Dyspnea & Cough Flashcards
Common diagnoses in pts who present with dyspnea d/t impaired ventilatory mechanics
Asthma
COPD
Common diagnoses in pts who present with dyspnea d/t muscle weakness
Myasthenia gravis
Guillain barre syndrome
Myopathies
Common diagnoses in pts presenting with dyspnea d/t decreased chest wall compliance
Kyphoscoliosis
Obesity
Cardiovascular causes of dyspnea
ACS
Tachycardia
Cardiac tamponade
Respiratory causes of dyspnea
Asthma COPD Bronchospasm Aspiration Obstruction Pneumonia ARDS Pulmonary embolism Pleural effusion Pneumothorax
Common diagnoses in pts who present with dyspnea d/t impaired respiratory drive
Parenchymal or pulmonary vascular lung dz
CHF
Chemoreceptor stimulation (hypoxemia, hypercapnia, acidemia)
Impaired gas exchange
Pregnancy
Behavioral factors (hyperventilation, anxiety, panic attacks)
Common associated symptoms in pts with dyspnea d/t cardiac etiology
Orthopnea
Edema
Angina
Common associated sx in pts with dyspnea d/t pulmonary etiology
Wheezing
Cough
Hx of smoking or environmental exposure
Use the MRC scale to quantify the degree of dyspnea
Grade 1: not troubled by breathlessness except on strenuous exercise
Grade 2: short of breath when hurrying on level ground, or walking up a slight hill
Grade 3: walks slower than most people on that level, stops after a mile or so, or stops after 15 minutes of walking at own pace
Grade 4: stops for a breath after walking about 100 yards or after a few minutes on level ground
Grade 5: too breathless to leave the house, or breathless while dressing
Diagnostic approach to dyspnea
Assess vitals including HR, BP, RR, and pulse ox; stablize the pt
History and physical — hx includes quality of dyspnea, precipitating events, associated features, and risk factors for cardiac and pulmonary dz
Chest radiography
Other testing may include: CT angiography, V/Q perfusion ratio (r/o PE), serum BNP (r/o heart failure), laryngoscopy and bronchoscopy (r/o FB aspiration, airway obstruction, and vocal cord dysfunction), bronchoscopy and alveolar lavage (may help dx PNA)
Primary diagnostic tool in evaluating a pt with dyspnea
Chest radiography
Common diagnoses in pts who present with acute cough (<3 wks duration)
Viral URI (common cold) Bronchitis Pneumonia Bacterial sinusitis Allergic rhinitis Asthma exacerbation COPD exacerbation Aspiration or foreign body Medication reaction (ACE-I) Pulmonary embolism
Common diagnoses in pts who present with chronic cough (>8 wks duration)
Upper airway cough syndrome Asthma GERD Non-asthmatic eosinophilic bronchitis Bronchiectasis Medication reaction (ACE-I) Chronic bronchitis caused by smoking
Common symptoms associated with cough d/t viral rhinitis
Rhinorrhea, sneezing, nasal congestion, postnasal drainage
Common symptoms associated with cough due to influenza
Fever, malaise, myalgia, pharyngitis
Common symptoms associated with cough d/t acute exacerbation of chronic bronchitis or bronchiectasis
Increased cough
Purulent sputum production
Shortness of breath
Diagnostic approach to pt with cough
Maintain airway and ventilation
History and physical
Viral cultures, bacterial cultures, PCR, immunoassays
Spirometry
CXR, can later consider CT
Trial a PPI if suspicious of GERD
All patients presenting with a cough and _______ should undergo chest radiography
Hemoptysis
76 y/o female presents with >150 pack year smoking history but stopped 20 years ago. Admits 30 year history of cough productive of scant white to yellow sputum. She was able to walk 3 miles 5 years ago but now is limited to walking about 20 minutes per day and at a slower pace than others her age. She also has a 70 year history of wheezing and a 9 year history of dyspnea. PFTs reveal:
FVC = 62% FEV1 = 52% FEV1/FVC = 68%
What is her GOLD classification?
A. Stage I: Mild
B. Stage II: Moderate
C. Stage III: Severe
D. Stage IV: Very Severe
B. Stage II: Moderate
[FEV1 is between 50-80% and FEV1/FVC is <70%]
76 y/o female presents with >150 pack year smoking history but stopped 20 years ago. Admits 30 year history of cough productive of scant white to yellow sputum. She was able to walk 3 miles 5 years ago but now is limited to walking about 20 minutes per day and at a slower pace than others her age. She also has a 70 year history of wheezing and a 9 year history of dyspnea. PFTs reveal:
FVC = 62% FEV1 = 52% FEV1/FVC = 68%
You diagnose her with as GOLD Stage II; which of the following is the most appropriate initial treatment?
A. ICS inhaler B. Roflumilast C. Theophylline D. Combination LABA/LAMA E. Oxygen therapy
D. Combination LABA/LAMA
A 36 y/o man is evaluated for progressive SOB over the last 3 years. He has episodic wheezing and decreased exercise capacity when he climbs stairs or walks quickly. He has a 10-pack-year history of smoking but has not used tobacco for the past 5 years. His father is 60 y/o and has severe emphysema. On PE, vital signs are normal and O2 sat is 92% on RA. BMI is 22. There is wheezing in the posterior and lower lung fields. The remainder of the findings on PE are normal.
FEV 1 = 53%
FEV1/FVC = 64%
DLCO = 67%
A 6-minute walk test shows no significant O2 desaturation while breathing ambient air.
What is this patient’s GOLD Classification?
A. Stage I: Mild disease B. Stage II: Moderate disease C. Stage III: Severe disease D. Stage IV: Very severe disease E. Not enough information
B. Stage II: Moderate disease
A 36 y/o man is evaluated for progressive SOB over the last 3 years. He has episodic wheezing and decreased exercise capacity when he climbs stairs or walks quickly. He has a 10-pack-year history of smoking but has not used tobacco for the past 5 years. His father is 60 y/o and has severe emphysema. On PE, vital signs are normal and O2 sat is 92% on RA. BMI is 22. There is wheezing in the posterior and lower lung fields. The remainder of the findings on PE are normal.
FEV 1 = 53%
FEV1/FVC = 64%
DLCO = 67%
A 6-minute walk test shows no significant O2 desaturation while breathing ambient air.
What is this patient’s MRD score? A. 0 B. 1 C. 2 D. 3 E. 4
B. 1
[grade 1 defined as “not troubled by breathlessness except on strenuous exercise”]
A 36 y/o man is evaluated for progressive SOB over the last 3 years. He has episodic wheezing and decreased exercise capacity when he climbs stairs or walks quickly. He has a 10-pack-year history of smoking but has not used tobacco for the past 5 years. His father is 60 y/o and has severe emphysema. On PE, vital signs are normal and O2 sat is 92% on RA. BMI is 22. There is wheezing in the posterior and lower lung fields. The remainder of the findings on PE are normal.
FEV 1 = 53%
FEV1/FVC = 64%
DLCO = 67%
A 6-minute walk test shows no significant O2 desaturation while breathing ambient air.
In addition to smoking cessation, which of the following is the most appropriate next step in management?
A. AAT level B. Chest CT C. Inhaled glucocorticoid tx D. Oxygen therapy E. LABA inhaler
A. AAT level
[he is young!]
Chronic cough is defined as cough lasting beyond:
A. 7 days B. 2 weeks C. 4 weeks D. 8 weeks E. 4 months
D. 8 weeks
The most common cause of acute cough is:
A. Viral URI B. Influenza C. Pertussis D. Asthma E. Pneumonia
A. Viral URI
In patients with chronic bronchitis, which agent can decrease sputum production and decrease cough?
A. Metaproterenol B. Albuterol C. Ipratropium D. Methacholine E. Salmeterol
C. Ipratropium
Chronic dyspnea is defined as dyspnea persisting beyond ______
A. 2 weeks B. 1 month C. 3 months D. 6 months E. 1 year
B. 1 month
According to the Medical Research Council Dyspnea Scale, a patient who stops for breath after walking about 100 yards, or after a few minutes on level ground has a score of:
A. 1 B. 2 C. 3 D. 4 E. 5
D. 4
T/F: a serum BNP level <100 pg/mL helps exclude heart failure in the setting of acute dyspnea
True
The spirometric finding of reversible bronchopulmonary obstruction is consistent with the diagnosis of:
A. Eosinophilic bronchitis B. Influenza C. Aspiration pneumonia D. Asthma E. GERD
D. Asthma
A pt with a known cardiac disease presents with rapid onset of dyspnea over 2 days. He is afebrile and has a nonproductive cough and an S3 gallop. He loves bratwurst. The most likely cause of his dyspnea is:
A. Pulmonary embolus B. Influenza C. Volume overload D. Aspiration pneumonia E. Pleural effusion
C. Volume overload
An adult pt with a cough lasting >2 weeks without apparent cause with paroxysms of coughing, inspiratory whoop, or post-tussive emesis should raise suspicion for:
A. Asthma B. Upper airway cough syndrome C. Medication reaction D. Pertussis E. Aspiration of foreign body
D. Pertussis
Pts with ALS have dyspnea as a result of:
A. Bronchospasm B. Impaired respiratory drive C. Chemoreceptor downregulation D. Respiratory muscle weakness E. Altered gas exchange
D. Respiratory muscle weakness
A 26 y/o woman presents with gradual onset of mild dyspnea over the past 4 weeks. She is 36 weeks pregnant and does not smoke. Other than an appropriately enlarged uterus, her clinical exam is normal. Her pulse oximetry is 98% on RA. The most likely cause of her dyspnea is:
A. Pulmonary embolus B. Pregnancy-induced takotsubo cardiomyopathy C. Impaired diaphragmatic excursion D. Pleural effusion E. Acute interstitial pneumonitis
C. Impaired diaphragmatic excursion
