Dyspnea and Acute Cough

Question 1

What are the two main mechanisms leading to the sensation of Dyspnea?

Answer 1

Impaired ventilators mechanics

Increased respiratory drive

Question 2

3 common conditions falling under the category of impaired ventilators mechanics?

Answer 2

Airway obstruction, muscle weakness and chest wall is not very compliant.

Question 3

5 common conditions falling under the increased respiratory drive category?

Answer 3

CHF, impaired alveolar exchange, chemoreceptors stimulus, pregnancy, and behavioral factors

Question 4

What are the two types of dyspnea?

Answer 4

Acute and chronic

Question 5

What are 4 CV causes of acute dyspnea?

Answer 5

Left heart failure, ACS, tamponade, and tachycardia

Question 6

What are respiratory causes of dyspnea? What are the categories and give an example of each?

Answer 6

Airway obstruction (bronchospasm), has exchange sucks like pneumonia, vascular disease like PE, and jacking up the ventilatory pump like pleural effusion or pneumothorax.

Question 7

What is the first step in approaching a patient with acute dyspnea?

Answer 7

Assess VS and stabilize. Might need oxygen or invasive/non invasive ventilation support.

Question 8

What are 3 symptoms of acute dyspnea?

Answer 8

Tachypnea, accessory muscle use and conversational dyspnea.

Question 9

Once we stabilize the patient, what do we do next?

Answer 9

History and PE.

Question 10

Low sat of o2 suggest what cause of dyspnea and what 6 causes?

Answer 10

Gas exchange sucks.

Asthma, COPD flare up, ARDS, HF, pulmonary fibrosis, or PVD.

Question 11

What is the primary initial diagnostic tool for dyspnea after PE and history?

Answer 11

CXR

Question 12

Focal infiltrates, air in the pleural space, basal opacity with meniscus, and cardiomegaly suggest what?

Answer 12

Pneumonia
Pneumothorax
Pleural effusion
Heart failure

Question 13

What test allows us to exclude heart failure in the setting of acute dyspnea?

Answer 13

BNP level less than 100

Question 14

What does laryngoscopy and bronchoscopy allow us to detect?

Answer 14

Aspirated caused dyspnea

Question 15

What does Bronchoscopy and Bronchoalveolar lavage help us detect?

Answer 15

Pneumonia caused dyspnea

Question 16

When does dyspnea become chronic?

Answer 16

After 1 month

Question 17

What are the 4 most common causes of chronic dyspnea?

Answer 17

COPD, asthma, ILD, and heart failure.

Question 18

What is the key to working up chronic dyspnea?

Answer 18

Detailed history

Question 19

What are the 4 common causes of symptoms worsening with chronic dyspnea?

Answer 19

Natural disease progression, patient not compliant with meds, and exposure to environmental or dietary factors.

Question 20

What are esymptoms associated with cardiac caused chronic dyspnea?

Answer 20

Orthopnea and edema

Question 21

2 pulmonary associated symptoms with pulmonary caused chronic dyspnea?

Answer 21

Cough and wheezing

Question 22

What test do you do if history, exam and workup is not revealing of their dyspnea?

Answer 22

Cardiopulmonary exercise test.

Question 23

What is the length of weeks for acute, subacute, and chronic cough?

Answer 23

Less than 3 weeks, 3-8 weeks and more than 8 weeks

Question 24

What is the most common cause of acute cough?

Answer 24

Viral upper respiratory tract infection

Question 25

What are the 3 most common pathogens causing lower respiratory tract infections?

Answer 25

Flu a and b, parainfluenza, and RSV

Question 26

What are the 4 most common viruses causing upper RTI?

Answer 26

Rhinovirus, adenovirus, echovirus, and coronavirus

Question 27

3 clinical symptoms of rhinitis?

Answer 27

Sneezing, congestion and runny nose

Question 28

What is clinical criteria to diagnose influenza?

Answer 28

Temp over 37.7 or 100 and 1 of the following | Cough, pharyngitis, and rhinorrhea

Question 29

Two meds to treat flu a and B?

Answer 29

Neuraminidase inhibitors, oseltamivir and zanamivir

Question 30

What are you top 3 dogs causing uncomplicated acute bronchitis?

Answer 30

Pertussis, mycoplasma pneumonia, and C pneumonia.

Question 31

Which of the three is it recommended to use antibiotics?

Answer 31

Pertussis

Question 32

How do we clinically diagnose pertussis?

Answer 32

Cough greater than 2 weeks and one of the following: Paroxysm of cough, inspiratory whoop or post tussive vomiting OR Cough greater than 2 weeks with a documented outbreak of pertussis

Question 33

What is the gold standard diagnostic tool for pertussis?

Answer 33

Recovery of bacteria by culture or PCR

Question 34

What is the third most common cause of acute cough?

Answer 34

Pneumonia

Question 35

What are 3 other causes of acute cough to be familiar with?

Answer 35

Asthma, flare ups of chronic bronchitis and bronchiectasis