Dyspnea Lecture Powerpoint

Question 1

Dyspnea definition

Answer 1

Shortness of breath, breathlessness, troubled or labored breathing, either acute over a few hours or days or chronic over 4-8 weeks, can be related to almost any system in the body as a symptom

Question 2

3 Categories of dyspnea

Answer 2

• Oxygen ingress problem (uptake of air into airways)
• Oxygen uptake problem (cannot absorb the O2 into the bloodstream)
• Neuromuscular or miscellaneous

Question 3

Common pulmonary causes of dyspnea (4)

Answer 3

• Pneumothorax
• PE
• COPD
• Restrictive lung disease (obesity or sarcoidosis for example)

Question 4

Common cardiac causes of dyspnea (5)

Answer 4

• CAD MI/angina
• Congestive heart failure
• Aortic aneurysm
• valvular dysfunction
• arrhythmias (early sign)

Question 5

Other system causes of dyspnea (immunology, endocrinology, neurology, musculoskeletal, infectious, psychiatric, and airway)

Answer 5

Immunology: angioedema
Endocrine: metabolic acidosis
Neurologic: myasthenia gravis
Musculoskeletal: kyphoscoliosis
Infectious: epiglottitis
Psych: anxiety
Airway causes: foreign body aspiration, epiglottitis, retropharyngeal abscess

Question 6

PPOPPA acronym for acute dyspnea causes in adult

Answer 6

• Pulmonary embolism
• Pulmonary edema
• Obstructed airway
• Pneumothorax
• Pneumonia
• Asthma or COPD

Question 7

Common causes of acute dyspnea in children (4)

Answer 7

• asthma
• pneumonia
• croup
• foreign body aspiration

Question 8

How to differentiate between foreign body in trachea and esophagus

Answer 8

Look for the pattern of airway (esophagus only widens around the object and is flat otherwise, airway is clear and wide

Question 9

3 important HPI questions to ask patient

Answer 9

• What were you doing?
• When does it happen?
• What makes it worse?

Question 10

Dyspnea at rest with pleuritic chest pain strongly indicates…

Answer 10

….PE

Question 11

Important to distinguish between dyspnea at ____ and dyspnea ____ when documenting

Answer 11

rest, upon exertion

Question 12

Postprandial dyspnea

Answer 12

Dyspnea after ingesting food, can be caused due to food allergy, aspiration, GERD, or due to filling preventing diaphragm contracting (perhaps a sign of restrictive lung disease being further exacerbated by full stomach and noncompliant diahpragm)

Question 13

Contributing factors of dyspnea (3)

Answer 13

• Tobacco use
• medications
• occupational exposure

Question 14

Immunization status in dyspnea (3)

Answer 14

• Influenza
• Pneumonia
• Tdap (diphtheria and pertussis are causes of dyspnea)

Question 15

Concerns with travel history and dyspnea (3)

Answer 15

• Altitude changes (High altitude pulmonary edema)
• PE
• exposure to SARS, MERS, etc.

Question 16

Signs of imminent respiratory distress (5)

Answer 16

• depressed mental status
• inability to maintain respiratory effort
• brief, fragmented speech
• cyanosis
• inability to lie supine

Question 17

Acute dyspnea diagnostic studies (7)

Answer 17

• CXR (AP lateral)
• CBC
• BNP
• D-Dimer
• ABG
• Peak flows
• echocardiogram

Question 18

Peak flows can be useful in tracking progress…

Answer 18

…of a stable patient with dyspnea

Question 19

Obliterative bronchiolitis

Answer 19

“Popcorn lung”, obstruction of bronchioles due to inflammation, commonly due to vaping

Question 20

Angioedema is often caused by what drug class?

Answer 20

ACEI such as lisinopril

Question 21

Pleuritic chest pain

Answer 21

Sharp chest pain with inspiration caused by inflammation of the pleura

Question 22

ABC approach to diagnosis of dyspnea

Answer 22

Correct anything immediately correctable, (airway, breathing, circulation), then determine acute, chronic, or acute on chronic

Question 23

Epiglottis (thumb print sign)

Answer 23

A neck x ray radiologic sign that suggests epiglottitis from a thickened free edge of the epiglottis looking like a thumb

Question 24

Croup (steeple sign)

Answer 24

A neeck x ray radiologic sign that presents with subglottic tracheal narrowing creating the shape of a church steeple, indicative of croup caused by paramyxovirus