Jaynstein - Dyspnea Flashcards by Alice Richards

chronic dyspnea is defined as SOB >

1 month

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t/f: the severity of dyspnea correlates w. severity of pathology

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how might a pt describe sensation of dyspnea (2)

i can’t catch my breath
chest tightness

*it’s a subjective feeling of SOB or breathing discomfort

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dyspnea accounts for __% of all FP visits

i guess we need to know these stats

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what 2 pt pops does dyspnea affect

peds
55-65 yo

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where do most dyspnea pt’s present

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dyspnea is usually an __ attack of a __ process

acute
chronic

majority have preexisting cardiopulmonary d.o

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what fraction of dyspnea is related to cardiopulmonary d.o

2/3 (67%)

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2/3 of dyspnea pt’s fall into what ddx

asthma
chf
copd
PNA
ischemia
ILD

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1/3 of dyspnea pt’s fall into what ddx

metabolic
deconditioning
anemia
psychogenic

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what pt pop does dyspnea related to deconditioning make you think of

older pt’s

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cardiac causes of chronic dyspnea (> 1 mo) (5)

CHF
CAD
arrhythmias
pericardial dz
valvular dz

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pulmonary causes of chronic dyspnea (6)

COPD
asthma
ILD
pleural effusion
malignancy (primary vs metastatic)
bronchiectasis

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non cardiac causes of chronic dyspnea (11)

thromboembolic dz
psychogenic causes
deconditioning
pulmonary HTN
obesity
severe anemia
GERD
metabolic
cirrhosis
thyroid dz
neuromuscular (myasthenia gravis)

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3 psychogenic causes of dyspnea

GAD
PTSD
panic disorder

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__ of pt’s will have another complaint w. dyspnea

2/3

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mc complaints associated w. dyspnea (6)

cough
cp
fatigue
ran out of meds
wheezing
peripheral edema

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__ of patients w. dyspnea have concurrent pathology

1/3

ex COPD w.URI

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cause of dyspnea can be determined by history alone in __% of pt’s

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4 factors suggesting dyspnea related to lung dz (4)

h.o smoking
slower onset
resting dyspnea
productive cough

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3 factors suggesting dyspnea related to cardiac dz

h.o HTN/obesity/valve d.o
rapid onset
exertional dyspnea

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__ is rare if dyspnea is related to cardiac cause

cough

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what do you think when you see: increased WOB, feeling of suffocation, and air hunger

COPD

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what do you think when you see: rapid breathing, feeling of suffocation, and air hunger

CHF

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what do you think when you see increased WOB alone

ILD

what do you think when you see: incomplete exhalation, shallow breathing, increased WOB, chest tightness, and heavy breathing

asthma

what do you think when you see: shallow breathing and increased WOB

neuromuscular and chest wall dz

what do you think when you see air hunger alone

pregnancy

what do you think when you see rapid breathing alone

pulmonary vascular dz

how does SOB affect related tachypnea/bradypnea

initially: tachypnea later: bradypnea

5 signs of acute respiratory distress (punt them)

labored breathing cyanotic word dyspnea chest pain hypoxia

important history consideration with hypoxia

baseline SpO2

t/f: SOB alone indicates "sick" pt

what do you think when you see a pt w. SpO2 93% who is tachycardic

what symptom has the highest LR related to COPD

wheezing (15)

besides wheezing, 4 other symptoms with high LR related to COPD

smoking hx > 40 years ronchi hyperresonance to percussion FE time > 9

poor man's bedside exam for COPD

forced expiratory time

gs test for COPD

PFTs

earliest symptom of CHF: symptom most specific for CHF:

earliest: DOE most specific: paroxysmal nocturnal dyspnea

3 PE findings with high LR suggesting CHF

S3 gallop displaced PMI JVD

5 findings that increase likelihood of CHF 80%

DOE paroxysmal nocturnal dyspnea S3 gallop displaced PMI JVD

most important aspect of asthma diagnosis

history!! more important than PE

what do you think when you see slow progression of exertional dyspnea

ILD pt usually presents when it has progressed to dyspnea at rest

what lung sound is heard in 80% of pt's w. ILD

inspiratory crackles that are present after coughing

symptom that suggests advanced ILD

clubbing

what does dyspnea w. normal SpO2 suggest

mild disorder -> exercise-induced bronchospasm

what does abnormal SpO2 with mild exertion suggest

mild-mod cardiopulmonary dz

what does abnormal SpO2 at rest suggest

moderate to severe cardiopulmonary dz

what simple test can you do to evaluate severity of dyspnea

walking O2 -> if SpO2 remains stable w. continuous walking, underlying pathology is unlikely

first line test for cc of dyspnea hint: it's not EKG ;)

PFTs

what do normal PFTs indicate in a pt w. cc of dyspnea

pt is very unlikely to have significant cardiopulmonary dz w. the exception of asthma

what is the obstructive PFT pattern

FEV < 80% FEV1/FVC < 70%

what is the restrictive PFT pattern

FEV 1 < 80% FEV1/FVC > 70%

what are the obstructive respiratory diseases (3)

COPD asthma bronchiectasis

what are the restrictive lung diseases (6)

ILD pulmonary fibrosis obesity AI pleural effusion HF

when are EKG's helpful in pt w. dyspnea (4)

cardiac ischemia MI ventricular hypertrophy pericardial dz

when is CXR helpful in pt w. dyspnea (6)

chest wall abnormalities hyperinflation CM pleural effusion mass/mets PNA

when is CTA useful for pt w. dyspnea

when would you order a chest CT for pt w. dyspnea (2)

you have no idea what's going on ILD bronchiectasis PE

CBC might be useful for diagnosis what conditions related to dyspnea (3)

anemia infxn COPD

what is the use of a BMP helpful in dyspnea work up

to evaluate acid-base disturbance

what does elevated bicarb + SOB indicate

metabolic alkalosis -> COPD ILD neuromuscular d.o

what does low bicarb + SOB indicate

metabolic acidosis -> DKA

t/f: a single troponin is useful to r.o MI

f! you need 2 unless it's been like 12 hr w.o CP

t/f: a single elevated troponin can rule in MI

BNP > __ is __% sensitive and __% specific for CHF

100 82% sensitive 99% specific

t/f: the higher the BNP, the worse the CHF

t/f: the higher the troponin, the worse the MI

BNP is super helpful in what condition

dx and monitoring of CHF

what is the usefulness of echo in eval of dyspnea

gives us info about structural issues in pt's w. CHF

what arrhythmia might be an easily missed cause of dyspnea

proxysmal afib -> order holter monitor

lung bx is the gs for dx of (2)

ILD malignancy

what do you think when you see a pt w. diagnosed cardiopulmonary disorder who has chronic dyspnea despite max therapy

the presence of a cofactor -> obesity deconditioning emotional response to illness

4 indications to refer a dyspnea pt

underlying cause is unclear sx disproportionate to apparent dz severity lung bx not adequately responding to tx

Jaynstein - Dyspnea Flashcards

(74 cards)