Question 7

What is the differential diagnosis for the cause of dyspnea in this patient?

Pneumonia

Rule in• Dyspnea• Productive cough with yellowish

sputum• Febrile at 38°C• Crackles• Joint pain and myalgia• Chest pain • Cold clammy skin• Leukocytosis

Rule out• CXR - negative consolidation

Pleural effusion

Rule in• Chest pain when you inhale

and exhale (between breaths, you feel almost no pain)

• Shortness of breath • Fever and chills, depending

on the cause

Rule out• Symmetrical chest

expansion – in PE, there is lagging in the affected side.

Most common cause is Left ventricular failureIn CHF, pleural effusion is transudative

Pulmonary edema

Rule in• Dyspnea• CXR findings = pulmonary edema• Tachycardia, Tachypnea• abnormal lung sounds, such as rales

or crackles• Chest pain, if pulmonary edema is

caused by heart disease • A rapid, irregular heartbeat

(palpitations) • Hypertension d/t endogenous

catecholamines • Weakness

Rule out• Pulmonary edema would

show cyanosis if there is severe hypoxemia