Joseph Turner - I'm feeling short of breath
psychological
respiratory
haematological
What systems can be the cause of chest cardiovascular
pain and breathlessness on the right nervous
side? *29 year old male plasterer* endocrine
muscular
skeletal
digestive
Who
What - systems or anatomical structures
involved
Why
How - apply patho and physiological
How to think like a doctor, 3 W's, H, R, S,
knowledge
D?
Red flags - can't miss
Summary - summarise case and rele-
vant positive and negative findings
Diagnostic Hypothesis - suggest up to 3
differential diagnosis's and justifications.
Joseph Turners Socrates:
Joseph has pain in his right upper chest
which started suddenly, feels like a sharp
mechanism right pleuritic chest pain
knife, radiated to the right armpit and
differentials include pneumothorax,
shoulder, is associated with breathless-
pleurisy, musculoskeletal and pulmonary
ness and pain has been constant, be-
embolism
comes worse with breath.
What are the mechanisms causing this
and what are the differential diagnoses
site
onset
character
radiation
SOCRATES
associated features
timings
exacerbating factors
severity
Musculoskeletal Pain
1/8
, Joseph Turner - I'm feeling short of breath
caused by injury to the muscles or bones
that is detected by pain receptors
occurs after some exertion or injury but
can be as minimal such as turning in bed
and is exacerbated by movement
pain can be severe enough to make pa-
tient breathless but no additional fea-
tures such as coughing blood or fever
pleurisy is inflammation of the pleu-
ra (visceral and/or parietal) can cause
sharp pain due to innervation of the pari-
etal pleura.
Pleurisy Caused by many conditions but most
commonly viral (influenza or covid) or
bacterial infections
symptoms include a cough runny nose or
fever with haemoptysis absent
presence of abnormal air between the
two pleural linings called the pleural
space, normally contains a very small
amount of pleural fluid
this leak builds up stretching the lining
Pneumothorax
and causing lungs to collapse
pneumothorax causes sudden onset of
sharp chest pain and breathlessness
pneumothorax can be spontaneous or
caused by trauma
in absence of any trauma including iatro-
spontaneous pneumothorax occur....
genic causes
type of pneumothorax that doesn't have
an underlying cause
primary pneumothorax
potential air leak from apical subpleural
bleb and bullae
Underlying lung disease leads to weak-
ened small airways which collapse with
secondary pneumothorax
respirations such as asthma or lung car-
cinoma
2/8
psychological
respiratory
haematological
What systems can be the cause of chest cardiovascular
pain and breathlessness on the right nervous
side? *29 year old male plasterer* endocrine
muscular
skeletal
digestive
Who
What - systems or anatomical structures
involved
Why
How - apply patho and physiological
How to think like a doctor, 3 W's, H, R, S,
knowledge
D?
Red flags - can't miss
Summary - summarise case and rele-
vant positive and negative findings
Diagnostic Hypothesis - suggest up to 3
differential diagnosis's and justifications.
Joseph Turners Socrates:
Joseph has pain in his right upper chest
which started suddenly, feels like a sharp
mechanism right pleuritic chest pain
knife, radiated to the right armpit and
differentials include pneumothorax,
shoulder, is associated with breathless-
pleurisy, musculoskeletal and pulmonary
ness and pain has been constant, be-
embolism
comes worse with breath.
What are the mechanisms causing this
and what are the differential diagnoses
site
onset
character
radiation
SOCRATES
associated features
timings
exacerbating factors
severity
Musculoskeletal Pain
1/8
, Joseph Turner - I'm feeling short of breath
caused by injury to the muscles or bones
that is detected by pain receptors
occurs after some exertion or injury but
can be as minimal such as turning in bed
and is exacerbated by movement
pain can be severe enough to make pa-
tient breathless but no additional fea-
tures such as coughing blood or fever
pleurisy is inflammation of the pleu-
ra (visceral and/or parietal) can cause
sharp pain due to innervation of the pari-
etal pleura.
Pleurisy Caused by many conditions but most
commonly viral (influenza or covid) or
bacterial infections
symptoms include a cough runny nose or
fever with haemoptysis absent
presence of abnormal air between the
two pleural linings called the pleural
space, normally contains a very small
amount of pleural fluid
this leak builds up stretching the lining
Pneumothorax
and causing lungs to collapse
pneumothorax causes sudden onset of
sharp chest pain and breathlessness
pneumothorax can be spontaneous or
caused by trauma
in absence of any trauma including iatro-
spontaneous pneumothorax occur....
genic causes
type of pneumothorax that doesn't have
an underlying cause
primary pneumothorax
potential air leak from apical subpleural
bleb and bullae
Underlying lung disease leads to weak-
ened small airways which collapse with
secondary pneumothorax
respirations such as asthma or lung car-
cinoma
2/8
