#131 A Case of Cough and Dyspnea

December 17, 2018 | By Matthew Watto, MD

Kashlak Morning Report with Reza Manesh of Human Dx

Hone your diagnostic skills with this mystery case of cough and dyspnea hdx.org/pdp (click link to follow along). The Curbsiders deconstruct a case and discuss their diagnostic schemas for these common problems with the help of returning guest, Reza Manesh MD, editor of Global Morning Report at The Human Diagnosis Project aka Human Dx.

Use this link hdx.org/pdp to follow along with the case on the Human Dx app or website and check out more Global Morning Report cases.

Credits

Written and produced by: Hannah R Abrams

Hosts: Matthew Watto MD, Paul Williams MD, Stuart Brigham MD

Edited by: Matthew Watto MD

Guest: Reza Manesh MD

Special thanks to: Steph Sherman, Zaven Sargsyan, Anand Jagannath, John Inou Hwang, and Rabih Geha for contributing and editing the cases; and to Tyler Brandon for helping to coordinate these wonderful episodes.

Time Stamps

• 00:00 Announcement, disclaimer, intro, guest bio
• 03:13 When and how to practice clinical reasoning
• 05:53 Creating diagnostic schemas and Clinical Problem Solvers Podcast
• 09:40 A bit on Human Dx and the show format
• 12:00 Case of a 40 yo male with a cough and dyspnea
• 23:22 Some insights from Reza on “signal versus noise”
• 37:10 Case conclusion/answer, cognitive autopsy and Reza’s take home points
• 45:36 Outro

Cough and Dyspnea Pearls

Consider creating two separate problem representations (e.g. 40 yo M with cough and dyspnea vs 40 yo M taxidermist with cough and dyspnea) to help filter “signal versus noise”.

Create Venn Diagrams for each major problem, then see where they overlap to decide which diagnosis is most likely.

Diagnostic schema for patient with dyspnea aka “the dyspnea pyramid” by Hannah R Abrams adapted from figure by Jeff Wiese (included above)

Diagnostic schema for patient with chronic cough (see below)

Goals and Learning Objectives

Goal

Listeners will practice their diagnostic skills and clinical reasoning while learning schemas for cough and dyspnea.

Learning objectives

After listening to this episode listeners will…

1. Improve their diagnostic skills and clinical reasoning through use of problem representations, illness scripts and creation of diagnostic schemas
2. Develop a diagnostic schema for dyspnea
3. Develop a diagnostic schema for cough

Disclosures

Dr Manesh receives a small honorarium for his work with Human Dx. The Curbsiders are an educational partner of Human Dx for this episode.

Links from the show

1. Human Dx app and Global Morning Report
2. The Clinical Problem Solvers website, videos and podcast

Citation for guest CV

Manesh, Reza. Guest expert. “#131 A Case of Cough and Dyspnea. Kashlak Morning Report with Reza Manesh of Human Dx. The Curbsiders Internal Medicine Podcasthttp://thecurbsiders.com. December 17, 2018. http://thecurbsiders.com/podcast/131-case-cough-dyspnea(opens in a new tab)