Dyspnea

Question 1

Dyspnea is subjective or objective?

Answer 1

Subjective

Question 2

What is dyspnea?

Answer 2

A subjective sensation of shortness of breath or breathing discomfort

Question 3

What is chronic dyspnea?

Answer 3

Sx greater than 1 month

Question 4

T/F underlying cause of dyspnea is not directly related to duration or severity

Answer 4

True

Question 5

How do pts describe dyspnea?

Answer 5

“I cant catch my breath”
“chest tightness”

Question 6

What % accounts for FP visits for dyspnea?

Answer 6

4%

Question 7

What age gets dyspnea?

Answer 7

Pediatrics and 55-69 years of age

Question 8

T/F A large percentage of patients will have an already diagnosed cardiopulmonary disorder which accounts for the dyspnea

Answer 8

True

Question 9

Dyspnea is approximately 2/3rds of cases are caused by _____?

Answer 9

Pulmonary or cardiac disorder

Question 10

85% of dyspnea is caused by (detailed list)?

Answer 10

Asthma, CHF, COPD, PNA, cardiac ischemia, interstitial lung disease

Question 11

What are the 1/3 (not caused by heart/lungs)?

Answer 11

Metabolic, deconditioning, anemia, or psychogenic

Question 12

About what # of pt will have another complaint?

Answer 12

2/3

Mostly cough (17%)

Question 13

T/F The diagnosis can be made in half of all patients with history alone (if a good history is taken!)

Answer 13

True

Question 14

T/F Dyspnea is not multifactorial

Answer 14

False, it is multifactorial

Question 15

Which (lung/cardiac) has slower onset?

Answer 15

Lung

Question 16

Dyspnea at rest is most likely lung or cardiac?

Answer 16

Lungs

Question 17

Cough that is more productive is more lungs or cardiac?

Answer 17

lungs

Question 18

Which (lungs/cardiac) has more rapid onset?

Answer 18

Cardiac

Question 19

Dyspnea with exertion is more likely (lung/cardiac)?

Answer 19

Cardiac

Question 20

T/F Cough is common with cardiac dz

Answer 20

False, cough is rare

Question 21

What are sx to send immediately to the ER?

Answer 21

Acute respiratory distress
- Labored (Wheezing, accessory muscle use, unable to speak in full sentence (two/word dsypnea).
- cyanotic, word dyspnea
(Chest pain)
(Hypoxic)

Question 22

T/F 87% can be normal for pt with lung dz

Answer 22

True

Question 23

In addition to O2 %, what should you keep in mind?

Answer 23

vital signs

Question 24

COPD’s what is highest PE exam correlation

Answer 24

Wheezing

Question 25

what is most specific question for CHF?

Answer 25

DOE is the earliest symptom, but PND is more specific

Question 26

T/F S3 gallop is never normal

Answer 26

True

Question 27

What is S3 gallop associated with?

Answer 27

CHF

Question 28

New murmur is associated with?

Answer 28

CHF

Question 29

Which lung disease has slow progression of exertional dyspnea?

Answer 29

ILD

Question 30

What is present in 80% of pt with ILD?

Answer 30

Persistent inspiratory crackles

Question 31

25-50% will have what with ILD?

Answer 31

Clubbing

Question 32

What does normal O2 implies?

Answer 32

a mild disorder such as exercise-induced bronchospasm

Question 33

What does abnormal O2 with exertion implies?

Answer 33

mild to moderate cardiopulmonary disease

Question 34

What does abnormal O2 at rest implies?

Answer 34

moderate to severe cardiopulmonary disease

Question 35

Whats important to get with in lung dz pt?

Answer 35

Walking O2

Question 36

Whats the diagnostic approach for dyspnea?

Answer 36

If you get good H&P, you will prob have a diagnosis

Question 37

T/F Patients who present with dyspnea as a primary complaint are more likely to get an EKG than lung function testing

Answer 37

True but it needs to change

Question 38

What is your first choice of test for dyspnea?

Answer 38

PFT

Question 39

What is obstructive for FEV1 and FEV1/FVC?

Answer 39

FEV1 = <80% FEV1/FVC? = <70%

Question 40

What are the obstructive lung dz?

Answer 40

COPD Asthma Bronchiectasis

Question 41

What is FEV1 and FEV1/FVC for restrictive?

Answer 41

FEV1 = <80% FEV1/FVC? = >70%

Question 42

What are example of restrictive lung dz?

Answer 42

Interstitial lung disease Pulmonary fibrosis Obesity Autoimmune diseases Pleural effusion and heart failure

Question 43

How can EKG help in eval of dyspnea?

Answer 43

Cardiac ischemia or infarction Ventricular hypertrophy Pericardial disease

Question 44

Eval of dyspnea with CXR

Answer 44

Chest wall abnormalities, hyperinflation, CM or pleural effusions, Mass/Mets, PNA - good for dyspnea

Question 45

When would you order CT chest?

Answer 45

I have no idea what’s causing this patients dyspnea… Interstitial lung disease, bronchiectasis, PE You will see PE with this

Question 46

List the dx test

Answer 46

- EKG - CXR - CTA PE - High res CT chest - CBC - BMP

Question 47

Why would you order CBC with dyspena?

Answer 47

Anemia Infection COPD

Question 48

Why would you order BMP with dyspena?

Answer 48

Acid-Base disturbance (bicard level) Metabolic acidosis

Question 49

T/F BNP is good for CHF?

Answer 49

Yes, the higher it is, worse their CHF is

Question 50

T/F Echo is high yield for pt who we think have CHF

Answer 50

True

Question 51

Can paroxysmal afib cause dyspnea?

Answer 51

Yes, best with holter monitor

Question 52

If it doesn't correlate with anything, sometimes at night, sometimes day etc what should you get?

Answer 52

Holter Monitor

Question 53

How will Lung bx help with eval of dyspnea- PANCE

Answer 53

Interstitial lung disease Malignancy

Question 54

When should we refer dyspnea pt?

Answer 54

- Underlying cause of dyspnea is unclear - Symptoms disproportionate to the apparent severity of the disease - For lung biopsy - Patient not adequately responding to treatment