Dyspnoea sob

Orthopnoea sob when lying flat, so need 3-4 pillows congestive heart failure
(left ventricle), also in asthma & chronic bronchitis or sleep apnoea
Paroxysmal nocturnal dyspnoea sob that occurs at night, awakens the person
reduced pulmonary compliance & asthmatics
Acute coronary syndrome
Acute coronary syndrome frequently presents with retrosternal chest
discomfort and difficulty catching the breath.[2] It however may atypically present
with shortness of breath alone.[13] Risk factors include old
age, smoking, hypertension, hyperlipidemia, and diabetes.
[13]
An electrocardiogram and cardiac enzymes are important both for diagnosis
and directing treatment.[13] Treatment involves measures to decrease the oxygen
requirement of the heart and efforts to increase blood flow. [2]
Congestive heart failure
Congestive heart failure frequently presents with shortness of breath with
exertion, orthopnea, and paroxysmal nocturnal dyspnea.[2] It affects between 12% of the general United States population and occurs in 10% of those over
65 years old.[2][13] Risk factors for acute decompensation include high
dietary salt intake, medication noncompliance, cardiac
ischemia, dysrhythmias, renal failure, pulmonary emboli, hypertension, and
infections.[13] Treatment efforts are directed towards decreasing lung congestion.
[2]

Chronic obstructive pulmonary disease

People with chronic obstructive pulmonary disease (COPD), most
commonly emphysema or chronic bronchitis, frequently have chronic shortness
of breath and a chronic productive cough. [2] An acute exacerbation presents with
increased shortness of breath and sputum production.[2] COPD is a risk factor
for pneumonia; thus this condition should be ruled out. [2] In an acute
exacerbation treatment is with a combination of anticholinergics, beta2adrenoceptor agonists, steroids and possibly positive pressure ventilation.[2]
Asthma
Asthma is the most common reason for presenting to the emergency room with
shortness of breath.[2] It is the most common lung disease in both developing and
developed countries affecting about 5% of the population. [2] Other symptoms
include wheezing, tightness in the chest, and a non productive cough. [2] Inhaled
corticosteroids are the preferred treatment for children, however these drugs can
reduce the growth rate.[14] Acute symptoms are treated with short-acting
bronchodilators.
Pneumothorax - displacement of the trachea away from the affected side.
- percussion hyperresonant, tactile fremitus - decreased
Pneumothorax presents typically with pleuritic chest pain of acute onset and
shortness of breath not improved with oxygen.[2] Physical findings may include

absent breath sounds on one side of the chest, jugular venous distension, and
tracheal deviation.[2]

Pneumonia - percussion dull, tactile fremitus increased

The symptoms of pneumonia are fever, productive cough, shortness of breath,
and pleuritic chest pain.[2] Inspiratory crackles may be heard on exam.[2] A chest
x-ray can be useful to differentiate pneumonia from congestive heart failure. [2] As
the cause is usually a bacterial infection, antibiotics are typically used for
treatment.[2]
Important to remember: Severity and prognosis of Pneumonia can be estimated
from CURB65, where C=Confusion, U= Uremia (>7), R=Respiratory rate >30, B=
BP<90, 65= Age>65.
Uremia urea in blood
Pulmonary embolism
Pulmonary embolism classically presents with an acute onset of shortness of
breath.[2] Other presenting symptoms include pleuritic chest pain,
cough, hemoptysis, and fever.[2]Risk factors include deep vein thrombosis, recent
surgery, cancer, and previous thromboembolism.[2] It must always be considered
in those with acute onset of shortness of breath owing to its high risk of
mortality.[2] Diagnosis however may be difficult[2] and Wells Score is often used to
assess the clinical probability. Treatment, depending on severity of symptoms
typically start with anticoagulants, presence of ominous signs (low blood
pressure), may warrant the use of thrombolytic drugs.[2]
Anaemia
Anaemia caused by low hemoglobin levels is often a cause of dyspnea.
Menstruation, particularly if excessive, can contribute to anaemia and to
consequential dyspnea in women. Headaches are also a symptom of dyspnea in
patients suffering from anaemia. Some patients report a numb sensation in their
head, and others have reported blurred vision caused by hypotension behind the
eye due to a lack of oxygen and pressure; these patients have also reported
severe head pains, many of which lead to permanent brain damage. Symptoms
of this can be loss of concentration, focus, fatigue, language faculty impairment
and memory loss.
Pleural Effusion
Detectable clinical signs in the patient, such as decreased movement of the
chest on the affected side, stony dullness to percussion over the fluid,
diminished breath sounds on the affected side, decreased vocal resonance and
fremitus (though this is an inconsistent and unreliable sign), and pleural friction
rub. Above the effusion, where the lung is compressed, there may be bronchial
breathing and egophony. A large effusion there may cause tracheal deviation
away from the effusion.
Percussion stony dull, tactile fremitus - decreased

For example starting to take thyroxine for hypothyroidism may precipitate

or exacerbate angina
Side effect of ACE inhibitor is dry cough

Respiratory
Sputum

amount and colour

purulent infection

Foul smelling and tasting anaerobic

infection

rusty pneumococcal pneumonia

pink and frothy or foamy pulmonary

oedema

Copious, frothy and saliva like

bronchoalveolar carcinoma

Asthma management 1) b-adrenoceptor agonists

2) oral corticosteroids
Hypoxemia low lvl of oxygen in blood
PaO2 Oxygen partial pressure - Oxygen molecules dissolved in plasma (i.e., not
bound to hemoglobin)
SaO2 Oxygen Saturation - Oxygen molecules bound to haemoglobin
CaO2 Total Oxygen
Cyanosis is the appearance of a blue or purple coloration of the skin or mucous
membranes due to the tissues near the skin surface having low oxygen
saturation content.
Pyrexia fever
Hemiparesis is weakness of the entire left or right side of the body.

Hemiplegia is its most severe form, complete paralysis of half of the body.
Hemianopia, or hemianopsia, is a decreased vision or blindness (anopsia) in
half the visual field of one or both eyes, usually on one side of the vertical
midline.
Pos Circulation Stroke Vertebral/Basilar/Poster Cerebral A Homonymous
hemianopia/cerebellar/cranial nerve syndrome
Ant Circulation Stroke Ant Cerebral A Homonymous
hemianopia/aphasia/hemiparesis/hemisensory loss
Lacunar Stroke Thrombosis in situ in small vessels pure motor/sensory
stroke/no higher dysfunction
Brocas aphasia broken words/expressive aphasia/can understand but cant
articulate words/patient know and is frustrated/frontal lobe
Wernickes aphasia what?!what u saying??!!/can speak smoothly but cant
form proper meaningful sentences/receptive aphasia/no understanding of what is
said/patient doesnt realise it/temporal lobe of the dominant side
Vertigo the feeling like youre spinning/whirling

GIT
Dyspepsia indigestion/heartburn
Odynophagia painful swallowing
Ureteric pain -> INGUINAL CANAL REGION
Diaphragmatic pain -> RIGHT SHOULDER
Gallbladder pain -> EPIGASTRIUM/TIP OF SCAPULA OR SHOULDER
BLADE
Acute Pancreatitis -> ABDOMINAL PAIN THAT SHOOTS TO THE BACK
Pruritus itching
Colicky pain comes and goes abruptly
Murphys sign manoeuvre during GIT exam positive: cholecystitis
Incontinence leakage of urine
Dysarthria motor speech problem as muscles used for speaking are weak

Renal calculi kidney stone

Pulmonary consolidation is a region of (normally compressible) lung tissue

that has filled with liquid[1] a condition marked by induration[2] (swelling or
hardening of normally soft tissue) of a normally aerated lung.
Cushing disease is caused by a tumour or excess growth (hyperplasia) of the
pituitary gland.
Myeloma is a cancer of the plasma cells in the bone marrow.
Renin is an enzyme.