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Differential Diagnosis > Dyspnea > Flashcards

Dyspnea Flashcards

1
Q

Is dyspnea a subjective or objective finding?

A

subjective feeling, “I can’t catch my breath”

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2
Q

Is tachypnea a subjective or objective finding?

A

objective finding, rapid resp rate may or may not be associated with the feeling of not being able to breathe properly

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3
Q

What are the pathophysiologies for tachypnea and dyspnea?

A

The mechanisms are the same: inadequate oxygen for body needs or inability to excrete CO2

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4
Q

What goes into an inadequate oxygen rate for the bodies needs or inability for the body to excrete CO2?

A

decrease intake of O2
decrease absorption of O2
decrease perfusion of lungs with blood
Inability of the body to transport enough O2 to the tissues
Increased demand of O2 by tissues
decrease ability to excrete CO2 and other waste products of metabolism

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5
Q

What are ways the body can have a decreased intake to O2?

A

There is a block in the resp passages
Malfunction of the resp muscles of inspiration
Malfunction of the resp center in the brain
High altitude

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6
Q

What conditions cause a decreased intake of O2 via a block in the resp. passage?

A

Laryngitis
Foreign bodies
Asthma
Acute bronchitis

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7
Q

What conditions cause a decreased intake of O2 via a malfunction of the resp muscles of inspiration?

A

kyphoscoliosis
Amyotrophic lateral sclerosis (ALS)
Peritonitis

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8
Q

What conditions cause a decreased intake of O2 via a malfunction of the resp center in the brain?

A

encephalitis

brain tumor

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9
Q

What conditions cause an impaired absorption of O2?

A 
lobar pneumonia
sarcoidosis
silicosis
idiopathic pulmonary fibrosis
pulmonary edema
ARDS
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10
Q

Why is there an impaired absorption of O2 with diseases such as silicosis?

A

the alveoli are damaged and/or the lung tissue is scarred

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11
Q

What would cause an inadequate perfusion of the lungs with blood?

A

conditions in which unoxygenated blood bypasses the alveoli

diseases with ventilation-perfusion defects

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12
Q

What are conditions that bypass the alveoli with unoxygenated blood?

A

pulmonary embolism

congenital heart disease

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13
Q

What are conditions that have a ventilation-perfusion defect and thus cause an inadequate ventilation of the lungs with blood?

A

emphysema

pneumoconioses

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14
Q

What is an a way to describe the processes that cause an inadequate perfusion of the lungs with blood?

A

shunt vs dead space

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15
Q

What are examples of disorders with decreased O2 transport?

A

Disorders that cause the tissue to not get enough O2

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16
Q

What are reasons that the tissue will not get enough O2?

A

not enough blood to transport it
not enough BP to perfuse them
Heart pump fails
Blood is unable to carry it

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17
Q

What is an example of a disorder that does not have enough blood to transport the necessary amount of O2?

A

Anemia and hemorrhagic shock

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18
Q

What is an example of a disorder that does not have enough BP to perfuse the blood cells to the body?

A

vasomotor shock and cardiogenic shock

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19
Q

What is an example of a disorder where the heart pump fails, inhibiting ventilation and perfusion?

A

CHF

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20
Q

What is an example of a disorder where the blood is unable to carry the necessary amount of O2 for the body?

A

Methemoglobinemia and CO poisoning

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21
Q

What is methemoglobinemia?

A

the iron atom in deoxyhemeglobin loses an electron, resulting in ferric (fe+3) ion instead of ferrous (fe+2) ion. It can no longer bind O2, thereby reducing the oxygen carrying capacity

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22
Q

Which way does methemoglobinemia shift the O2 curve?

A

Shifts the curve left, decreased release of O2 to tissues

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23
Q

What is the most common cause of methemoglobinemia?

A

Acquired through pharm agents such as sulfonamides, dapsone, benzocaine and more; rarely lidocaine)

24
Q

What are clues to the diagnosis of methemoglobinemia?

A

Pt appears cyantotic and doesnt improve with O2, blood appears chocolate, shows a normal ABG

25
Q

How do you treat methemoglobinemia?

A

methylene blue enhances the conversion back to hemeglobin; it is given IV

26
Q

What type of conditions increase the demand of O2 to the tissues?

A

Those that increase the tissues metabolism

27
Q

What disease states increase the cells/tissues metabolism?

A

nervous stress, panic disorders, fever, leukemia, malignancies, hyperthyroidism

28
Q

What else increases the cells metabolism?

A

exercise

29
Q

What are conditions that inhibit the bodies ability to excrete CO2 and other wastes?

A

emphysema, lactic acidosis, diabetic acidosis, uremia

*damaged lung tissue

30
Q

What are the 4 categories of differential diagnosis of dyspnea?

A

Pulm
Cardio
Mixed
Neither

31
Q

What conditions that cause dyspnea have a pulmonary etiology?

A 
asthma
COPD
pneumonia
pneumothorax
PE
pleural effusion
restrictive lung disorders
hereditary lung disorders
pulmonary HTN
cancer
32
Q

What conditions that cause dyspnea have a cardiology etiology?

A 
CAD
MI (recent or pmhx)
CHF
cardiomyopathy
valvular dysfunction
left ventricular hypertrophy
pericarditis
arrythmias
33
Q

What conditions that cause dyspnea have a pulmonary and cardiology etiology?

A

COPD w/ pulmonary HTN and/or cor pulmone

Deconditioning

34
Q

What conditions that cause dyspnea have neither etiology?

A 
metabolic conditions (acidosis)
pain
anemia
neuromuscular disorders
chemical exposure
functional (anxiety, panic disorders, hyperventilation)
35
Q

What is the specific cause and treatment of dyspnea?

A

There is no specific cause or treatment

36
Q

What does treatment vary in regards to?

A

the patients condition

37
Q

What in the chief complaint can give you clues as to the etiology?

A 
chest tightness (myocardial disease)
chest tightness with air hunger (asthma)
can't take a deep breath (COPD)
suffocation or smothering (CHF)
heavy breathing (deconditioning)
38
Q

What is the single most useful diagnostic modality?

A

the history

39
Q

What percentage of the time is the diagnosis established just by the history?

A

75

40
Q

What other signs, to help guide your diagnosis of dyspnea, do you look for?

A 
accessory muscle use
fever
cyanosis
purse lip breathing
clubbing
barrel chest
adventitious breath sounds
edema
JVD
BP abnormalities
arrhythmias and murmur
hepatosplenomegaly
ascites
obesity
41
Q

What are PFTs?

A

simple spirometry that confirms airflow limitation with a reduced FEV1, FEV1/FVC ratio and PEF. Reversibility is demonstrated by a >12% and 200 ml increase in FEV1 15 min after an inhaled short acting agonist (albuterol)

42
Q

What questions do we need to ask the patient when taking a history for dyspnea?

A

Was the onset sudden or gradual?
Is the dyspnea constant or intermittent?
Does it occur during activity or while at rest?
If the patient has had dyspnea before, is it getting worse?
What effect does it have on the patient’s ADLs?
Is there an aggravating factor?
Is there an alleviating factor?
Are there other symptoms (cough, sputum, chest pain, orthopnea, PND, hemoptysis, fatigue, urticaria)
Is there a history of trauma?
Is there a history of infection?
Is there a history of DVT? Inactivity? OCPs?
Does the patient smoke?
Does the patient have occupational exposures?

43
Q

What is the causative agent of Community acquired pneumonia?

A

Streptococcus pneumoniae is the most frequent cause of bacterial pneumonia, otitis, and meningitis.

44
Q

What are the signs and symptoms of community acquired pneumonia?

A

rapid onset of cough, fever (can be high), chills, SOB.

45
Q

How do we diagnose community acquired pneumonia?

A

H&P, CXR, sputum cx, blood cx

46
Q

How do we treat community acquired pneumonia?

A

give them a macrolide

47
Q

What are the causative agents of Atypical pneumonia?

A

Mycoplasma pneumoniae
Chlamydia pneumoniae
Legionella pneumophilia
Respiratory viruses

48
Q

How does atypical pneumonia present?

A

Injected pharynx and scattered rhonci?

usually cause milder forms of pneumonia and are characterized by a more drawn out course of symptoms unlike other forms of pneumonia which can come on more quickly with more severe early symptoms

49
Q

Who does mycoplasma pneumonia effect and how does it affect them?

A

Mycoplasma pneumonia often affects younger people and may be associated with symptoms outside of the lungs (such as anemia and rashes), and neurological syndromes

50
Q

What are the symptoms of pneumonia?

A 
Generalized aches and pains 
Fever (usually less than 102°F) 
Cough - Usually nonproductive 
Sore throat (nonexudative pharyngitis) 
Headache/myalgias 
Chills but not rigors 
Nasal congestion with coryza 
Earache 
General malaise
51
Q

How does pneumonia affect ages differently?

A

In very young children, upper respiratory tract manifestations may predominate, whereas in older children and adults, lower respiratory tract symptoms are more likely.

52
Q

What are the physical findings of pneumonia?

A 
Oropharyngeal inflammation 
Cervical adenopathy - Usually absent 
Erythematous tympanic membranes 
Conjunctivitis 
Maculopapular or urticarial rash
53
Q

How does chest auscultation present with pneumonia?

A

Chest auscultation in patients with pneumonia may demonstrate localized rhonchi and scattered moist rales, generally involving multiple lobes of the lung and sometimes accompanied by wheezes, with no signs of consolidation, egophony, or bronchial breathing.

54
Q

How does emphysema present on a CT?

A

Lobes reveal airspace enlargement with surrounding fibrosis.
The infiltrates are shown to be reticular abnormalities with “ground glass” opacities.

55
Q

On a chest xray what would signify CHF?

A

Cardiomegaly is the most sensitive finding for heart failure. Pulmonary venous congestion and interstitial edema are highly specific, and when present strongly suggest heart failure.

Differential Diagnosis (2 decks)

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