Lecture 0: Student Led Clinical Presentation

Question 1

Using the MRC dyspnea scale what does a grade of 1-3 mean?

Answer 1

• Grade 1 = not troubled by breathlessness except on strenous exercise
• Grade 2 = SOB when hurrying on the level or walking up a slight hill
• Grade 3 = walks slower than most people on the level, stops after a mile or so, or stops after 15 minutes walking at own pace

Question 2

Using the MRC dyspnea scale what does a grade of 4-5 mean?

Answer 2

• Grade 4 = stops for breath after walking about 100 yards or after a few minutes on level ground
• Grade 5 = too breathless to leave the house, or breathless when undressing

Question 3

In patient presenting with acute dyspnea, a low oxygen saturation should lead you to what differentials?

Answer 3

• Asthma
• Acute exacerbation of COPD
• ARDS
• HF
• Pulmonary Fibrosis
• Pulmonary Vascular Dz

Question 4

What is the primary initial diagnostic tool for pt with acute dyspnea?

Answer 4

CXR

Question 5

Which imaging modality may be useful when CXR is nondiagnostic an suspicion for parenchymal lung disease is high?

Answer 5

High-resolution chest CT

Question 6

Dyspnea becomes chronic when the sx’s persist for how long?

Answer 6

>1 month

Question 7

In 2/3’s of pt’s chronic dyspnea results from which 4 underlying processes?

Answer 7

• COPD
• Asthma
• Interstitial lung disease
• HF

Question 8

How do pt’s with dyspnea due to chronic heart failure tend to describe their dyspnea vs. those with asthma?

Answer 8

• Chronic HF = air hunger or suffocating
• Asthma = chest tightness

Question 9

Dry crackles on lung examination can signify the presence of what underlying disease process?

Answer 9

Pulmonary parenchymal disease

Question 10

What does the presence of conjunctival pallor, tachycardia, and a flow murmur in patient with dyspnea suggest?

Answer 10

Anemia

Question 11

ABG measurements can be useful in further evaluating a pt with dyspnea and what would a low maximum O₂ uptake in the absence of an identifiable abnormality often indicate?

Answer 11

Deconditioning as a cause of dyspnea

Question 12

Acute cough is defined as cough lasting how long?

Answer 12

<3 weeks

Question 13

How long must a cough last to be considered subacute?

Answer 13

3-8 weeks

Question 14

Which organism is associated with the sudden onset of fever and malaise followed by cough, HA, myalgia, and nasal/pulmonary sx’s?

Answer 14

Influenza

Question 15

Clinical criteria suggesting the diagnosis of influenza include temperature ≥37.7 °C (100 °F) and at least one of which 3 sx’s?

Answer 15

Cough, pharyngitis, or rhinorrhea

Question 16

What is the diagnostic gold standard for B. pertussis?

Answer 16

• Recovery of bacteria in culture
• PCR

Question 17

What is the primary reason for the use of antibiotics for suspected pertussis infection in adults?

Answer 17

• Prevent shedding of the pathogen and spread of the disease
• Abx tx does NOT appear to improve resolution of sx’s if initiated beyond 7-10 days after onset of illness

Question 18

What is the primary diagnostic objective when evaluating acute cough?

Answer 18

Exclusion of pneumonia

Question 19

Chronic cough is defined as lasting for how long?

Answer 19

>8 weeks

Question 20

What are the 3 major causes of chronic cough in pt’s who are nonsmokers, have normal CXR, and are not taking an ACE inhibitor?

Answer 20

• Upper airway cough syndrome (UACS)
• Asthma
• GERD

Question 21

What is the most consistently effective therapy for pt with Upper airway cough syndrome (UACS) not caused by sinusitis?

Answer 21

Nonsedating antihistamine + decongestant

Question 22

In pt with suspected cough-variant asthma, which test is 100% sensitive in ruling out asthma if the test is negative?

Answer 22

Bronchoprovocation testing

Question 23

What is the most sensitive and specific test for suspected GERD-induced cough; howevever what should be done first?

Answer 23

• 24-hour esophageal pH monitoring = sensitive and specific
• Trial w/ PPI is recommended BEFORE invasive testing

Question 24

What is the first-line tx for nonasthmatic eosinophilic bronchitis (NAEB)?

Answer 24

Glucocorticoids + avoidance of responsible allergens

Question 25

Which imaging modalities may be diagnostic for suspected Bronchiectasis?

Answer 25

CXR and high-resolution CT showing thickened bronchial walls in a “tram line” pattern

Question 26

How is the diagnosis of Upper Airway Cough Syndrome confirmed?

Answer 26

When drug therapy eliminates the discharge and cough

Question 27

What are the signs/sx’s that should raise suspicion of pertussis in adult patients?

Answer 27

• Cough lasting ≥2 weeks without apparent causes
• Paroxysms of coughing
• Inspiratory whoop
• Posttussive emesis