Shortness of Breath Flashcards
List some broad mechanisms that can lead to shortness of breath. Give an example of a disease that falls under each of these mechanisms.
Insufficient oxygen entering the lungs – COPD
Insufficient oxygen entering the blood - emphysema
Insufficient oxygen reaching the tissues - anaemia
Increased respiratory drive - acidaemia
Which diseases can cause an inability to fully inflate the lungs?
Increased work – due to obesity and stiffness due to interstitial lung disease
Weak respiratory muscles – Guillain-Barre syndrome, myasthenia gravis
Hyperinflated lungs – COPD
Which diseases can cause insufficient oxygen to be delivered across the body?
Anaemia
Reduced cardiac output (e.g. heart failure, aortic stenosis)
Shock (e.g. sepsis, hypovolaemia)
What are two important features of the history of presenting complaint of a patient presenting with shortness of breath?
Time of onset
Alleviating/exacerbating factors
When does asthma tend to get worse?
At night
On exercise
On exposure to triggers (e.g. the cold)
List some important risk factors that are associated with various causes of shortness of breath.
Smoking Pets Occupational history Medications Past medical history
Which occupational disease is associated with chronic dust inhalation?
Pneumoconiosis
List some drugs that are associated with interstitial lung disease.
Methotrexate
Amiodarone
Nitrofurantoin
List some autoimmune diseases that are associated with interstitial lung disease.
Rheumatoid arthritis
Sarcoidosis
SLE
List some important associated symptoms that you should enquire about in a patient presenting with shortness of breath.
Cough (and haemoptysis) Chest pain Muscular weakness or fatigue Tender limbs Weight loss, loss of appetite, night sweats Fever Loss of blood
Describe the pattern of cough in:
Pneumonia
Chronic bronchitis
Asthma
- Pneumonia
3-4 day history of persistent, productive cough - Chronic bronchitis
Persistent, productive cough on most days of the past 3 months and spanning years - Asthma
Dry cough present mainly during episodes of shortness of breath or at night
List some causes of blood-stained sputum.
Cavitating pneumonia
PE
Lung cancer
Bronchiectasis
List some diseases that cause pleuritic chest pain and shortness of breath.
Pneumonia
PE
Pneumothorax
Which differentials would you consider if a patient complains of shortness of breath and muscle weakness/fatigue?
Myasthenia gravis Lambert-Eaton syndrome Motor neurone disease Guillain-Barre syndrome Polymyositis
Why is it important to ask about loss of blood (e.g. GI, menstrual)?
Chronic blood loss can lead to anaemia which, in turn, leads to breathlessness
List some differentials for sudden-onset (seconds to minutes) shortness of breath.
Bronchospasm (e.g. acute asthma) Anaphylaxis Laryngeal oedema PE Pneumothorax Foreign body Hysterical hyperventilation
List some differentials for shortness of breath that occurs over hours/days.
Pneumonia Heart failure Pleural effusion ARDS Post-operative atelectasis
List some differentials for gradual-onset (weeks to months) shortness of breath.
COPD Chronic asthma Heart failure Pulmonary fibrosis Anaemia Bronchiectasis
Which inherited condition can cause emphysema and liver disease?
a1-antitrypsin deficiency
List some signs of COPD on physical examination.
Chest wall deformity (e.g. barrel chest) Breathing through pursed lips Use of accessory muscles Reduced chest expansion Prolonged expiratory phase
Which atopic conditions might a patient with asthma also suffer from?
Hay fever
Eczema
Allergies
Nasal polyps
List some drugs that exacerbate the symptoms of asthma.
NSAIDs
Beta-blockers
Aspirin
List some signs of interstitial lung disease on physical examination.
Clubbing
Reduced chest expansion
Late inspiratory fine crackles
List some presenting symptoms of heart failure.
SOBOE
Orthopnoea (=SOB when lying flat)
Paroxysmal nocturnal dyspnea
Swollen ankles
