Sandbox:iqra

1. SOB 2. Chest pain 3. Cough 4. Cyanosis

Hyperventilation

Organ system	Diseases	Clinical manifestations									Diagnosis					Other features
		Symptoms				Physical exam
		Chest pain	Dyspnea	Fever	Palpitations	Cyanosis	Tachypnea	JVD	Peripheral edema	Ascultation	ABGs	Lab findings	Imaging	PFT	Gold standard
Pulmonary system	Pneumothorax
	Pulmonary embolism
	Pneumonia
	Exacerbation of asthma/COPD
	Interstitial lung disease
	Intrapulmonary shunt
	Upper airway obstruction
	High altitude sickness
Cardiovascular system	Acute coronary syndrome
	Heart failure
	Dysrhythmias
	Shock
Metabolic/Systemic disorders	Diabetic ketoacidosis
	Hypocalcemia
	Hypoglycemia
Endocrine system	Hyperthyroidism
	Pheochromocytoma
CNS	Central nervous system tumor
	Anxiety/panic attacks
Others	Pregnancy
	Hepatic failure
	Sepsis

Hypoventilation

Diseases	Clinical manifestations										Diagnosis					Associated features
	Symptoms						Physical exam
	Chest pain	Dyspnea	Orthopnea	Fever	Palpitations	Poor quality sleep	Cyanosis	JVD	Peripheral edema	Auscultation	ABGs	Lab findings	Imaging	Spirometry	Gold standard
Central hypoventilation syndrome CHS	-	+	+	-	+/-	+	+	+/-	+/-	Normal	↓O2, ↑CO2	PHOX2B screening testing via fragment analysis or sequencing tests  Polysomnography	Brain MRI (exclude other brainstem lesions)	Normal	Molecular testing for PHOX2B mutations	Hirschsprung disease Neural crest tumors Box-shaped face Meiosis Strabismus
Asphyxia	-	+	+/-	-	+/-	+	+	+/-	+/-	Systolic murmur	↓O2, ↑CO2	Basal Metabolic Profile Cardiac troponin T and I levels is specific for cardiac dysfunction	Chest X-ray typically shows cardiomegaly Echocardiography (to exclude other structural heart diseases)	Normal	The fetal biophysical profile score (BPS) shows loss of accelerations of the fetal heart rate, decreased body movement, breathing, hypotonia and decreased amniotic fluid volume	Acute respiratory distress syndrome (RDS) Meconium aspiration syndrome (MAS) Necrotizing enterocolitis
Chiari II malformation (Arnold-Chiari)
Spinal muscular atrophy
Guillain-Barré syndrome
Phrenic nerve injury	+/-	+	+	+/-	-	+/-	-	-	-	Normal	Normal	CBC (to rule out anemia as the cause of dyspnea) Thyroid function tests	CXR shows unilateral or bilateral diaphragmatic flattening	↓Vt, ↑RV (anatomical)	Fluoroscopic "sniff" test ( diaphragmatic movement is observed fluoroscopically while the patient sniffs forcefully)	Respiratory insufficiency
Myasthenia gravis
Muscular dystrophy
Pneumonia
Aspiration
Obstructive sleep apnea
Lung hypoplasia
Metabolic alkalosis
Sepsis
ROHHAD

Obstructive lung Diseases

Diseases	Clinical manifestations										Diagnosis
	Symptoms					Physical exam					Lab findings	PFT				Imaging			Gold standard	Other features
	Cough	Dyspnea	Hemoptysis	Fever	Weight loss	Cyanosis	Clubbing	JVD	Peripheral edema	Auscultation		ABGs	FEV1/FVC	TLC	DLCO
																CXR	CT scan	Other
Asthma
Chronic bronchitis
Bronchiolitis
Emphysema
Bronchiectasis
Central airway obstruction (Benign/Malignant lung mass)
Heart failure
Tuberculosis
Lymphangioleiomyomatosis

Restrictive lung Diseases

Diseases	Clinical manifestations										Diagnosis
	Symptoms				Physical exam						Lab findings	PFT				Imaging			Gold standard	Other features
	Cough	Dyspnea	Hemoptysis	Fever	Environmental/Occupational exposure	Cyanosis	Clubbing	JVD	Peripheral edema	Auscultation		ABGs	FEV1/FVC	TLC	DLCO
																CXR	CT scan	Other
Acute Respiratory Distress Syndrome	-	+	-	-	Inciting event, such as Trauma Sepsis Drug overdose Massive transfusion Acute pancreatitis Aspiration	+	-	-	-
Asbestosis	+	+	+/-	-	Ship yard workers
Bronchitis
Chronic Obstructive Pulmonary Disease (COPD)
Coal Worker's Pneumoconiosis
Emphysema
Eosinophilic Pneumonia
Hypersensitivity Pneumonitis
Idiopathic Pulmonary Fibrosis
Interstitial (Nonidiopathic) Pulmonary Fibrosis
Lung Transplantation
Lymphocytic Interstitial Pneumonia
Obesity
Pulmonary Eosinophilia