Knowledge - Students should be able to describe and define:

1. What is meant by the term "dyspnea" and how patients describe this sense of shortness of breath.
2. The different patterns of dyspnea: exertional and positional (those not directly related to exertion), i.e., paroxysmal nocturnal dyspnea, orthopnea.
3. The basic mechanisms of dyspnea:
   1. cardiac: high cardiac output (anemia, hyperthyroidism, intracardiac shunt) normal cardiac output (obesity, deconditioning) low cardiac output (left ventricular dysfunction, pericardial disease, valvular disease)
   2. pulmonary: disorders of ventilatory control (ASA toxicity, dyspnea of pregnancy, hyperventilation syndrome) derangements of the ventilatory pump (disorders of the ribcage, vertebral bodies, muscles and pleura) gas exchange abnormalities (pneumonia, emphysema, interstitial fibrosis, pulmonary embolus)
4. Risk factors for the various causes of dyspnea especially cardiovascular and venous thromboembolism.  

Skills - Students should be able to:

1. History-taking: obtain, document and present a medical history that differentiates among the various causes of dyspnea.
2. Physical examination: perform a physical exam to establish the diagnosis of a patient with dyspnea.
3. Differential Diagnosis: generate a differential diagnosis that recognizes specific history and physical exam findings that distinguish:
   1. potentially life-threatening from trivial or less serious causes of dyspnea
   2. chronic from acute dyspnea and list specific/common causes of each
   3. cardiac from pulmonary dyspnea
4. Laboratory: order and interpret diagnostic and lab tests based on the differential diagnosis.  

Attitudes and Professional Behaviors:

• Students should be able to understand the urgency of accurately diagnosing the etiology of dyspnea.  

Recommended Readings

1. Ingram L, Braunwald E, Dyspnea, Chapter 32, in Harrison=s Principles of Internal Medicine, 14th ed. Fauci AS, et al eds. 1998, McGraw-Hill, New York, pp 190-193.