Differentials for acute presentations - SOB

Question 1

What are life threatening differentials for SOB that need to be initially excluded?

Answer 1

• PE
• Penumothorax
• Asthma/COPD exacerbation
• Pneumonia
• Acute LVF
• Anaphylaxis
• ACS

Question 2

How would you explore SOB as a symptoms?

Answer 2

• When didi it start?
• Anything triggered it?
• Exercise tolerance (current vs normal)
• Orthopnoea
• PND

Question 3

What would you want to ask about on systems review in someone with SOB?

Answer 3

• How patient feels
• Fever
• Chest pain
• Wheeze
• Cough
• Sputum
• Leg swelling

Question 4

What would you sepcifically want to ask about in the PMH in someone with SOB?

Answer 4

• Other medical conditions
• Happened before
• Asthma/COPD - baseline, severity, exacerbation history, normal PEFR
• Recent surgery

Question 5

What would you want to ask about in the drug history in someone with SOB?

Answer 5

• Medications they are on
• Inhaler compliance/usage

Question 6

What is important to ask about in social history in someone with SOB?

Answer 6

• SMoking
• Alcohol
• Long-haul travel - DVT

Question 7

What would you specifically want ot examine in someone with SOB?

Answer 7

Cardiorespiratory

• Tracheal deviation and JVP
• Inspect chest
• Expansion
• Heaves/apex
• Auscultate heart and lungs
• Leg swelling/tenderness/odema
• PEFR

Question 8

What bloods would you consider doing in someone with SOB?

Answer 8

• FBC
• U+E’s
• CRP
• Consider D-dimer
• BNP
• BC if pyrexial
• ABG

Question 9

What imaging would you consider doing in someone with SOB?

Answer 9

• CXR
• CTPA

Question 10

What Bedside tests would you consider doing in someone with SOB?

Answer 10

• NEWs
• ECG

Question 11

What cultures would you consider doing in someone with SOB?

Answer 11

• Blood Cultures
• Sputum cultures

Question 12

What structured approach would you take to determining what investigations wo consider doing for someone with SOB?

Answer 12

• Bloods/Bedside tests
• Orifices - cultures etc.
• Xrays/imaging
• ECG
• Specific tests

Question 13

What are respiratory causes of acute SOB?

Answer 13

• PE
• Pneumonia
• Pneumothorax
• Asthma exacerbation
• COPD exacerbation
• Laryngitis
• Bronchitis
• Pneumonitis
• Bronchiectasis
• LRTI
• Pleural effusion

Question 14

What are cardiac causes of acute SOB?

Answer 14

• ACS
• Acute LVF
• Cardiomyopathy
• Myocarditis
• Acute valvular disease
• Pericardial effusion
• Pulmonary hypertension

Question 15

What are non-cardiorespiratory causes of acute SOB?

Answer 15

• Hyperventilation in axiety
• DKA
• Overdose
• Metabolic acidosis
• Sepsis/SIRS
• Foreign body
• Anaphylaxis
• Anaemia