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Toronto Notes - Case 1: Shortness of Breath

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General OSCE Tips Respirology Cardiovascular Case 1: Shortness of Breath Case 2: Chest Pain Case 3: Volume Status Case 4: Syncope Gastroenterology Musculoskeletal Urology Pediatrics Peripheral Vascular Women's Health Neurology Psychiatry Ophthalmology and Otolaryngology Geriatrics

Case 1: Shortness of Breath

You 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
My Account Suggestions/Feedback

Inspects patient, Note Padcomments Info 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 patients 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

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