Topic Info - BotMed Application

TopicName

Chronic dyspnea (SOB)

ClinicalTests

CBC with dif, ferritin (Anemia, Pneumonia);
TSH (Hypothyroid);
D-dimer (PE);

ImagingStudies

Echocardiography (Aortas Stenosis);
ECG (MI);
Peak expiratory flow, PEF (Asthma, COPD);
Chest x-ray (bronchiectasis);
CT scan (cancer, metastasis);
BNP (CHF);
Endoscopy with biopsy (GERD);
x-Ray (Pneumonia);

PhysicalExams

Vitals + puls ox.  – tachycardia, tachypnea, hyper/hypotensive, fever;
General appearance – signs of distress, LOC, sense of doom, restlessness;
HEENT - Exam of nasal mucosa, oropharynx – erythema, lymphadenopathy, examine pharynx;
Heart – JVP distention, murmurs, carotid bruits;
Respiratory – symmetric chest expansion, orthopnea, dullness/ consolidation, hyper resonance, wheeze, stridor, rales, rhonchi, intercostal retraction/ use of secondary respiratory muscles, dry or productive cough;
Peripheral vascular – cyanosis, clubbing, edema;

Comment

Always R/O: COPD, Asthma, PE, CHF, Pneumonia;
Obstructive: asthma, COPD, bronchiectasis, cystic fibrosis;
Restrictive: sarcoidosis, fibrosing lungs;
Chest walls: MG, AS
Effusion: pneumonia, malignancy, SLE, cirrhosis;
Trauma: rib fracture, pneumothorax;
ER:  Lung cancer, PE (DVT), pneumonia, CHF, pericarditis;

Location, quality, severity, radiation, duration, context (exertional, postprandial, positional, cocaine use, trauma); associated symptoms (sweating, nausea, dyspnea, palpitations, sense of doom, fever);  exacerbating and alleviating factors (especially medications); history of similar symptoms; known heart or lung disease or history of diagnostic testing; cardiac risk factors (hypertension, hyperlipidemia, smoking, family history of early MI); pulmonary embolism risk factors (history of DVT, coagulopathy, malignancy, recent immobilization).
R/O: thoracic aortic aneurism;

WebLink

https://www.aafp.org/afp/2020/0501/p542.html | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5247680/