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CDM2 - Final > Jaynstein - Dyspnea > Flashcards

Jaynstein - Dyspnea Flashcards

1
Q

chronic dyspnea is defined as SOB >

A

1 month

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2
Q

t/f: the severity of dyspnea correlates w. severity of pathology

A

f!

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3
Q

how might a pt describe sensation of dyspnea (2)

A

i can’t catch my breath
chest tightness

*it’s a subjective feeling of SOB or breathing discomfort

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4
Q

dyspnea accounts for __% of all FP visits

A

4

i guess we need to know these stats

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5
Q

what 2 pt pops does dyspnea affect

A

peds
55-65 yo

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6
Q

where do most dyspnea pt’s present

A

ED

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7
Q

dyspnea is usually an __ attack of a __ process

A

acute
chronic

majority have preexisting cardiopulmonary d.o

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8
Q

what fraction of dyspnea is related to cardiopulmonary d.o

A

2/3 (67%)

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9
Q

2/3 of dyspnea pt’s fall into what ddx

A

asthma
chf
copd
PNA
ischemia
ILD

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10
Q

1/3 of dyspnea pt’s fall into what ddx

A

metabolic
deconditioning
anemia
psychogenic

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11
Q

what pt pop does dyspnea related to deconditioning make you think of

A

older pt’s

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12
Q

cardiac causes of chronic dyspnea (> 1 mo) (5)

A

CHF
CAD
arrhythmias
pericardial dz
valvular dz

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13
Q

pulmonary causes of chronic dyspnea (6)

A

COPD
asthma
ILD
pleural effusion
malignancy (primary vs metastatic)
bronchiectasis

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14
Q

non cardiac causes of chronic dyspnea (11)

A

thromboembolic dz
psychogenic causes
deconditioning
pulmonary HTN
obesity
severe anemia
GERD
metabolic
cirrhosis
thyroid dz
neuromuscular (myasthenia gravis)

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15
Q

3 psychogenic causes of dyspnea

A

GAD
PTSD
panic disorder

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16
Q

__ of pt’s will have another complaint w. dyspnea

A

2/3

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17
Q

mc complaints associated w. dyspnea (6)

A

cough
cp
fatigue
ran out of meds
wheezing
peripheral edema

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18
Q

__ of patients w. dyspnea have concurrent pathology

A

1/3

ex COPD w.URI

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19
Q

cause of dyspnea can be determined by history alone in __% of pt’s

A

50

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20
Q

4 factors suggesting dyspnea related to lung dz (4)

A

h.o smoking
slower onset
resting dyspnea
productive cough

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21
Q

3 factors suggesting dyspnea related to cardiac dz

A

h.o HTN/obesity/valve d.o
rapid onset
exertional dyspnea

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22
Q

__ is rare if dyspnea is related to cardiac cause

A

cough

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23
Q

what do you think when you see: increased WOB, feeling of suffocation, and air hunger

A

COPD

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24
Q

what do you think when you see: rapid breathing, feeling of suffocation, and air hunger

A

CHF

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25
Q

what do you think when you see increased WOB alone

A

ILD

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26
Q

what do you think when you see: incomplete exhalation, shallow breathing, increased WOB, chest tightness, and heavy breathing

A

asthma

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27
Q

what do you think when you see: shallow breathing and increased WOB

A

neuromuscular and chest wall dz

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28
Q

what do you think when you see air hunger alone

A

pregnancy

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29
Q

what do you think when you see rapid breathing alone

A

pulmonary vascular dz

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30
Q

how does SOB affect related tachypnea/bradypnea

A

initially: tachypnea
later: bradypnea

31
Q

5 signs of acute respiratory distress (punt them)

A

labored breathing
cyanotic
word dyspnea
chest pain
hypoxia

32
Q

important history consideration with hypoxia

A

baseline SpO2

33
Q

t/f: SOB alone indicates “sick” pt

A

f!

34
Q

what do you think when you see a pt w. SpO2 93% who is tachycardic

A

PE

35
Q

what symptom has the highest LR related to COPD

A

wheezing (15)

36
Q

besides wheezing, 4 other symptoms with high LR related to COPD

A

smoking hx > 40 years
ronchi
hyperresonance to percussion
FE time > 9

37
Q

poor man’s bedside exam for COPD

A

forced expiratory time

38
Q

gs test for COPD

A

PFTs

39
Q

earliest symptom of CHF:
symptom most specific for CHF:

A

earliest: DOE
most specific: paroxysmal nocturnal dyspnea

40
Q

3 PE findings with high LR suggesting CHF

A

S3 gallop
displaced PMI
JVD

41
Q

5 findings that increase likelihood of CHF 80%

A

DOE
paroxysmal nocturnal dyspnea
S3 gallop
displaced PMI
JVD

42
Q

most important aspect of asthma diagnosis

A

history!!

more important than PE

43
Q

what do you think when you see slow progression of exertional dyspnea

A

ILD

pt usually presents when it has progressed to dyspnea at rest

44
Q

what lung sound is heard in 80% of pt’s w. ILD

A

inspiratory crackles that are present after coughing

45
Q

symptom that suggests advanced ILD

A

clubbing

46
Q

what does dyspnea w. normal SpO2 suggest

A

mild disorder -> exercise-induced bronchospasm

47
Q

what does abnormal SpO2 with mild exertion suggest

A

mild-mod cardiopulmonary dz

48
Q

what does abnormal SpO2 at rest suggest

A

moderate to severe cardiopulmonary dz

49
Q

what simple test can you do to evaluate severity of dyspnea

A

walking O2 ->
if SpO2 remains stable w. continuous walking, underlying pathology is unlikely

50
Q

first line test for cc of dyspnea

hint: it’s not EKG ;)

A

PFTs

51
Q

what do normal PFTs indicate in a pt w. cc of dyspnea

A

pt is very unlikely to have significant cardiopulmonary dz w. the exception of asthma

52
Q

what is the obstructive PFT pattern

A

FEV < 80%
FEV1/FVC < 70%

53
Q

what is the restrictive PFT pattern

A

FEV 1 < 80%
FEV1/FVC > 70%

54
Q

what are the obstructive respiratory diseases (3)

A

COPD
asthma
bronchiectasis

55
Q

what are the restrictive lung diseases (6)

A

ILD
pulmonary fibrosis
obesity
AI
pleural effusion
HF

56
Q

when are EKG’s helpful in pt w. dyspnea (4)

A

cardiac ischemia
MI
ventricular hypertrophy
pericardial dz

57
Q

when is CXR helpful in pt w. dyspnea (6)

A

chest wall abnormalities
hyperinflation
CM
pleural effusion
mass/mets
PNA

58
Q

when is CTA useful for pt w. dyspnea

A

PE

59
Q

when would you order a chest CT for pt w. dyspnea (2)

A

you have no idea what’s going on
ILD
bronchiectasis
PE

60
Q

CBC might be useful for diagnosis what conditions related to dyspnea (3)

A

anemia
infxn
COPD

61
Q

what is the use of a BMP helpful in dyspnea work up

A

to evaluate acid-base disturbance

62
Q

what does elevated bicarb + SOB indicate

A

metabolic alkalosis ->
COPD
ILD
neuromuscular d.o

63
Q

what does low bicarb + SOB indicate

A

metabolic acidosis ->
DKA

64
Q

t/f: a single troponin is useful to r.o MI

A

f! you need 2

unless it’s been like 12 hr w.o CP

65
Q

t/f: a single elevated troponin can rule in MI

A

t!

66
Q

BNP > __ is __% sensitive and __% specific for CHF

A

100
82% sensitive
99% specific

67
Q

t/f: the higher the BNP, the worse the CHF

A

t!

68
Q

t/f: the higher the troponin, the worse the MI

A

f!

69
Q

BNP is super helpful in what condition

A

dx and monitoring of CHF

70
Q

what is the usefulness of echo in eval of dyspnea

A

gives us info about structural issues in pt’s w. CHF

71
Q

what arrhythmia might be an easily missed cause of dyspnea

A

proxysmal afib -> order holter monitor

72
Q

lung bx is the gs for dx of (2)

A

ILD
malignancy

73
Q

what do you think when you see a pt w. diagnosed cardiopulmonary disorder who has chronic dyspnea despite max therapy

A

the presence of a cofactor ->
obesity
deconditioning
emotional response to illness

74
Q

4 indications to refer a dyspnea pt

A

underlying cause is unclear
sx disproportionate to apparent dz severity
lung bx
not adequately responding to tx

CDM2 - Final (9 decks)

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