Dyspnoea 3+

Question 1

What questions on HxPC should you ask when someone presents with dyspnoea?

Answer 1

Onset: Acute vs chronic
Duration/Time course: intermittent, constant, progressive
Exacerbating: exertion, rest
Severity: quantify metres, talking
Positionality: supine vs sitting, how many pillows do you use at night?

Associated features:
- Central chest pain
- Pleuritic chest pain
- Cough
- Sputum production
- Fever
- Haemoptysis
- Dysphagia
- Weight loss, night sweats
- Palpitations
- Syncope
- Muscle weakness
- Sx of CHF
- Sx of DVT

Question 2

What do you want to know about the PMHx of someone presenting with dyspnoea?

Answer 2

Asthma
COPD
Interstitial lung disease
Recently post-op (PE)
Cardiac conditions
AI or Rheumatological = predisposed to PE, Pul HTN and interstitial lung disease
Known malignancy

Question 3

What medications can worsen COPD and Asthma?

Answer 3

Beta-blockers

Question 4

What bedside investigations should you do when someone presents with Dyspnoea?

Answer 4

ECG
Spirometry: FEV1/FVC
Pulse oximetry

Question 5

What laboratory investigations should you do when someone presents with dyspnoea?

Answer 5

FBC: WCC (infection), Hb (anaemia)
CRP: infection/inflammation
UEC: electrolyte, renal
ABG is suspect CO2 retention
If quite unwell: blood culture
BNP if suspect CHF or PE
D-dimer if suspect PE
Troponin if chest pain

Question 6

What imaging might you do when someone presents with dyspnoea?

Answer 6

CXR: consolidation, effusion, pneumothorax, pulmonary venous congestion (HF)
V/Q Scan: if suspect PE
Echocardiogram if suspect heart valve insufficiency or HF

Question 7

How can you further investigate an arrhythmia in someone presenting with dyspnoea?

Answer 7

24 hr Holter

Question 8

What other investigation (not bedside, laboratory or imaging) would you do when someone presents with dyspnoea and you want to evaluate chronic disease?

Answer 8

Formal Pulmonary Function testing: interstitial lung disease, COPD, emphysema, asthma

Question 9

COPD Hx

Answer 9

Progressive dyspnoea (yrs)
Slowly worsening exercise tolerance
Chronic productive cough (can be dry)
Worse in morning
Worse with exercise

Exacerbations present as:
Fever
Subacute worsened dyspnoea
Increased sputum/change in sputum character

Question 10

COPD Ex

Answer 10

Cyanosis
Hyper-expanded chest
Prolonged exhalation
Wheeze
Rhonchi
Can be clubbing

Question 11

Ix when you suspect COPD

Answer 11

Spirometry: Decreased FEV1, decreased FEV1/FVC (obstructive)
Pulmonary Function Tests: increased RV, increased TLC
CXR: increased lung volume, flattened hemidiaphragms
ABG: hypoxaemia, hypercapnia