as possible • Investigate possible causes
30
What are the S/Sx & HPC for MI?
MI • Central crushing chest pain >20mins • Radiates • N+V, sweating associated Unstable angina • Pain <5 minutes • Relieved by GTN
31
What are the RF and Ddx for MI?
• Classic cardiac risk factors ddx: • The other ACSs that you don’t think it is
32
What investigations should be done for ?MI in dyspnoea hx?
• A to E assessment • Bedside: ECG, BM, start ACS protocol • Labs: FBC, U+E, troponin I (for SGUL), CK-MB, lipid profile • Imaging: ECG
33
What are the S/Sx & HPC of a PE?
"PE • RF inc. Virchow's triad • Recent leg swelling • Cough and haemoptysis • Pleuritic chest pain • Associated weightloss ?undiagnosed malignancy"
34
What are the RF and DDx for PE?
RF: • Classic PE risk factors (think Virchow's triad) • Care for associated weightloss! • Remember to ask about pregnancy/ OCP • Remember to ask about kidney problems (important for management) DDx: • Acute pulmonary oedema • Tension pneumothorax
35
What investigations should be done for a ?PE in a dypnoea hx?
"• A to E assessment • Risk stratify, Well's score • Depending on Well's score/ pregnancy do D-dimer/ CTPA • Bedside: ECG, ABG • Labs: FBC, U+E, possible clotting screen, possible serum Ca2+/ LFTs for ?malignancy • Imaging: CXR"
36
What are the S/Sx & HPC of tension pneumothorax?
Tension pneumothorax • Pleuritic chest pain • ?Marfan's/ Ehlers Danlos
37
What are the RF and DDx for tension pneumothorax?
• Trauma! • Other pneumothoraces: primary spontaneous (think marfan's)/secondary spontaneous (tb, asthma, COPD)/ traumatic" Ddx: PE, Asthma
38
What should the investigation for ?tension pneumothorax in a dypnoea hx be?
"• (If tension large bore needle into second intercostal space midclavicular line) • A to E assessment • Bedside: ECG, ABG • Imaging: CXR (if suspected pneumothorax insert needle before CXR!)
39
What are the S/Sx & HPC of lung malignancy?
Lung malignancy • Cough/ haemoptysis • Chest pain • Progressive decline • Constitutional symptoms • If you have time you can ask about mets (ie. bones ""any bone pain?""/ liver ""has your skin become more yellow""/ brain- ask about focal neurological defecits) • If you have more time.. paraneoplastic syndromes (lambert eaton/ SIADH/ ectopic ACTH/ PTHrp)
40
What are the RF and DDx associated with lung malignancy?
RF: • Long smoking history • Asbestos exposure DDx: • COPD • Pulmonary fibrosis
41
What investigations should be done in a ?lung malignancy for dyspnoea hx?
• Bedside: Full exam and hx • Labs: FBC, U+E, serum Ca2+, anaemia screen • Imaging: CXR • Depending on results of XR: if central lesion bronchoscopy for biopsy for histology and brushings for cytology, if peripheral lesion do biopsy for histology and FNA for cytology under CT guidance
42
What are the S/Sx & HPC of COPD?
"COPD • Cough/ wheeze/ sputum • Overlying pneumonia/ IECOPD? • Long smoking Hx • Weightloss"
43
What are the RF and ddx for COPD?
RF: • Long smoking history Ddx: • Asthma • Lung cancer
44
What Ix should be done for ?COPD in a dyspnoea Hx?
• Bedside: full exam and Hx, PEF, BMI • Labs: FBC, U+E, serum Ca2+, anaemia screen • Imaging: CXR • Special: spirometry
45
What are the S/Sx and HPC for pulmonary fibrosis?
"Pulmonary fibrosis • SOBOE • Weightloss • Persistent dry cough • Might be idiopathic or associated with asbestos/ living or working on a farm/ other occupational hazards"
46
What are the RF and ddx for pulmonary fibrosis?
RF: • Occupational • Be prepared for pt to get worried at the mention of asbestos Ddx: "• Lung cancer • COPD"
47
What Ix should be done for ?pulm fibrosis in a dyspnoea hx?
• Bedside: full exam and Hx, ABG • Labs: FBC, U+E, • Imaging: CXR/ high resolution CT
48
What are the S/Sx & HPC for heart failure?
HF • SOBOE • PND/ orthopnoea • Cough with pink frothy sputum (sig: pulm oed) • Leg swelling • Consider determining whether RHF/ CHF
49
What are the RF and Ddx for HF?
RF: • Recent: MI • Underlying HTN • Valvular problems Ddx: • Acute pulmonary oedema
50
What investigations should be done in a ?heart failure in a SOB hx?
• Bedside: full exam and hx, ABG • Labs: FBC, U+E, BNP • Imaging: CXR/ TOE
51
What are the S/Sx & HPC of pleural effusion?
"Pleural effusion • Pleuritic chest pain • Exudative (inflam leaky capils): infection (pneumonia/tb)/ neoplasm/ inflammation (RA/ SLE)/ infarction • Transudative (high pressure): CCF/ renal failure/ decreased albumin"
52
What are the RF and Ddx for pleural effusion?
RF:• Any underlying cause ddx:• Pulmonary oedema
53
What Ix should be done for a ?pleural effusion in SOB Hx?
"• Full exam and Hx • Labs: FBC, U+E, LFT, TFT, Ca ESR • Imaging: CXR, US (for tapping) • Diagnostic tap, send to: chemistry, bacteriology, cytology, immunology"
54
What are the red flags for chest pain?
- Sudden onset - Duration >10/20 mins - not relieved by GTN - Associated dyspnoea - PE RF - Weight loss - New onset dyspepsia and ALARMS (anaemia, loss of weight, malena, swallowing diff)
55
What are the differentials for chest pain?
- Stable angina - unstable angina - MI (and silent) - Pneumonia - PE - Tension pneumothorax - GORD - MSK - Aortic dissection - Pericarditis
56
What are the S/Sx & HPC for stable angina?
"Stable angina • Lasts for 5 mins • Central chest pain that radiates • SOBOE • Relieved by: GTN, sometime antacids/ rest"
57
What are the RF and Ddx for stable angina?
RF: • Cardiac risk factors • Ask about cholesterol • Ask about diabetes • Ask about HTN" Ddx: • Other ACSs
58
What investigations should be done for ?stable angina in a chest pain hx?
"• Bedside: full exam and Hx, ECG, BM, basic obs (including BP) • Labs: FBC, U+Es, lipid profile, trops to rule out • Imaging: coronary angiography with Doppler • Special: 24 hour ECG/ stress echo"
59
What are the S/Sx & HPC of unstable angina?
"Unstable angina • Lasts for 5 mins • Central chest pain that radiates • SOBOE • Background of stable angina • Not relieved by: GTN, sometime antacids/ rest"
60
what are the rf and ddx for unstable angina?
• Cardiac risk factors • Ask about cholesterol • Ask about diabetes • Ask about HTN ddx: • Other ACSs
61
What investigations should be done for ?unstable angina in a chest pain hx?
• Bedside: full exam and Hx, ECG, BM, basic obs (including BP) • Labs: FBC, U+Es, lipid profile, trops to rule out • Imaging: coronary angiography with Doppler • Special: 24 hour ECG/ stress echo
62
What are the S/Sx & HPC of MI?
MI • Central crushing chest pain >20mins • Radiates • N+V, sweating associated Silent MI • N+V, sweating associated • Diabetics and elderly
63
What are the RF and Ddx in a ?MI chest pain hx?
RF: • Cardiac risk factors • Ask about cholesterol • Ask about diabetes • Ask about HTN" Ddx: • Other ACSs
64
What are the investigations in a ?MI chest pain hx?
• A to E assessment • Bedside: ECG, BM, start ACS protocol • Labs: FBC, U+E, troponin I (for SGUL), CK-MB, lipid profile • Imaging: ECG
65
What are the S/Sx of pneumonia?
"Pneumonia • Cough with green sputum (maybe haemoptysis) • Fevers • Pleuritc chest pain • Possible background of COPD (H.Influenzae) • It is essential to determine whether community/ hospital acquired"
66
What are the RF and ddx for pneumonia (chest pain hx?)
RF: • Immunocompromised patients • HAP: care home/ hospital stay • ""Is anyone else around you experiencing similar symptoms) Ddx: "• Flu • IECOPD (in smokers) • Asthma"
67
What are the investigations to be done in a ?pneumonia chest pain hx?
"• Bedside: full exam and Hx, peak flow, basic obs • Labs: FBC, U+E, CRP, ESR, ABG, sputum culture, from results you would like to assess CURB65 • Imaging: CXR • Special: spirometry, methacholine reversal test"
68
What are the S/Sx & HPC of PE?
"PE • RF inc. Virchow's triad • Recent leg swelling • Cough and haemoptysis • Pleuritic chest pain • Associated weightloss ?undiagnosed malignancy"
69
What are the RF and ddx associated with PE?
RF: • Classic PE risk factors (think Virchow's triad) • Care for associated weightloss! • Remember to ask about pregnancy/ OCP • Remember to ask about kidney problems (important for management)" "• Ddx: Acute pulmonary oedema • Tension pneumothorax"
70
What are the Ix for a ?PE in a chest pain history?
• A to E assessment • Risk stratify, Well's score • Depending on Well's score/ pregnancy do D-dimer/ CTPA • Bedside: ECG, ABG • Labs: FBC, U+E, possible clotting screen, possible serum Ca2+/ LFTs for ?malignancy • Imaging: CXR"
71
What are the S/Sx of tension pneumothorax? the RF? the ddx? treatment?
"Tension pneumothorax • Pleuritic chest pain • ?Marfan's/ Ehlers Danlos" RF: • Trauma! • Other pneumothoraces: primary spontaneous (think marfan's)/secondary spontaneous (tb, asthma, COPD)/ traumatic" DDx: • PE • Asthma Ix: "• (If tension large bore needle into second intercostal space midclavicular line) • A to E assessment • Bedside: ECG, ABG • Imaging: CXR (if suspected pneumothorax insert needle before CXR!)
72
What are the S/Sx of GORD?
"GORD • Retrosternal/ pain on laying flat/ bending forward/ straining • Relieved by swallowing/ antacids • ALARM: Anorexia/ Loss of weight/ Anaemia/ Recent onset or progression/ Melaena (>55 with dyspepsia, ALARM and dyspepsia with dysphagia get 2wr)"
73
What are the RF and ddx for gord?
RF: • Increased abdominal pressure (weight/ prengancy) ddx: "• Gastritis • Oesophageal carcinoma"
74
What investigations should be done for GORD?
• Bedside: full exam and hx • Labs: FBC, anaemia screen • Imaging: OGD
75
What are the S/Sx of MSK on a chest pain hx? RF? DDx?
MSK • Pain on pressure • Trauma • Younger RF: • Trauma ddx: • Pleuracy • GORD
76
What are the S/Sx of aortic dissection?
"Aortic dissection • Tearing between shoulder blades • Recent trauma/ surgery • Background HTN/ bicuspid aortic valve/ Ehler's Danlos • Ischaemic limbs/ "
77
What are the RF and ddx for an aortic dissection?
RF • Recent trauma/ surgery • Background HTN/ bicuspid aortic " ddx: - ACS
78
What are the investigations that should be done in a ?aortic dissection chest pain hx?
"• A to E assessment • Bedside: obs/ BM, full exam and hx, ECG • Labs: FBC, U+E, cardiac enzymes • Imaging: CT angiogram"
79
What are the S/Sx of pericarditis?
"Pericarditis • Pleuritc chest pain felt retrosternally • Aggravated by coughing • Better leaning forward • Dresslers: high grade fever/ malaise/ weakness • Post fibrinous: low grade fever"
80
What are the Rf & ddx for pericarditis?
RF: • Previous MI Ddx: • GORD • ACS
81
What are the investigations for a ?pericarditis in a chest pain history?
"• Bedside: full exam and Hx, basic obs, ECG • Labs: FBC, U+E, CRP, ESR

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