tailieunhanh - Ebook Symptom to diagnosis (3/E): Part 2

Part 2 book “Symptom to diagnosis” has contents: Wheezing and stridor, sore throat, weight loss, unintentional, kidney injury, acute, jaundice and abnormal liver enzymes, hematuria, hypertension, hypercalcemia, GI bleeding, fatigue, edema, and other contents. | 15 I have a patient with dyspnea. How do I determine the cause? CHIEF COMPLAINT PATIENT Mr. C is a 64-year-old man who comes to see you complaining of shortness of breath. What is the differential diagnosis of dyspnea? How would you frame the differential? CONSTRUCTING A DIFFERENTIAL DIAGNOSIS Heart disease, lung disease, and anemia are the most common causes of dyspnea. Neuromuscular disease and anxiety are less common causes. The simplest approach to the differential diagnosis is to consider the anatomical components of each of these systems. This allows us to develop a fairly comprehensive differential diagnosis of dyspnea. Differential Diagnosis of Dyspnea A. Heart 1. Endocardium: Valvular heart disease (ie, aortic stenosis, aortic regurgitation, mitral regurgitation, and mitral stenosis) 2. Conduction system a. Bradycardia (sick sinus syndrome, atrioventricular block) b. Tachycardia (1) Atrial fibrillation and other supraventricular tachycardias (2) Ventricular tachycardia 3. Myocardium: Heart failure (HF) a. Systolic failure (coronary artery disease [CAD], hypertension, alcohol abuse) b. Diastolic failure (hypertension, aortic stenosis, hypertrophic cardiomyopathy) 4. Coronary arteries (ischemia) 5. Pericardium (tamponade, constrictive pericarditis) B. Lung 1. Alveoli a. Pulmonary edema (HF or acute respiratory distress syndrome) b. Pneumonia 2. Airways a. Suprathoracic airways (ie, laryngeal edema) b. Intrathoracic airways (1) Asthma (2) Chronic obstructive pulmonary disease (COPD) (see Chapter 33, Wheezing & Stridor) 3. Blood vessels a. Pulmonary emboli b. Primary pulmonary hypertension 4. Pleural a. Pneumothorax b. Pleural effusions (1) Transudative (a) HF (b) Cirrhosis (c) Nephrotic syndrome (d) Pulmonary embolism (PE) (2) Exudative (a) Tuberculosis (b) Cancer (c) Parapneumonic effusions (d) Connective tissue diseases (e) PE 5. Interstitium a. Edema b. Inflammatory (1) Organic exposures (eg, hay, cotton, grain) (2) Mineral exposures (eg, asbestos,