Intended for healthcare professionals

Student Education

Clinical exam skills: Breathlessness

BMJ 2004; 329 doi: (Published 01 December 2004) Cite this as: BMJ 2004;329:0412446
  1. Ian Bickle, senior house officer, medical rotation1,
  2. Fionnuala Crummy, specialist registrar, respiratory medicine1,
  3. Barry Kelly, consultant radiologist1
  1. 1Royal Victoria Hospital, Belfast

In the fourth part of our series, Ian Bickle, Fionnuala Crummy, and Barry Kelly guide you through another typical exam question

An 86 year old woman was admitted acutely short of breath. She had become progressively short of breath over the past five years, to the extent that she was virtually housebound. Her exercise tolerance at best was 100 metres walking on flat ground. Doctors also noted an irritating dry cough. She was a non-smoker and otherwise in good health. There was no family history of note. She was living alone at the time and received limited formal help with daily living activities.

On examination, she was in overt respiratory distress. The oxygen saturation while breathing room air was 81%. This increased to 96% after administration of oxygen via a face mask (fractional inspired oxygen (Fio2) 0.28).

Her respiratory rate was 30 breaths per minute; her heart rate was 98 beats per minute and regular in nature; and her blood pressure was 142/78. The jugular venous pulse was raised 3 cm. She had peripheral oedema up to her mid-calf bilaterally. There was no finger …

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