Sudden Breath
What classifys a chronic cough? Give an example of a chronic cough illness
Lasting greater then 8 weeks
UACS,asthma ,COPD,GERD
Define trepopnea
Dyspnea that occurs in the lateral position on one side but not the other
Define dyspnea
Abnormal increased awareness of breathing or sensation of difficulty breathing
What classifies an acute cough? Give an example of an acute cough illness
A cough lasting less than 3 weeks
URI, acute viral infection, common cold, bronchitis
Define orthopnea
Dyspnea when lying flat
What would you consider as a differential if a patient presented with a cough and hemoptysis?
Lung cancer
tuberculosis
PE
pneumonia
What are the most common illnesses associated with a cough?
Chronic allergic rhinitis, Asthma, GERD, medications (ACE inhibitors, Beta blockers)
What are 2 other causes if hemoptysis?
1. Bronchiectasis ( found in cystic fibrosis and bronchitis)
2. cryptogenic
Define chronic dyspnea and types of illnesses associated with this.
Chronic lasting longer than 1 month
COPD, asthma, interstit disease, myocardial dysfunction
Define hemoptysis
Coughing of blood, or blood stained sputum, originating from the lungs or bronchial tubes
What would be you differentials for a patient with cough and excessive chronic sputum production?
Bronchiectasis
lung abscess
lung cancer
What is your differentials for a patient presenting with cough and chest pain?
PE
acute coronary syndrome
What is platypnea?
Dysphasia that improves when lying down
What would be the differentials for a patient presenting with cough, dyspnea, and lower extremity edema?
CHF
PE
What are the 4 important causes of hemoptysis
1. Acute/chronic bronchitis
2. pneumonia
3. tuberculosis
4. lung cancer
Identify alarm symptoms of dyspnea
Pleuritic chest pain, lips swelling/hives/wheezing, sub stern Al chest pressure, pink frothy sputum, fever and sputum, fever with signs of shock, ascending weakness, know or suspected diabetes or renal failure
what are some cardiovascular differentials for chronic dyspnea?
cardiomyopathies ( muscle)
ichemia, pulmonary hypertension (vessel’)
regurgitation, stenosis, infection (valves)
effusion, inflammation (pericardium)
What are the alarm symptoms for cough?
Hemoptysis, fever, purulence, wheezing, dyspnea, chest pain, increased sputum, weight loss/gain, edema, decrease in activity, decreased sleep ( from cough)
What would you consider if cough, fever and purulent sputum production were symptoms present in a patien?
Pneumonia
lung abscess
What is paroxysmal nocturnal displeased?
BONUS- what diseases are associated with this?
Dyspnea that wakes patient from sleep
CHF, asthma, COPD
Give an interview framework with a patient complaint of cough
When did the cough start?
is it a dry or productive cough?
have you had this cough before?
what is concerning about your cough?
any recent new travel?
ect…
Differentiate between hemoptysis and hemaemesis
Hemoptysis:proceeded by tingling in throat, or chest and cough. Nausea and vomiting Absent. Frothy sputum. Blood tinged sputum for days. Hx of lung disease. Lacks symptoms of significant blood loss.
hemaemesis: No cough. Nausea and vomiting present. No frothy sputum. No blood tinged sputum. Hx of liver and gastric disease.symptoms of blood loss
Name miscellaneous differentials for chronic dyspnea
Anemia, chest wall abnormalities, deconditioning, metabolic acidosis, neuromuscular disease, panic attack, anxiety disorder
What are the classification s of hemoptysis?
Scant less than 20ml, tablespoon
submassive (moderate) between 20-250ml, less than cup, in 24 hours
Massive (severe)- more than 250ml, more than a cup, in 24 hours, common etiology is cancer
cryptogenic- idiopathic, no cause is found after extensive evaluation
Apply interview framework for a patient with displeasure.
Do you smoke?
do you have a history of prolonged immobilisation?
do you have diabetes, high BP, high cholesterol, or heart disease?
is your chest tight, or does it cause increased effort to breathe?
do you feel as if your throat is closing or that air can’t get all the way into your lungs?