Sandbox:Vindhya

Jump to navigation Jump to search


_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 Others
Pulmonary system Pneumothorax + + + + + + _ _
  • Decreased breath sounds

-

Decreased Vt

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 +/- + - - + +/- - - 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
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 +/- + - + - +/- - - 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