Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

RRCCPA Clinical Decision Making II > Eval of Dyspnea (Final) > Flashcards

Eval of Dyspnea (Final) Flashcards

1
Q

What is dyspnea?

A

A subjective sensation of shortness of breath or breathing discomfort

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Chronic dyspnea = symptoms greater than ___

A

1 month

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

The underlying cause of dyspnea is NOT directly related to?

A

duration or severity!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

How might a patient describe the sensation of dyspnea?

A

Varies widely from “I can’t catch my breath” to “chest tightness”

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Dyspnea accounts for what percentage of all FP visits?

A

4%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

At what ages does dyspnea most commonly occur?

A

Pediatrics and Ages 55-69

(bell shaped presentation)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What type of disorder will a large percentage of dyspneic patients already have diagnosed?

A

Cardiopulmonary disorder - which accounts for the dyspnea

*REMEMBER, patients can have more than one issue!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Approximately 2/3rds of dyspnea cases are caused by what two disorders?

A

Pulmonary or Cardiac

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Of the 2/3rds of dyspnea cases caused by pulmonary or cardiac disorders, 85% of them have what conditions?

A
  • Asthma
  • CHF
  • COPD
  • PNA
  • Cardiac ischemia
  • Interstitial lung disease
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

1/3 of dyspnea causes have nothing to do with the heart and lungs, and include what conditions?

A
  • Metabolic (DKA)
  • Deconditioning
  • Anemia
  • Psychogenic
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What should be on your DDX for cardiac causes of chronic dyspnea?

A
  • CHF
  • CAD
  • Cardiac arrhythmias
  • Pericardial dz
  • Valvular heart dz
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What should be on your DDX for pulmonary causes of chronic dyspnea?

A
  • COPD
  • Asthma
  • Interstitial lung dz
  • Pleural effusion
  • Malignancy
  • Bronchiectasis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What fraction of patients will have another complaint other than dyspnea?

A

2/3rds

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Patients with dyspnea often complain of what other symptoms?

A
  • Cough 17%
  • CP 5%
  • Fatigue 3.5%
  • Out of medication 3.2%
  • Wheezing 2.5%
  • Peripheral edema 2%
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

The cause of dyspnea is ___ in 1/3 of patients

A

Multifactoral (Jaynstein’s favorite word ever)

*ie COPD with concurrent URI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

The diagnoses of dyspnea can be made in ___ of all patients with ___ alone!

A

The diagnoses of dyspnea can be made in half of all patients with history alone!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

A patient with a h/o smoking is more likely to have lung or cardiac disease?

A

Lung

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

A patient with a h/o HTN, CAD, obesity, valve disorder is more likely to have lung or cardiac disease?

A

Cardiac

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

A patient with a slower onset of symptoms is more likely to have lung or cardiac disease?

A

Lung

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

A patient with a more rapid onset of symptoms is more likely to have lung or cardiac disease?

A

Cardiac

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

A patient with dyspnea at rest is more likely to have lung or cardiac disease?

A

Lung

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

A patient with dyspnea with exertion is more likely to have lung or cardiac disease?

A

Cardiac

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

A patient with a productive cough is more likely to have lung or cardiac disease?

A

Lung

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

A true cough is rare in lung or cardiac disease?

A

Cardiac

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
What is on the top of your DDX for a patient who presents with increased work of breathing, feeling of suffocation, and air hunger?
COPD
26
What dyspnea symptoms would a patient with CHF commonly present with?
* Rapid breathing * Feeling of suffocation * Air hunger
27
What dyspnea symptoms would a patient with interstitial lung dz commonly present with?
Increased work of breathing
28
What dyspnea symptoms would a patient with Asthma commonly present with?
* Incomplete exhalation * Shallow breathing * Increased work of breathing * Chest tightness * Heavy breathing
29
What dyspnea symptoms would a patient with neuromuscular and chest wall disease commonly present with?
* Shallow breathing * Increased work of breathing
30
What dyspnea symptoms would a patient with pregnancy commonly present with?
Air hunger
31
What dyspnea symptoms would a patient with pulmonary vascular disease commonly present with?
Incomplete exhalation
32
What dyspnea symptoms should alert you to send your patient to the ED immediately?
* **Acute respiratory distress****​** * (CP) * (Hypoxic)
33
What are signs that your patient is in acute respiratory distress?
* Labored breathing * Cyanotic (fingertips) * Word dyspnea
34
What are you determining when performing a PE on a dyspneic patient?
Sick vs not sick * Vital signs! * Obtain objective info to evaluate subjective complaints
35
What symptoms are highly correlated with COPD according to LRs?
* Wheezing - LR +15 * Smoking - LR +8 * Rhonchi - LR +8 * Hyperresonance to percussion - LR +5.3 * Forced expiratory time \> 9 secs - LR +4.8
36
A LR of 10 is good but anything around what number is considered helpful in medicine?
5
37
What is the diagnostic test of choice for COPD
PFTs
38
What is the _earliest_ symptom for CHF
DOE
39
What is the more specific symptom for CHF
Paroxysmal nocturnal dyspnea (PND)
40
What symptoms are highly correlated with CHF according to LRs?
* **S3 Gallop** - LR +24 * Displaced PMI - LR +16.5 * JVD - LR +8.5
41
A **S3 gallop** is heard so what is at the top of your DDX?
CHF until proven otherwise
42
The finding of a S3 gallop, displaced PMI, or JVD in a patient who presents with dyspnea increases the likelihood of CHF as the dx by what percentage?
80%!!!
43
What do we need to remember about asthma patients?
* Get a good History and do a PE (unless acutely wheezing) * Asthma patients return to 100% normal baseline between episodes
44
What symptoms would a patient with interstitial lung disease present with?
* Slow progression of exertional dyspnea * Persistent inspiratory crackles - in 80% * Clubbing 25-50%
45
A patient presents with inspiratory crackles and you have them cough. You listen again and crackles are _no longer present_. This indicates what type of condition?
An underlying infectious cause NOT interstitial lung disease
46
On PE a _normal_ SaO2 implies a ___ disorder
Mild - such as exercise-induced bronchospasm
47
On PE an _abnormal SaO2 with exertion_ implies a ___ cardiopulmonary disease
mild to moderate
48
On PE an _abnormal SaO2 at rest_ implies a ___ cardiopulmonary disease
moderate to severe
49
What must you always remember to do during your PE of a dyspneic patient?
GET A WALKING O2! \*SpO2 correlates with severity of illness
50
Patients who present with dyspnea as a primary complaint are more likely to get an EKG than lung function testing. What's wrong with this?
We need to change this because _lung function results_ are what pave the way for the rest of your work up!
51
If a patient presents with dyspnea and their lung function tests are _normal_ what does this indicate?
The patient is very unlikely to have a significant cardiopulmonary disease with the expectation of asthma
52
What PFT results are diagnostic of _obstructive_ lung disease
* FEV1 **\< 80%** * FEV1/FVC **\< 70%**
53
What PFT results are diagnostic of _restrictive_ lung disease?
FEV1 **\< 80%** FEV1/FVC **\> 70%**
54
What lung diseases are obstructive?
* COPD * Asthma * Bronchiectasis \*cannot get air **_O_**UT
55
What lung diseases are restrictive?
* Interstitial lung disease * Pulmonary fibrosis * Obesity * Autoimmune diseases (sarcoidosis) * Pleural effusion and heart failure \*cannot get air IN
56
Obtaining an EKG in the evaluation of dyspnea is indicated for what conditions?
* Cardiac ischemia or infarction * Ventricular hypertrophy * Pericardial disease (effusion)
57
Obtaining a CXR in the evaluation of dyspnea is indicated for what conditions?
* Chest wall abnormalities * Hyperinflation * CM or pleural effusions * Mass/Mets * PNA
58
When would you want to obtain a CTA PE?
Evaluation of vascular issues
59
High res CT chest imaging is reserved for?
* When you have no idea what's causing the patients dyspnea * interstitial lung disease, bronchiectasis, PE * A lot of radiation exposure so talk to a radiologist first!
60
Ordering a CBC in the evaluation of dyspnea is indicated for what conditions?
* Anemia * Infection (careful in non sick) * COPD (polycythemia)
61
Ordering a BMP in the evaluation of dyspnea is indicated for what conditions?
* Acid-Base disturbance * Elevated bicarb - Metabolic alkalosis * COPD, interstitial lung dz, neuromuscular disorders * Metabolic acidosis * DKA
62
What cardiac tests may you want in the evaluation of dyspnea?
* Troponin * BNP * Echo (structural or functional issues)
63
What diagnostic test is the most specific for the evaluation of CHF?
**BNP!** BNP \>100 is 82% sensitive, 99% specific for CHF
64
The magnitude of elevation of BNP is ___ to the severity of heart failure
proportional
65
What type of afib can cause dyspnea?
Paroxysmal
66
What is your diagnostic test of choice in evaluation of paroxysmal afib?
Holter Monitor
67
Ordering a lung biopsy in the evaluation of dyspnea is indicated for what conditions?
* Interstitial lung disease * Malignancy
68
In patients who have a diagnosed cardiopulmonary disorder who have chronic dyspnea despite maximal therapy, you should STRONGLY consider the presence of a \_\_\_
**Cofactor** such as * Obesity * Deconditioning * Emotional response to illness
69
When do you refer a patient with dyspnea?
* Underlying cause of dyspnea is unclear * Sxs disproportionate to the apparent severity of the disease * For lung biopsy * Patient not adequately responding to tx \*make sure you get a PFT prior to sending

RRCCPA Clinical Decision Making II (10 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions