toronto notes - case 1_ shortness of breath
DESCRIPTION
Toronto Notes - Case 1_ Shortness of BreathTRANSCRIPT
11/24/12 Toronto Notes - Case 1: Shortness of Breath
1/2www.torontonotes.ca/osce-cardiovascular/case-1:-shortness-of-breath
Case 1: Shortness of BreathYou are seeing Mrs. Chan, an 81 year old female, in the ER for a one week history of progressive shortness of
breath. Take a focused history of her complaint.
History
Onset and duration of shortness of breath
Progression of shortness of breath
Alleviating factors
Orthopnea
Asks about nighttime symptoms and paroxysmal nocturnal dyspnea
Association with cough
Chest pain
Palpitations
Leg swelling
Nocturia
Abdominal distension
Syncope, pre-syncope
Presence of fever, chills, and other systemic symptoms
Adherence to medications, diet
Personal history of CHF, CAD, MI, and CVA
Smoking history (quantity in pack-years)
Occupational history
Diabetes
Dyslipidemia
Hypertension
Current medications
Family history of heart disease
Effect on daily activities
Physical Examination
Inspection
Inspects patient, comments on respiratory status
States that weight should be measured for BMI/fluid overload status
Volume Status
Examines lower extremities for pitting edema
Examines JVP and comments on its estimated height
Measures pulse, comments on rate and rhythm
Evaluates patient’s orthostatic vitals
Examines the abdomen for ascites and a pulsatile liver, indicating right heart failure
Pre-cordium/Carotid
Palpates for the presence of thrills, heaves
Palpates PMI and comments on size, amplitude, duration, and location
Auscultates in all 4 areas of precordium with bell and diaphragm
Comments on presence of murmurs, extra heart sounds
Examines carotid arteries for bruits
Respiratory
Percusses posterior chest, comments on dullness
Auscultates all lung fields, commenting on presence of crackles, wheezes or other adventitious breath sounds
General OSCE Tips
Respirology
Cardiovascular
Gastroenterology
Musculoskeletal
Urology
Pediatrics
Peripheral Vascular
Women's Health
Neurology
Psychiatry
Ophthalmology and Otolaryngology
Geriatrics
Case 1: Shortness of Breath
Case 2: Chest Pain
Case 3: Volume Status
Case 4: Syncope
© 2009-2012. Toronto Notes for Medical Students, Inc. All rights reserved. Web Development by Nader Consulting
My Account Suggestions/Feedback InfoNote Pad
Home About Toronto NotesFull text online
Resourcesatlas, practice & more
Ordering Pharmacology Contact search...
