Eval of Dyspnea (Final) Flashcards Preview

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Flashcards in Eval of Dyspnea (Final) Deck (69)
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1
Q

What is dyspnea?

A

A subjective sensation of shortness of breath or breathing discomfort

2
Q

Chronic dyspnea = symptoms greater than ___

A

1 month

3
Q

The underlying cause of dyspnea is NOT directly related to?

A

duration or severity!

4
Q

How might a patient describe the sensation of dyspnea?

A

Varies widely from “I can’t catch my breath” to “chest tightness”

5
Q

Dyspnea accounts for what percentage of all FP visits?

A

4%

6
Q

At what ages does dyspnea most commonly occur?

A

Pediatrics and Ages 55-69

(bell shaped presentation)

7
Q

What type of disorder will a large percentage of dyspneic patients already have diagnosed?

A

Cardiopulmonary disorder - which accounts for the dyspnea

*REMEMBER, patients can have more than one issue!

8
Q

Approximately 2/3rds of dyspnea cases are caused by what two disorders?

A

Pulmonary or Cardiac

9
Q

Of the 2/3rds of dyspnea cases caused by pulmonary or cardiac disorders, 85% of them have what conditions?

A
  • Asthma
  • CHF
  • COPD
  • PNA
  • Cardiac ischemia
  • Interstitial lung disease
10
Q

1/3 of dyspnea causes have nothing to do with the heart and lungs, and include what conditions?

A
  • Metabolic (DKA)
  • Deconditioning
  • Anemia
  • Psychogenic
11
Q

What should be on your DDX for cardiac causes of chronic dyspnea?

A
  • CHF
  • CAD
  • Cardiac arrhythmias
  • Pericardial dz
  • Valvular heart dz
12
Q

What should be on your DDX for pulmonary causes of chronic dyspnea?

A
  • COPD
  • Asthma
  • Interstitial lung dz
  • Pleural effusion
  • Malignancy
  • Bronchiectasis
13
Q

What fraction of patients will have another complaint other than dyspnea?

A

2/3rds

14
Q

Patients with dyspnea often complain of what other symptoms?

A
  • Cough 17%
  • CP 5%
  • Fatigue 3.5%
  • Out of medication 3.2%
  • Wheezing 2.5%
  • Peripheral edema 2%
15
Q

The cause of dyspnea is ___ in 1/3 of patients

A

Multifactoral (Jaynstein’s favorite word ever)

*ie COPD with concurrent URI

16
Q

The diagnoses of dyspnea can be made in ___ of all patients with ___ alone!

A

The diagnoses of dyspnea can be made in half of all patients with history alone!

17
Q

A patient with a h/o smoking is more likely to have lung or cardiac disease?

A

Lung

18
Q

A patient with a h/o HTN, CAD, obesity, valve disorder is more likely to have lung or cardiac disease?

A

Cardiac

19
Q

A patient with a slower onset of symptoms is more likely to have lung or cardiac disease?

A

Lung

20
Q

A patient with a more rapid onset of symptoms is more likely to have lung or cardiac disease?

A

Cardiac

21
Q

A patient with dyspnea at rest is more likely to have lung or cardiac disease?

A

Lung

22
Q

A patient with dyspnea with exertion is more likely to have lung or cardiac disease?

A

Cardiac

23
Q

A patient with a productive cough is more likely to have lung or cardiac disease?

A

Lung

24
Q

A true cough is rare in lung or cardiac disease?

A

Cardiac

25
Q

What is on the top of your DDX for a patient who presents with increased work of breathing, feeling of suffocation, and air hunger?

A

COPD

26
Q

What dyspnea symptoms would a patient with CHF commonly present with?

A
  • Rapid breathing
  • Feeling of suffocation
  • Air hunger
27
Q

What dyspnea symptoms would a patient with interstitial lung dz commonly present with?

A

Increased work of breathing

28
Q

What dyspnea symptoms would a patient with Asthma commonly present with?

A
  • Incomplete exhalation
  • Shallow breathing
  • Increased work of breathing
  • Chest tightness
  • Heavy breathing
29
Q

What dyspnea symptoms would a patient with neuromuscular and chest wall disease commonly present with?

A
  • Shallow breathing
  • Increased work of breathing
30
Q

What dyspnea symptoms would a patient with pregnancy commonly present with?

A

Air hunger

31
Q

What dyspnea symptoms would a patient with pulmonary vascular disease commonly present with?

A

Incomplete exhalation

32
Q

What dyspnea symptoms should alert you to send your patient to the ED immediately?

A
  • Acute respiratory distress
  • (CP)
  • (Hypoxic)
33
Q

What are signs that your patient is in acute respiratory distress?

A
  • Labored breathing
  • Cyanotic (fingertips)
  • Word dyspnea
34
Q

What are you determining when performing a PE on a dyspneic patient?

A

Sick vs not sick

  • Vital signs!
  • Obtain objective info to evaluate subjective complaints
35
Q

What symptoms are highly correlated with COPD according to LRs?

A
  • Wheezing - LR +15
  • Smoking - LR +8
  • Rhonchi - LR +8
  • Hyperresonance to percussion - LR +5.3
  • Forced expiratory time > 9 secs - LR +4.8
36
Q

A LR of 10 is good but anything around what number is considered helpful in medicine?

A

5

37
Q

What is the diagnostic test of choice for COPD

A

PFTs

38
Q

What is the earliest symptom for CHF

A

DOE

39
Q

What is the more specific symptom for CHF

A

Paroxysmal nocturnal dyspnea (PND)

40
Q

What symptoms are highly correlated with CHF according to LRs?

A
  • S3 Gallop - LR +24
  • Displaced PMI - LR +16.5
  • JVD - LR +8.5
41
Q

A S3 gallop is heard so what is at the top of your DDX?

A

CHF until proven otherwise

42
Q

The finding of a S3 gallop, displaced PMI, or JVD in a patient who presents with dyspnea increases the likelihood of CHF as the dx by what percentage?

A

80%!!!

43
Q

What do we need to remember about asthma patients?

A
  • Get a good History and do a PE (unless acutely wheezing)
  • Asthma patients return to 100% normal baseline between episodes
44
Q

What symptoms would a patient with interstitial lung disease present with?

A
  • Slow progression of exertional dyspnea
  • Persistent inspiratory crackles - in 80%
  • Clubbing 25-50%
45
Q

A patient presents with inspiratory crackles and you have them cough. You listen again and crackles are no longer present. This indicates what type of condition?

A

An underlying infectious cause NOT interstitial lung disease

46
Q

On PE a normal SaO2 implies a ___ disorder

A

Mild - such as exercise-induced bronchospasm

47
Q

On PE an abnormal SaO2 with exertion implies a ___ cardiopulmonary disease

A

mild to moderate

48
Q

On PE an abnormal SaO2 at rest implies a ___ cardiopulmonary disease

A

moderate to severe

49
Q

What must you always remember to do during your PE of a dyspneic patient?

A

GET A WALKING O2!

*SpO2 correlates with severity of illness

50
Q

Patients who present with dyspnea as a primary complaint are more likely to get an EKG than lung function testing. What’s wrong with this?

A

We need to change this because lung function results are what pave the way for the rest of your work up!

51
Q

If a patient presents with dyspnea and their lung function tests are normal what does this indicate?

A

The patient is very unlikely to have a significant cardiopulmonary disease with the expectation of asthma

52
Q

What PFT results are diagnostic of obstructive lung disease

A
  • FEV1 < 80%
  • FEV1/FVC < 70%
53
Q

What PFT results are diagnostic of restrictive lung disease?

A

FEV1 < 80%

FEV1/FVC > 70%

54
Q

What lung diseases are obstructive?

A
  • COPD
  • Asthma
  • Bronchiectasis

*cannot get air OUT

55
Q

What lung diseases are restrictive?

A
  • Interstitial lung disease
  • Pulmonary fibrosis
  • Obesity
  • Autoimmune diseases (sarcoidosis)
  • Pleural effusion and heart failure

*cannot get air IN

56
Q

Obtaining an EKG in the evaluation of dyspnea is indicated for what conditions?

A
  • Cardiac ischemia or infarction
  • Ventricular hypertrophy
  • Pericardial disease (effusion)
57
Q

Obtaining a CXR in the evaluation of dyspnea is indicated for what conditions?

A
  • Chest wall abnormalities
  • Hyperinflation
  • CM or pleural effusions
  • Mass/Mets
  • PNA
58
Q

When would you want to obtain a CTA PE?

A

Evaluation of vascular issues

59
Q

High res CT chest imaging is reserved for?

A
  • When you have no idea what’s causing the patients dyspnea
    • interstitial lung disease, bronchiectasis, PE
  • A lot of radiation exposure so talk to a radiologist first!
60
Q

Ordering a CBC in the evaluation of dyspnea is indicated for what conditions?

A
  • Anemia
  • Infection (careful in non sick)
  • COPD (polycythemia)
61
Q

Ordering a BMP in the evaluation of dyspnea is indicated for what conditions?

A
  • Acid-Base disturbance
    • Elevated bicarb - Metabolic alkalosis
      • COPD, interstitial lung dz, neuromuscular disorders
    • Metabolic acidosis
      • DKA
62
Q

What cardiac tests may you want in the evaluation of dyspnea?

A
  • Troponin
  • BNP
  • Echo (structural or functional issues)
63
Q

What diagnostic test is the most specific for the evaluation of CHF?

A

BNP!

BNP >100 is 82% sensitive, 99% specific for CHF

64
Q

The magnitude of elevation of BNP is ___ to the severity of heart failure

A

proportional

65
Q

What type of afib can cause dyspnea?

A

Paroxysmal

66
Q

What is your diagnostic test of choice in evaluation of paroxysmal afib?

A

Holter Monitor

67
Q

Ordering a lung biopsy in the evaluation of dyspnea is indicated for what conditions?

A
  • Interstitial lung disease
  • Malignancy
68
Q

In patients who have a diagnosed cardiopulmonary disorder who have chronic dyspnea despite maximal therapy, you should STRONGLY consider the presence of a ___

A

Cofactor such as

  • Obesity
  • Deconditioning
  • Emotional response to illness
69
Q

When do you refer a patient with dyspnea?

A
  • Underlying cause of dyspnea is unclear
  • Sxs disproportionate to the apparent severity of the disease
  • For lung biopsy
  • Patient not adequately responding to tx

*make sure you get a PFT prior to sending