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* Increased Plasma and urinary catecholamines and metanephrines
*Increased Urinary Vanillylmandelic acid level
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Normal
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* 24 hr urine test for metanephrines, catechoalmines and Vanillyl mandelic acid
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Revision as of 16:55, 2 March 2018


_NO TOC_ 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
X- ray -
  • Mediastinal shift
  • Deep sulcus sign
  • Hydropneumothorax
  • CT-scan- Bullae
CT-scan
  • Hypoxia,
  • Hypercapnia
  • Hyperesonance to percussion,
  • Vocal resonance
  • Tactile fremitus decreased
Pulmonary embolism + + + + + +
Pneumonia + + + + + + - -
  • Bronchial breath sounds
  • Crepitations
  • Bronchophony
  • Egophony
  • Whispering pectoroloqy
  • CBC
  • Blood culture
  • Mantoux test
  • Serology (mycoplasma, viruses)
  • Sputum: Gram stain and culture
  • CXR- Lobar consolidation, Air bronchogram;
  • Atypical pneumonia: Diffuse interstitial infiltrates
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
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
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
Heart failure + + -

+/-

+/-

+/-

+

+

Dysrhythmias
Shock
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

Normal

  • 24 hr urine test for metanephrines, catechoalmines and Vanillyl mandelic acid
CNS Central nervous system tumor
Anxiety/panic attacks
Others Pregnancy
Hepatic failure
Sepsis