Game 1: List all causes of dyspnea

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Horowitz

Horowitz

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Let the fun begins! While it's good to talk about non-academic stuff on SDN to preserve our sanity, I reckon it's also good to play this sort of nerdy game that, while it's useful, it's not THAT boring. I'll start with the first one (please list the cause as well as the mechanism, at least briefly):


Cause: Left Heart Failure

(left heart failure --> increased pulmonary venous pressure --> pulmonary edema --> dyspnea)
 
I can't believe I'm doing this...

Cause: any anemia (ie iron deficiency)

Mechanism:

Metabolic acidosis --> decrease pH --> stimulates peripheral chemoreceptors in carotid body --> increases resp rate to blow off CO2 with the eventual effect of increasing blood pH
 
Adult intrinsic alveolitis---bronchospasm> inflammation > dyspnea

Secondary TB-----caseation necrosis> cavities> calcification >possible scar cancer>dyspnea

Good thought Horowitz!!
 
Cyanide inhalation
Phosgene inhalation
organophosphorus compound inhalation deactivated AChE increased glandular secretions in lungs increased fluid
vesicant exposure bronchial inflammation sloughing of tissue
chlorine gas

Sorry just got done with chemical warfare agent medical management at my post.
 
Horowitz said:
Let the fun begins! While it's good to talk about non-academic stuff on SDN to preserve our sanity, I reckon it's also good to play this sort of nerdy game that, while it's useful, it's not THAT boring. I'll start with the first one (please list the cause as well as the mechanism, at least briefly):


Cause: Left Heart Failure

(left heart failure --> increased pulmonary venous pressure --> pulmonary edema --> dyspnea)
Click to expand...

Horowitz--Most are asleep with the minimal pathophysiology..🙄
 
A basketball in your trachea.

V/Q mismatch
 
wild luvin. If you're not short of breath you're not doin it right
 
mjl1717 said:
In this arena you do NOT always want to say what is so very obvious, common and what a layman might say..

{makes ya look bad}
Click to expand...

but but what if they have asthma...
The obvious and common should be the first thing checked, and discarded if necessary, not completely ignored. 👍
 
when a gunner sees the opportunity to gain 1 point back on a quiz
 
At some point computers will be doing this DDx business and put and end to the game of one upmanship among ambitious med students.
 
Had a 40-ish yo lady come in to ED Friday night/early Sat am c/o acute dyspnea that began while having sex an hour earlier.
O2 sat high 80s, tachypneic, bilateral rales all the way up, 2/6 systolic murmur, maybe 2+ nonpitting edema BLE. Fact was, she hadn't been taking her BP meds (can't remember what they were but she was noncompliant). Pressure was about 160s/100s. Other than being breathless she looked pretty good.
Checked everything out. Dx: flash pulmonary edema, markedly improved after 40mg Lasix IV, diuresed nicely. Admitted her for observation and an echo that was OK except for LVH (no surprise). Discharged with instructions to take her BP meds and follow up with her doctor.
So yeah, if you want to have sex, prolly a good idea to take your medicine regularly.

nogolfinsnow said:
wild luvin. If you're not short of breath you're not doin it right
Click to expand...
 
primadonna22274 said:
Had a 40-ish yo lady come in to ED Friday night/early Sat am c/o acute dyspnea that began while having sex an hour earlier.
O2 sat high 80s, tachypneic, bilateral rales all the way up, 2/6 systolic murmur, maybe 2+ nonpitting edema BLE. Fact was, she hadn't been taking her BP meds (can't remember what they were but she was noncompliant). Pressure was about 160s/100s. Other than being breathless she looked pretty good.
Checked everything out. Dx: flash pulmonary edema, markedly improved after 40mg Lasix IV, diuresed nicely. Admitted her for observation and an echo that was OK except for LVH (no surprise). Discharged with instructions to take her BP meds and follow up with her doctor.
So yeah, if you want to have sex, prolly a good idea to take your medicine regularly.
Click to expand...

And don't forget the real victim here, the husband/boyfriend who had to quit gettin busy to call 911. I bet he won't let her forget to take her meds again
 
lord_jeebus said:
Myasthenia Gravis

Selenium deficiency
Click to expand...

M.G.--autoantibodies to the Ach receptor> cause gradual onset of respiratory paralysis > dyspnea

Selenium def. --has to do with glutathione peroxidase> works as antioxidant and free radical> without which can lead to muscle weakness at diaphram > dyspnea
 
mjl1717 said:
Selenium def. --has to do with glutathione peroxidase> works as antioxidant and free radical> without which can lead to muscle weakness at diaphram > dyspnea
Click to expand...

I think the more significant issue is selenium deficiency-induced cardiomyopathy (Keshan disease). I have not heard of it causing diaphragmatic weakness, although your explanation seems feasible.

EDIT: found a paper on rat diaphragms. Seems reasonable.
 
obesity, pneumothorax, hemothorax

also, death
 
Don't forget the little people:

Choanal atresia in the neonate.
Croup.
Tracheoesophageal fistula.
Hyaline membrane disease.
Meconium aspiration.
Transient tachypnea due to delayed resorbtion of fetal lung fluid.
Acidosis, whether due to sepsis or metabolic errors.
Pulmonary hypoplasia.
Anemia or polycythemia
Congenital heart disease.
Tracheomalacia, tracheal stenosis.
Pierre Robin Syndrome (micrognathia).
 
lord_jeebus said:
I think the more significant issue is selenium deficiency-induced cardiomyopathy (Keshan disease). I have not heard of it causing diaphragmatic weakness, although your explanation seems feasible.

EDIT: found a paper on rat diaphragms. Seems reasonable.
Click to expand...

Thank you! Thank you! Glad someone has the guts and boy this takes guts(brains) to battle out the pathophysiology....

[Instead of a frenzied guy copying a differential diagnosis list for dyspnea over 200 diseases long!]🙂 👍
 
Histiocytosis X
Mitral Stenosis (inc pulmonary venous pressure --> inc transudate)
pulmonary alveolar proteinosis
 
strongyloides stercoralis infection.

pregnancy.
 
digitlnoize said:
😀
I see your elephant and raise you:

Kicked in the chest by a horse. Hard.
Click to expand...

In keeping with the spirit of this thread, shouldn't that be "kicked in the chest by a zebra?"
 
Good point.
In other words, pulmonary contusion.
Also: inhalation injury; such as: head-on MVA, your airbag deploys, you inhale the dust and have a nice little hypersensitivity reaction to the talc and other stuff in the airbag.
Or, you decide to clean your (tiny, unventilated) bathroom with Kaboom! cleaner (which you swear works GREAT!), or the usual combination of ammonia and bleach in the toilet, and you inhale the nasty fumes, and are still coughing and wheezing a week later. Never had a lick of asthma in your life. FEV1 about 40%...for a classical singer. That's pretty crappy since you're a trained singer who has great lungs, even for a 58-year-old. And a month later you're still sick and have a little bit of pneumonia even after steroids and B2 agonists and of course lots of fresh air.
Nasty stuff.

swpm said:
In keeping with the spirit of this thread, shouldn't that be "kicked in the chest by a zebra?"
Click to expand...
 
MI

Pneumonia

Deconditioning

Pulmonary effusion

Hemothorax

Pneumothorax

Circumferential burns to the chest with eschar formation

PE (mentioned)

COPD/Asthma (mentioned)

Myasthenia (mentioned)

Botulism

Lambert-Eaton syndrome

CVA, especially of the midbrain/pontine region

Upper cervical spinal injury

Phrenic nerve transection

About 100mg of Succinylcholine rapid IV :meanie:

Any infiltrating disease (lung cancer, TB, PCP or MAC in AIDS, pulmonary fungal infections, sarcoid, histiocytosis, lymphoma, etc...)

Anxiety/psychiatric disease (mentioned somewhere in there)

Drug seeking behavior

Obstructive sleep apnea

CHF

Liver disease with ascites and/or pulmonary effusions

Renal failure with fluid overload

Thyroid disorders

Pheochromocytoma

Electrolyte imbalance

SIADH

pancreatitis with pseudocyst formation or pulmonary effusion

retroperitoneal bleeding

retroperitoneal mass

mediastinal mass

AAA/dissection/rupture

Thoracic aortic dissection

Biliary colic

any of the pediatric causes listed above (good list, btw)

RSV

Reactive airways disease

Influenza, or any of a host of billions of viral illness

Bowel obstruction

chest trauma (blunt or penetrating)

valvular heart disease

cardiac tamponade/restrictive pericarditis

that's about all I can come up with right now off the top of my head... there are about a billion causes of dyspnea/respiratory distress.

next time, try something fun, like causes of fatigue :laugh:
 
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