CARDIOPULMO - Shortness Of Breath

Question 1

What are the differentials of shortness of breath

Answer 1

1. Spontaneous Pneumothorax *
2. Pneumonia*
3. Pleural effusion*
4. Pulmonary embolism*
5. Occupational Lung disease*
6. Lung Ca*
7. COPD*
8. CHF*

LUNGS 
Pneumonia 
Pneumothorax 
Pleural effusion 
Pulmonary embolism 
Asthma 
COPD 
Lung Ca

CARDIAC
Myocardial infection 
Angina 
Pericarditis
Congestive heart failure 

Anemia
Psychogenic
Trauma
Occupational Lung Disease

Question 2

Spontaneous Pneumothorax - History

Answer 2

History
1-ask hemodynamic stability (vitals and O2 sat.)
2-pain questions
-severity+ painkillers and allergy
-duration, sudden or gradual, constant or come and go, getting worse
-site
-radiation (tip of shoulder)
-character (sharp, stabbing)
-aggravating (deep breathing)
-relieving (None)
-1st episode
3-Shortness of breath questions
-sudden or gradual?
-on rest or exertion or both?
4-What were you doing when it started?
5-Associated symptoms
-cough, fever? (Pneumonia)
-Palpitations
-sweating
6-General questions
-past medical history (underlying lung or heart disease) (secondary pneumothorax)
-PSH
-trauma
-travel history, clotting problems (pulmonary embolism)
-SADMA (especially smoking)
-occupation (athlete)
-family history

Question 3

Spontaneous Pneumothorax - PE

Answer 3

Physical examination findings from the examiner
1-General appearance
-cyanosis, dyspnea, Oedema
-pallor, LAP
-BMI
2-Vital signs 
3-chest examination
inspection: chest movement with respiration
palpation: tracheal position, chest expansion, apex beat
percussion: dullness (hyper resonance)
auscultation: air entry, breathing sounds, wheeze or crackles, vocal resonance (decreased breath sound)
4-CVS
-heart sound and murmurs.
-JVP
5-quick abdomen
6-office tests
-UDT, BSL
7-Any X-ray available

Question 4

Spontaneous Pneumothorax - Management

Answer 4

Explain diagnosis and differential diagnosis.
-from history and examination, most likely you have a condition we call spontaneous pneumothorax, where there is a rupture in one of air filled sacs on the surface of the lung called blebs leading to escape of air from lung to the space surrounding the lung causing pressure or compression on lung and causing pain and SOB.
-the cause is unknown and it is usually occurs in healthy young persons.
-let me assure you that…
-other possibilities like above but less likely from history, examination and x-ray findings.
Management
-admit for observation
-doing serial x-ray to monitor if there is any increase in the air escaping or lung collapse.
-seen by registrar to decide upon management if need chest drainage or not.
-once discharge:
avoid smoking
avoid flying or diving
red flags
review