Condition + History

Question 1

SOB?

Answer 1

Not enough O2 getting around the body or there’s an increased respiratory drive.

Question 2

Insufficient O2 getting to lungs; obstructed airway (4)?

Answer 2

obstructive lung disease impairing airflow, e.g. asthma, COPD, lung cancer, or upper airway obstruction, e.g. anaphylaxis

Question 3

Insufficient O2 getting to lungs; decreased lung compliance (1)?

Answer 3

restrictive lung disease limiting inspiratory volumes, e.g. pulmonary fibrosis

Question 4

Insufficient O2 getting to lungs decreased lung space (2)?

Answer 4

pneumothorax, lung collapse

Question 5

Insufficient O2 getting to lungs weak diaphragm (2)?

Answer 5

Guillain–Barré syndrome, myasthenia gravis

Question 6

Insufficient O2 getting from air to blood (6)?

Answer 6

ventilation-perfusion mismatch Pulmonary oedema (e.g. heart failure, liver failure, nephrotic syndrome) Pneumonia, Pulmonary embolism (PE; area of lung is not perfused) Pulmonary fibrosis

Question 7

Insufficient oxygen getting around the body (4)?

Answer 7

Reduced cardiac output (e.g. heart failure, aortic stenosis) Anaemia Shock (i.e. blood pressure <90/60 mmHg from any cause, e.g. sepsis, haemorrhage)

Question 8

Increased respiratory drive (2)?

Answer 8

Hysterical hyperventilation,

Acidaemia (e.g. diabetic ketoacidosis)

Question 9

History Onset?

Answer 9

vascular (PE) and mechanical (pneumothorax, foreign body) are sudden.

Lung cancer or pulmonary fibrosis take months.

Question 10

History alleviating or exacerbating factors?

Answer 10

Most is worse on excertion,

but heart failure is worse when lying flat,

asthma will be worse at certain times of year or in certain places.

Physcogenic hyperventilation is worse at times of stress or anxiety.

Question 11

History risk factors?

Answer 11

smoking, pets occupational history, medications (can cause hypersensitivity pneumonitis),

PMH (autoimmune conditions like rheumatoid arthritis and SLE can cause interstitial lung disease).

Question 12

SOB + cough?

Answer 12

points towards respiratory pathology.

A persistent, productive cough over the last few days suggests pneumonia;

a persistent, productive cough on most days of the past 3 months and spanning years suggests chronic bronchitis;

a dry cough present mainly during the episodes of shortness of breath or at night suggests asthma, but may also be a feature of left ventricular failure;

blood-stained sputum may suggest a PE, lung cancer, or a cavitating pneumonia

Question 13

SOB + chest pain?

Answer 13

Pleuritic chest pain can suggest pneumonia, a PE, a pneumothorax.

Non-pleuritic can suggest cardiovascular

Question 14

SOB + muscle weakness or fatigue?

Answer 14

Neuromuscular diseases.

Question 15

SOB + tender limbs?

Answer 15

PE can originate anywhere in the venous system, (DVT) if it occurs in a limb as this will usually cause inflammation – a swollen red, tender, warm, shiny looking limb

Question 16

SOB + weight loss, night sweats, loss of appetite?

Answer 16

red flag signs of highly metabolic, systemic inflammatory processes like cancer.

Question 17

SOB + loss of blood?

Answer 17

Anaemia can exacerbate SOB, ask about heavy menstrual bleeding, fresh rectal bleeding, melaena.

Question 18

SOB common diagnoses?

Answer 18

Acute asthma attack leads to bronchospasm, COPD can also cause this.

Question 19

COPD?

Answer 19

chronic bronchitis and emphysema, so they’ll be a history of bronchitis with permanent, largely irreversible SOB.

Question 20

COPD signs (5)?

Answer 20

hyperexpanded chest, breathing through pursed lips, reduced air entry, prolonged expiratory phase, hyper-resonant percussion note.

Question 21

Chronic asthma (7)?

Answer 21

hist of wheeze, breathlessness, chest tightness, cough, worse at night/morning.

Can have presence of associated atopic conditions.

Symptoms can be exacerbated by NSAIDs aspirin Beta blockers

Question 22

Interstitial lung disease?

Answer 22

hist of exposure to asbestos, silica or coal or drugs

Question 23

Interstitial lung disease signs?

Answer 23

clubbing, reduced air entry, late inspiratory, fine crackles.

Question 24

Heart failure (4)?

Answer 24

hist of SOBOE, orthopnoea, paroxysmal nocturnal dyspnoea, swollen ankles.

Question 25

Heart failure risk factors?

Answer 25

ischaemic heart disease (smoking, diabetes mellitus, hypercholesterolaemia, hypertension, South Asian descent, strong family history),

other atherosclerotic disease (e.g. stroke, transient ischaemic attack (TIA), limb claudication),

hypertension (can cause heart failure by itself, in the absence of ischaemic heart disease),

valvular disease (e.g. rheumatic fever, endocarditis, Marfan’s syndrome), cardiomyopathy

Question 26

Signs of heart failure (4)?

Answer 26

displaced apex beat, 3rd and 4th heart sounds, crackles in both lung bases, raised JVP.

Question 27

Anaemia (7)?

Answer 27

hist of bleeding, fatigue as well as SOBOE, signs of peripheral cyanosis, koilonychia, glossitis, and angular stomatitis, conjunctival pallor

Question 28

Bronchiectasis?

Answer 28

hist of productive cough and recurrent chest infections, or hist of cystic fibrosis.