Sandbox:Vindhya

_NOTOC _ Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Vindhya BellamKonda, M.B.B.S [2]

Hyperventilation

Organ system	Diseases	Clinical manifestations									Diagnosis					Other features
		Symptoms				Physical exam
		Chest pain	Dyspnea	Fever	Palpitations	Cyanosis	Tachypnea	JVD	Peripheral edema	Auscultation	ABGs	Lab findings	Imaging	PFT	Gold standard
Pulmonary system	Pneumothorax	+	+	+	+	+	+	_	_	Decreased breath sounds	-	Decreased Vt	X- ray - Mediastinal shift Deep sulcus sign Hydropneumothorax CT-scan- Bullae	Decreased Vt	CT-scan	Hypoxia, Hypercapnia Hyperesonance to percussion, Vocal resonance Tactile fremitus decreased
	Pulmonary embolism	+	+	+	+	+	+	-	-	S3 gallop S4 gallop	Respiratory alkalosis	Increased D- dimers Increased Troponins	Duplex ultrasound EChocardiography Ventilation-perfusion scanning	Normal	CT angiography	Hemoptysis History of coagulation abnormalities Malignancy
	Pneumonia	+	+	+	+	+	+	-	-	Bronchial breath sounds Crepitations Bronchophony Egophony Whispering pectoroloqy	Normal	CBC Blood culture Mantoux test Serology (mycoplasma, viruses) Sputum: Gram stain and culture	CXR- Lobar consolidation, Air bronchogram; Atypical pneumonia: Diffuse interstitial infiltrates	Normal	CXR- Lung infiltrates Blood culture	Productive cough Altered mental status Tachycardia Central cyanosis
	Exacerbation of asthma/COPD	-	+	-	+	+	+	-	-	Decreased breath sounds Wheezing Coarse crackles	Increased PaCo2 Decreased PaO2	CBC- Increased hematocrit from chronic hypoxia Sputum evaluation, BNP( to rule out heart failure)	X- ray: Hyperinflated lungs Flattening of the diaphragm Narrow heart shadow Cardiomegaly	Increased TLC Increased RV Decreased Vital capacity Decreased DLco ( Emphysema) Normal DLco ( Chronic bronchitis)	HRCT ( High resolution computed tomography of the lung)	Productive cough Exercise intolerance Altered mental status Cor-pulmonale Hyperresonance on percussion
	Interstitial lung disease	+	+	-/+	+	+	+	-/+	-	Fine crackles Loud P2	Increased A-a gradient Decreased PaO2 Increased PaCo2	-	Chest X-ray- Reticular infiltrates Honey combing	FEV1 decreased FVC decreased TLC decreased RV decreased DLco decreased FEV1/FVC normal	HRCT -more accurate than chest xray Most accurate test is lung biopsy	Physical examination shows clubbing Decreased pulmonary compliance
	Intrapulmonary shunt	+/-	+	-	-	+	+/-	-	-	Diminished breath sounds	* Decreased O2 Increased CO2	CBC- Anemia, polycythemia	Chest X-ray and CT : Smooth nodule with a feeding artery and a draining vein	Decreased Vt, increased residual volume ( physiological)	CT angiography	Chronic hypoxemia Clubbing
	Upper airway obstruction	-/+	+	-	-/+	-/+	+	-/+	-	Inspiratory stridor	Increased PaCo2 Decreased PaO2	-	Plain radiograph of the neck Steeple sign (Croup in pediatric population) CT MRI	Decreased vital capacity	HRCT Bronchoscopy	Hoarseness Accessory muscle use during respiration Chest retractions
	High altitude sickness	-	+	+/-	+	+/-	+	-	+	-/+ Crackles	Respiratory alkalosis	CBC EKG- Right sided heart strain	CXR- Bilateral patchy infiltrates Brain Ct scan	Decreased FVC	Test in hypobaric chamber with and without supplemental oxygen	Headache Altered mental status Pulmonary edema Peripheral edema Epistaxis Rapid pulse
Cardiovascular system	Acute coronary syndrome	+	+	-	+/-	+/-	+/-	+/-	+/-	S3 Systolic murmur Rales	Cardiac enzymes EKG CBC BNP	Chest radiograph: Cardiomegaly Pulmonary edema Echo cardiography Myocardial perfusion imaging Cardiac angiography	-	Cardiac troponin Coronary angiography	Diaphoresis Nausea Vomiting Presyncope Displacement of apical impulse
	Heart failure	+	+	-	+/-	+/-	+/-	+	+
	Dysrhythmias	+/-	+	-	+	-	+/-	-	-	Tachycardia	Normal	Abnormal BMP	Normal	Normal	EKG	Etiology: Cardiac Throtoxicosis Electrolyte abnormalities Psychiatric Medication induced
	Shock	+/-	+/-	+	+/-	+/-	+/-	+/- Wheezing Stridor	Mixed acid base disorders	Leukocytosis	Chest X-ray	Decreased Vt	Depends on the cause of shock	Hypotension Pulsus paradoxus Altered mental status Oliguria
Metabolic/Systemic disorders	Diabetic ketoacidosis	-	+	-	-	-	+	-	-	-	Respiratory acidosis	Anion gap metabolic acidosis Serum Beta- hydroxy butyrate Acetone acetoacetate Urine ketones Hyponatremia Hyperkalemia Azotemia Hyperosmolality EKG	-	-	-	-
	Hypocalcemia	-	-/+	-	+	-/+	-/+	-/+	-/+	Inspiratory/expiratory wheezes S3		BMP LFT Serum albumin Coagulation markers Serum inonized calcium Serum 25 hydroxy Vitamin D Serum PTH ( Para thyroid hormone) EKG: QT prolongation				Chvostek sign Trousseausign Tetany Seizures
	Hypoglycemia	-	-	-	+	-	-	-	-	-	-	BMP Oral glucose tolerance test 72 hr fasting plasma glucose Serum Insulin level Serum Pro insulin Plasma C- Peptide Serum Cortisol Serum Thyroid hormone levels Urine analysis Blood culture Liver function tests	Chest X-ray: to rule out any infectious cause MRI : To rule out tumors like Insulinoma CT scan : To rule out any tumors producing Insulin like growth factors		Glucose tolerance test
Endocrine system	Hyperthyroidism	-/+	+	-/+	+	-	+/-	-/+	-/+	Systolic hypertension with wide pulse pressure	Respiratory acidosis	Serum freeT3 Serum freeT4 Serum TSH Radioactive iodine uptake (RAIU) Antithyroglobulin antibodies Antimicrosomal antibodies	Diffuse/ nodular uptake on thyroid scanning	Normal	Serum TSH level	Tremors Heat intolerance Excessive sweating Atrial fibrillation Exopthalmos
	Pheochromocytoma	-	+	-/+	+	-	-/+	-	-	-	Normal	Increased Plasma and urinary catecholamines and metanephrines Increased Urinary Vanillylmandelic acid level	Non contrast CT MRI Nuclear Imaging: Meta Iodo-benzyl guanidine(I-123 MIBG)	Normal	24 hr urine test for metanephrines, catechoalmines and Vanillyl mandelic acid	Von-Hippel Lindau syndrome MEN-I and MEN-II syndromes Hereditary paraganglionic syndromes Neurofibromatosis-I
CNS	Central nervous system tumor	-	-/+	-/+	-	-	-/+	-	-	Normal	Respiratory acidosis	CSF analysis- tumor cella Evoked potentials Audiometry	MRI with contrast CT scan	Normal	Contrast enhanced Magnetic resonance imaging	Headaches Focal neurological deficits Seizures Diplopia Gait ataxia Personality changes
	Anxiety/panic attacks	+/-	+	-	+/-	-	-	-	Normal	Normal	Normal	Urine toxicology EKG- sinus tachycardia	Normal	Normal	Psychiatric mental status examination General medical and neurologic examination	Restlessness Easy fatiguability Difficulty concentrating Irritability Sleep problems Muscle tension
Others	Pregnancy	-/+	+	-	-	-	-	-	-/+	Normal Systolic murmur in some women S3 heard in some women	Respiratory alkalosis	CBC Rh type and screen Urine analysis Beta-HCG Glucose tolerance test Cervical cultures for Gonorrhea and Chlamydia	Ultrasound	Decreased Vt Increased residual volume	Beta- HCG Ultrasound	Amenorrhea Hypercoagulability Hyperemesis gravidarum Hemodilution Chloasma Striae gravidarum
	Hepatic failure	-	-/+	-/+	-/+	-/+	+	+	+	Right ventricular gallop Abdominal venous hum (portal vein hypertension) Hepatic arterial bruit( Alcoholic hepatitis, Cancer) Hepatic friction rub(Cancer, Fitz-Hugh-Curtis syndrome)	Respiratory alkalosis	CBC Blood culture Abnormal liver function tests Abnormal prothrombin time Abnormal Serum ammonia levels Gamma glutamyl transpeptidase(GGT) Serum ceruloplasmin level Serum alpha-1 antitrypsin levels Serum alpha- feto protein levels Serum cholesterol levels	Doppler ultrasound establishes patency and direction of blood flow in hepatic and portal veins Ultrasound- ascites CT scan with contrast( in evaluation of parenchymal disease) Magnetic resonance imaging Magnetic resonance cholangio pancreatography (MRCP: for visualizing intra and extra hepatic bile ducts)	Normal	Liver biopsy	Jaundice Encephalopathy Ascites Hepatomegaly Splenomegaly Gynecomastia
	Sepsis	-	+	+	-/+	-	-	-	-	Normal	Respiratory acidosis	Leukocytosis	Normal	Normal	SIRS criteria	Altered mental status Chills