Breathlessness history Flashcards
How would you categorise the differential diagnoses for breathlessness?
- Respiratory
- Cardiovascular
- Miscellaneous
What are the respiratory causes of breathlessness?
- Acute asthma
- Pneumonia
- COPD
- PE
- Pleural effusion
- Lobar collapse
- Upper airway obstruction
- ARDS
- Exacerbation off bronchiectasis
What are the cardiovascular causes of breathlessness?
- Heart failure (pulmonary oedema)
- Silent MI (especially in diabetes)
- Pericardial effusion (due to malignancy)
- Tachyarrhythmia
- Cardiac tamponade
- Acute valvular dysfunction (IE, acute MI, aortic dissection)
What are the miscellaneous causes of breathlessness?
- Anaemia
- Metabolic acidosis (DKA, acute renal failure)
- Acute blood loss
- Thyrotoxicosis
- Neuromuscular disease
- Anxiety and hyperventilation
What are the most common causes of breathlessness (any category)?
- COPD
- Pulmonary oedema
- Pneumonia
- MI
- Atrial fibrillation (can be caused by alcoholism) and flutter
- Pulmonary embolism
- Malignant tumour
What questions would you ask as part of the systems review for breathlessness?
- Respiratory questions
- Asks about any leg swelling
- Cough
- Wheezing
- Sputum - Cardiovascular questions
- Palpitations
- Asks about any chest pain
- Asks about any palpitations
- Breathless affecting sleep? Worse when lying down?
- Dizziness - Cancer
- Fatigue
- Weight loss
- Appetite loss
- Haemoptysis
- Night sweats
- Fevers
What questions would you ask to explore the presenting complaint in light of breathlessness?
Use part of SOCRATES:
- The onset of the breathlessness.
- Character of the breathlessness
- Associated symptoms such as a cough, fever, palpitations, chest pain, leg swelling, and wheeze. If any of these symptoms had been present, you should have explored them in greater detail.
- TIME: How the breathlessness has changed over time. Is there any time of the day it is worse?
- Exacerbating and alleviating factors (exercise)
- The severity of the breathlessness
What would you ask if a cough is present?
- When the cough started.
- If the cough is productive or non-productive.
- If she has coughed up any blood.
What are the red flag symptoms for lung cancer?
The red flag symptoms for cancer including weight loss, appetite loss, fatigue, and haemoptysis.
What would you ask about the PMH?
- Asthma, COPD
- Cardiovascular history
- Recent operations
What would you ask about the drug history?
- Medications
- Over the counters
- Drug history
What would you ask about the family history?
Any diagnosis
What would you ask about the social history?
- Asks about smoking
- Ascertains pack history
- Asks about alcohol
- Finds out extent of drinking
- Ask about illicit drug use
- Asks about previous occupation
- Asks about any pets
- Ask about effects of shortness of breath on daily life
- Asks about mobility aids
- Asks about whether he needs help with his daily activities
