10. Shortness of Breath

Question 1

How can you classify the causes of SOB by timing?

Answer 1

Sudden- PE, pneumothorax, foreign body
Days- pneumonia, heart failure and pleural effusion
Weeks- COPD, chronic asthma

Question 2

What are some of the risk factors to ask about in someone with SOB?

Answer 2

Smoking
Occupation
DVT/ PE risk factors
Drugs
PMHx- autoimmune conditions like rheumatoid arthritis and SLE can cause interstitial lung disease and pleural effusions

Question 3

What associated symptoms should you ask someone with SOB?

Answer 3

Chest pain, cough, wheeze, FLAWS, muscle weakness/ fatigue

Question 4

What is COPD?

Answer 4

Bracket term covering chronic bronchitis and emphysema

Question 5

What causes COPD?

Answer 5

Smoking- >20 pack years usually
Occupational exposure to lung irritants
Alpha 1 antitrypsin deficiency

Question 6

What are signs of COPD?

Answer 6

Hyperexpanded chest, breathing through pursed lips, reduced air entry/ chest expansion, prolonged expiratory phase, hyper-resonant percussion

Question 7

What are some key features in the HPC for asthma?

Answer 7

Wheeze, cough that is worse at night, other atopies, symptoms worse with NSAIDs, aspirin, beta blockers

Question 8

What signs might you see on examination in someone with interstitial lung disease?

Answer 8

Clubbing, reduced chest expansion, late inspiratory fine crackles

Question 9

What are some of the key features in the HPC for heart failure?

Answer 9

History of CVD, hypertension, valve disease, cardiomyopathies

Orthopnea, paroxysmal nocturnal dyspnoea, swelling, sleeping with multiples pillows, pink frothy sputum

Question 10

What are some of the symptoms of congestive heart failure and the reasoning behind them?

Answer 10

SOB- heart isn’t pumping enough blood. Back pressure forces fluid from the pulmonary vasculature into the alveoli.

Orthopnoea- lying down increases venous return to the heart while it is already struggling to pump. Blood becomes more congested in pulmonary vaculature, forcing fluid into the lungs.

Displaced apex beat due to dilation of the heart.

Crackles in lungs due to build up of blood in pulmonary vessels, forcing fluid into alveoli.

Peripheral oedema due to back pressure in the venous system and salt + water retention due to activation of RAAS by a low cardiac output.