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Amresh Kumar (talk | contribs)
nocaptcha
705 edits
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!Gold standard
!Gold standard
|-
|-
!Central hypoventilation syndrome CHS
![[Congenital central hypoventilation syndrome|Central hypoventilation syndrome CHS]]
!-
!-
!+
!+
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* Strabismus                   
* Strabismus                   
|-
|-
!Asphyxia
![[Asphyxia]]
!-
!-
!+
!+
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* Necrotizing            enterocolitis             
* Necrotizing            enterocolitis             
|-
|-
!Chiari II malformation (Arnold-Chiari)
![[Arnold-Chiari malformation|Chiari II malformation (Arnold-Chiari)]]
!-
!-
!+
!+
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* Hydrocephalus     
* Hydrocephalus     
|-
|-
!Spinal muscular atrophy
![[Spinal muscular atrophy]]
!-
!-
!+
!+
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* Progressive            muscle weakness        and atrophy             
* Progressive            muscle weakness        and atrophy             
|-
|-
!Guillain-Barré syndrome
![[Guillain-Barré syndrome]]
!-
!-
!+
!+
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* Ascending fashion of weakness
* Ascending fashion of weakness
|-
|-
!Phrenic nerve injury
![[Phrenic nerve paralysis|Phrenic nerve injury]]
!+/-
!+/-
!+
!+
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* Respiratory          insufficiency                     
* Respiratory          insufficiency                     
|-
|-
!Myasthenia gravis
![[Myasthenia gravis]]
!-
!-
!+
!+
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* Fatigue                 
* Fatigue                 
|-
|-
!Muscular dystrophy<ref name="pmid7699962">{{cite journal| author=Takasugi T, Ishihara T, Kawamura J, Sasaki K, Toyoda T, Oosumi M et al.| title=[Blood gas changes in Duchenne type muscular dystrophy]. | journal=Nihon Kyobu Shikkan Gakkai Zasshi | year= 1995 | volume= 33 | issue= 1 | pages= 17-22 | pmid=7699962 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7699962  }} </ref><ref name="pmid25755201">{{cite journal| author=Mayer OH, Finkel RS, Rummey C, Benton MJ, Glanzman AM, Flickinger J et al.| title=Characterization of pulmonary function in Duchenne Muscular Dystrophy. | journal=Pediatr Pulmonol | year= 2015 | volume= 50 | issue= 5 | pages= 487-94 | pmid=25755201 | doi=10.1002/ppul.23172 | pmc=4402127 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25755201  }} </ref>
![[Muscular dystrophy]]<ref name="pmid7699962">{{cite journal| author=Takasugi T, Ishihara T, Kawamura J, Sasaki K, Toyoda T, Oosumi M et al.| title=[Blood gas changes in Duchenne type muscular dystrophy]. | journal=Nihon Kyobu Shikkan Gakkai Zasshi | year= 1995 | volume= 33 | issue= 1 | pages= 17-22 | pmid=7699962 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7699962  }} </ref><ref name="pmid25755201">{{cite journal| author=Mayer OH, Finkel RS, Rummey C, Benton MJ, Glanzman AM, Flickinger J et al.| title=Characterization of pulmonary function in Duchenne Muscular Dystrophy. | journal=Pediatr Pulmonol | year= 2015 | volume= 50 | issue= 5 | pages= 487-94 | pmid=25755201 | doi=10.1002/ppul.23172 | pmc=4402127 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25755201  }} </ref>
!+/-
!+/-
!+
!+
Line 647: Line 647:
* Gower sign                 
* Gower sign                 
|-
|-
!Pneumonia
![[Pneumonia]]
!+
!+
!+
!+
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!Productive cough
!Productive cough
|-
|-
!Aspiration
![[Aspiration pneumonia|Aspiration]]
!+/-
!+/-
!+
!+
Line 688: Line 688:
* Choking                 
* Choking                 
|-
|-
!Obstructive sleep apnea<ref name="pmid26209328">{{cite journal| author=Abdeyrim A, Zhang Y, Li N, Zhao M, Wang Y, Yao X et al.| title=Impact of obstructive sleep apnea on lung volumes and mechanical properties of the respiratory system in overweight and obese individuals. | journal=BMC Pulm Med | year= 2015 | volume= 15 | issue=  | pages= 76 | pmid=26209328 | doi=10.1186/s12890-015-0063-6 | pmc=4513967 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26209328  }} </ref>
![[Obstructive sleep apnea]]<ref name="pmid26209328">{{cite journal| author=Abdeyrim A, Zhang Y, Li N, Zhao M, Wang Y, Yao X et al.| title=Impact of obstructive sleep apnea on lung volumes and mechanical properties of the respiratory system in overweight and obese individuals. | journal=BMC Pulm Med | year= 2015 | volume= 15 | issue=  | pages= 76 | pmid=26209328 | doi=10.1186/s12890-015-0063-6 | pmc=4513967 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26209328  }} </ref>
!+
!+
!+
!+
Line 740: Line 740:
* Myopathic facies     
* Myopathic facies     
|-
|-
!Metabolic alkalosis
![[Metabolic alkalosis]]
!-
!-
!+
!+
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* Hypokalemia         
* Hypokalemia         
|-
|-
!Sepsis
![[Sepsis]]
!-
!-
!+
!+

Revision as of 16:59, 23 February 2018

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

Tachypnea

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

Bradypnea

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
  • Abnormal renal function tests
  • Cardiac troponin T and I levels are elevated
  • 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) - + + - + + - - - Stridor Normal _
  • CT Scan of Brain (hydrocephalus, herniated cerebellar tonsils, and a flattened spinal cord)
 _ MRI Brain
  • Myelomeningocele
  • Hydrocephalus
Spinal muscular atrophy - + + - +/- + + - -  Stridor _
  • Electromyography shows fibrillations and positive sharp waves
 _ _ Molecular genetic testing  by detection of homozygous deletions of exons 7 of the SMN1 gene
  • Progressive muscle weakness and atrophy
Guillain-Barré syndrome - + +/- - + +/- - - -
  • Diminished breath sounds
  • Absence of bowel sound
 ↓O2, ↑CO2
  • Albuminocytologic dissociation on CSF analysis
  • MRI shows selective anterior nerve root enhancement
 ↓FEV1

↓FVC

↓TLC

  • Nerve conduction studies (NCS) and needle electromyography (EMG)
  • Preceded by mild respiratory or GIT infection
  • Ascending fashion of weakness
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 - + +/- - - + - - -
  • Paradoxical abdominal breathing
  • ↓O2, ↑CO2
  • Anti-AChR ab
  • Anti–striated muscle ab
  • Anti-MuSK ab
  • CT may show anterior mediastinal mass (thymoma)
 ↓FEV1,↓FVC

↓TLC

  • Anti–acetylcholine receptor antibody test
  • Ptosis
  • Diplopia
  • Fatigue
Muscular dystrophy[1][2] +/- + +/- - +/- +/- - +/- +/-
  • Mid-systolic murmur
  • ↓O2, ↑CO2
  • Elevated CPK levels
  • ECG shows right ventricular strain
  • Ultrasonography shows increased echogenicity in the affected muscles
 ↓FVC, ↓PEF
  • Genetic testing for mutation of the dystrophin gene (DMD)
  • Waddling, wide- based gait 
  • Gower sign
Pneumonia + + +/- + +/- +/- - - - Wheeze, Rhonchi, and Crackles Normal
  • ↑WBC (neutrophilia)
 Lobar consolidation Normal Normal Productive cough
Aspiration +/- + +/- + +/- +/- + - - Diminished breath sounds Normal
  • ↑WBC
  • Blood cultures
  • CXR shows atelectasis
 ↓Vt, ↑RV Bronchoscopy
  • Choking
Obstructive sleep apnea[3] + + +/- - +/- + +/- +/- +/-
  • Wheeze
  • Systolic ejection murmur 
 ↓O2, ↑CO2
  • Polysomnography
  • MRI shows enlarged adenoids, tonsils, and soft palate
 ↑FRC Polysomnography
  • Loud snoring
  • Depression
  • Hypertension
  • Coronary artery disease
Pulmonary hypoplasia - + +/- - +/- +/- + - -
  • Breath sounds may be decreased or absent on the side of hypoplasia
  • ↓O2, ↑CO2
  • Abnormal BMP
  • Echocardiography is done to rule out cardiac complications
  • CXR shows crowded ribs and low thoracic-to- abdominal ratio
  • CT scan of chest
 ↑RV _
  • Myopathic facies
Metabolic alkalosis - + +/- - +/- +/- - +/- +/- _
  • ↓O2, ↑CO2
  • Serum Anion Gap is elevated
  • Abnormal Urine Sodium Ion Concentration
 _ _ _
  • Hypokalemia
Sepsis - + - + +/- +/- - - - Normal ↓O2, ↑CO2
  • CBC shows ↑WBC (neutrophilia)
 Normal Normal SIRS criteria
  • Chills
  • Confusion
ROHHAD[4][5][6] - + +/- - +/- + +/- - -
  • Displaced cardiac impulse
  • Loud pulmonic second heart sound                     
 ↓O2, ↑CO2
  • Abnormal Serum bicarbonate levels
  • Attended laboratory nocturnal polysomnography
  • Lateral neck radiographs shows airway narrowing
  • CXR shows chest wall deformity
 ↓TV _
  • Hypothalamic endocrine manifestations
  • Tumors of neural crest origin

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

Wheeze

  1. ↑ Takasugi T, Ishihara T, Kawamura J, Sasaki K, Toyoda T, Oosumi M; et al. (1995). "[Blood gas changes in Duchenne type muscular dystrophy]". Nihon Kyobu Shikkan Gakkai Zasshi. 33 (1): 17–22. PMID 7699962.
  2. ↑ Mayer OH, Finkel RS, Rummey C, Benton MJ, Glanzman AM, Flickinger J; et al. (2015). "Characterization of pulmonary function in Duchenne Muscular Dystrophy". Pediatr Pulmonol. 50 (5): 487–94. doi:10.1002/ppul.23172. PMC 4402127. PMID 25755201.
  3. ↑ Abdeyrim A, Zhang Y, Li N, Zhao M, Wang Y, Yao X; et al. (2015). "Impact of obstructive sleep apnea on lung volumes and mechanical properties of the respiratory system in overweight and obese individuals". BMC Pulm Med. 15: 76. doi:10.1186/s12890-015-0063-6. PMC 4513967. PMID 26209328.
  4. ↑ duRivage SK, Winter RJ, Brouillette RT, Hunt CE, Noah Z (1985). "Idiopathic hypothalamic dysfunction and impaired control of breathing". Pediatrics. 75 (5): 896–8. PMID 3991276.
  5. ↑ FISHMAN LS, SAMSON JH, SPERLING DR (1965). "PRIMARY ALVEOLAR HYPOVENTILATION SYNDROME (ONDINE'S CURSE)". Am J Dis Child. 110: 155–61. PMID 14320765.
  6. ↑ Paz-Priel I, Cooke DW, Chen AR (2011). "Cyclophosphamide for rapid-onset obesity, hypothalamic dysfunction, hypoventilation, and autonomic dysregulation syndrome". J Pediatr. 158 (2): 337–9. doi:10.1016/j.jpeds.2010.07.006. PMC 3976575. PMID 20727534.
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