Sandbox restrictive

Disease		Clinical manifestations											Diagnosis
		Symptoms				Physical exam							Lab findings	Imaging			Gold standard
		Cough	Dyspnea	Hemoptysis	Fever	History/Exposure	Cyanosis	Clubbing	JVD	Peripheral edema	Auscultation	Other prominent findings		CXR	CT	DLCco
Acute Respiratory Distress Syndrome (ARDS)		-	+	-	-	Inciting event, such as: Trauma Sepsis Drug overdose Massive transfusion Acute pancreatitis Aspiration	+	-	-	-	Coarse breath sounds Rhonchi crackles Decreased breath sounds	Initially respiratory alkalosis transforming to respiratory acidosis	BNP level of less than 100 pg/mL PaO2 / FiO2 <300 CBC Leukopenia Leukocytosis Thrombocytopenia	Bilateral pulmonary infiltrates Initially patchy peripheral Later diffuse bilateral Ground glass Frank alveolar infiltrate	Bronchial dilatation within areas of ground-glass opacification		PaO2 / FiO2 <300
Bronchitis	Acute	+	-	+/-	+	-	-	-	-	-	Diffuse wheezes High-pitched continuous sounds The use of accessory muscles  Prolonged expiration Rhonchi Rales	Hoarseness	N/A	Normal	N/A		Clinical diagnosis
	Chronic	+	+	-	-	A positive history of chronic productive cough  Shortness of breath	+	-	+	+	Prolonged expiration; wheezing Diffusely decreased breath sound Coarse crackles with inspiration Coarse rhonchi		Chronic hypoxemia may lead to polycythemia  Increase in Neutrophils count Chronic respiratory acidosis. To compensate for this, the body may develop metabolic alkalosis	Radiolucency Diaphragmatic flattening due to hyperinflation Increased retrosternal airspace on the lateral radiograph	N/A
Hypersensitivity Pneumonitis		+	+	-	+	History of allergen exposure	-	+	-	-	Diffuse fine bibasilar crackles	Constitutional symptoms Weight loss Anorexia Muscle weakness	Neutrophilia Elevated ESR Elevated CRP Elevated immunoglobulin No peripheral blood eosinophilia	Poorly defined micronodular or diffuse interstitial pattern In chronic form Fibrosis Loss of lung volume Coarse linear opacities	Ground-glass opacities or Diffusely increased radiodensities Diffuse micronodules Focal air trapping Mosaic perfusion Occasionaly thin-walled cysts Mild fibrotic changes
Pneumoconiosis	SIlicosis	+	+	+/-	-	History of substantial exposure to silica dusts Occupational history Sandblasting Bystanders Quartzite miller Tunnel workers Silica flour workers Workers in the scouring powder industry	+	+	+	-	Lungs are hyperresonant Finecrackles upon auscultation of the lung bases or apices, unilaterally or bilaterally Rhonchi Bronchial breath sounds Expiratory wheezing with normal or delayed expiratory phase Wheezing may be present Egophony present Bronchophony present Increased tactile fremitus. Loud P2	Increased susceptiblity to tuberculosis.	Abnormal ABG May indicate hypoxia, hypercapnia and respiratory acidosis Abnormal sputum analysis May contain bacteria, such as mycobacterium tuberculosis or inorganic particles, such as asbestos bodies or organic particles Peak flow assessment May be below normal range which is 100 liters/minute for men, and 80 liters/minute for women Spirometry May indicate an obstructive or restrictive pulmonary disease A FEV1/FVC ratio < 80% indicates and obstructive disease,such as asthma, whilst a FEV1/FVC ratio higher than restrictive pulmonary disease indicates a restrictive disease, such as pulmonary fibrosis CBC May indicate anemia, neutrophilia, elevated ESR, elevated CRP, and elevated immunoglobulin Bronchoscopy and bronchoalveolar lavage May reveal mineral dust Tuberculin skin test To test for tuberculosis, and induration > 5mm is positive Stool examination for occult blood May indicate colorectal carcinoma	Small round opacities Symmetrically distributed Upper-zone predominance Diffuse interstitial pattern of fibrosis without the typical nodular opacities in chronic case	Nodular changes in lung parenchyma Progressive massive fibrosis Bullae, emphysema Pleural, mediastinal, and hilar changes	↓	Lung biopsy
	Asbestosis					Shipyard workers Pipe fitting Insulators						Lung cancer Mesothelioma		Predilection to lower lobes Fine and coarse linear, peripheral, reticular opacities
	Berylliosis					Electronic manufactures								Multiple, rounded opacities with or without calcification Architectural distortion Loss of lung tissue volume Shadows Upper lobe predominance Chronic berylliosis shows emphysema with bulla formation
	Byssinosis					Cotton wool workers
Sarcodiosis		+	+	+	+	African Americans Autoimmune	-	-	-	-	Usually normal Crackles may be audible	Dermatologic manifestations Ocular involvement Osseous involvement Heart failure from cardiomyopathy Lymphocytic meningitis Cranial nerve palsies	Hypercalcemia or hypercalciuria  Elevated 1, 25-dihydroxyvitamin D levels Elevated angiotensin-converting enzyme (ACE)	Bilateral hilar lymphadenopathy	High-resolution CT (HRCT) scanning of the chest may identify Active alveolitis Fibrosis	↓	Biopsy Non-caseating granuolma
Pleural Effusion		+	+	+/-	+/-	Transudate Congestive heart failure Cirrhosis (hepatic hydrothorax) Atelectasis (may be due to occult malignancy or pulmonary embolism) Hypoalbuminemia Nephrotic syndrome Exudate Parapneumonic causes  Malignancy (most commonly lung or breast cancer, lymphoma, and leukemia; less commonly ovarian carcinoma, stomach cancer, sarcomas, melanoma)  Pulmonary embolism Collagen-vascular conditions (rheumatoid arthritis, systemic lupus erythematosus  Tuberculosis (TB) Pancreatitis	+/-	+/-	+/-	+/-	Dullness to percussion Decreased tactile fremitus, Asymmetrical chest expansion, Diminished or delayed expansion on the side of the effusion:  Diminished or inaudible breath sounds Pleural friction rub	Peripheral edema, distended neck veins, and S3 gallop suggest congestive heart failure. Edema may also be a manifestation of nephrotic syndrome, pericardial disease, or, when combined with yellow nailbeds, the yellow nail syndrome. Cutaneous changes and ascites suggest liver disease. Lymphadenopathy or a palpable mass suggests malignancy.	Thoracentesis  Exudate Transudate LDH, Glucose, cytology Other specific labs of underlying etiology	Supine Blunting of the costophrenic angle Homogenous increase in density spread over the lower lung fields Lateral decubitus Free flowing effusion as layers	Thickened pleura Mild effusions can aslo be detected		Thoracocentesis
Neuromuscular disease	Scoliosis	-	+	-	-	Postural abnormality	-	-	-	-	Decreased breathe sounds	In severe scoliosis, the rib cage may press against the lungs making it more difficult to breathe.	R/0 genetic conditions Marfan's syndrome Edward's syndrome Total lymphocyte count (should be >1500/μL) Nutritional status must be assessed	Accurate depiction of the true magnitude of the spinal deformity can be assessed by supine anteroposterior (AP) and lateral spinal radiographs	N/A		Clinical Radiographs
	Muscular dystrophy	-	+	-	-	Proximal muscle weakness (shoulder and pelvic girdle)	-	-	-	-	Decreased breathe sounds Decreased chest expansion	Rash	Elevated CPK and aldolase +ANA +Anti-Jo abs Elevated ESR, CRP and RF	N/A	N/A		Muscle biopsy
	ALS	-	+	-	-	Muscle weakness	-	-	-	-	Decreased breathe sounds Decreased chest expansion	Symptoms begin with limb involvement diue to muscle weakness and atrophy.  Cognitive or behavioral dysfunction Sensory nerves and the autonomic nervous system are generally unaffected	N/A	Not significant/diagnostic	Not significant/diagnostic	-	Clinical diagnosis Nerve conduction studies and needle electromyography (EMG)
	Myasthenia gravis	-	+	-	+	H/O of difficulty getting up from chair Combing Difficulty in swallowing	-	-	-	-	Decreased breathe sounds Decreased chest expansion	Extraocular, bulbar, or proximal limb muscles. Breathing as rapid and shallow, Respiratory muscle weakness can lead to acute respiratory failure may require immediate intubation.	Anti–acetylcholine receptor (AChR) antibody (Ab) test +	Thymoma as an anterior mediastinal mass.	Thymoma as an anterior mediastinal mass.		Electromyography
Interstitial (Nonidiopathic) Pulmonary Fibrosis		+	++	+	-	Connective-tissue disorder Pneumoconiosis	+	+	+	+	Wheezing S3 P2 End-inspiratory rales	Increased A-a gradient	Elevated ESR Serologic testing for ANA, RF, ANCA & ASCA may be positive	Reticular and/or nodular opacities Honeycomb appearance (late finding)	Bilateral reticular and nodular interstitial infiltrates	↓	Video-assisted thoracoscopic lung biopsy
Lymphocytic Interstitial Pneumonia		+	+	+	+	Autoimmune Lymphoproliferative disorders	-	+	-	-	Wheezing Rales	Increased A-a gradient	Polyclonal hypergammaglobulinemia Increased LDH	Bibasilar interstitial or micronodular infiltrates	Determines the degree of fibrosis Cysts (characterstic)	N	Open lung biopsy
Obesity		+	+	-	-	Overweight Diabetes mellitus Asthma	-	-	-	+	Wheezing		Increased hematocrit	X ray findings are often limited due to body habitus	CT findings are variable and depends upon severity of obesity	N	Clinical
Pulmonary Eosinophilia		+	+	+	+	Infections Prasitic Fungal Mycobacterial	+	-	+	+	Wheezing Rales	Increased A-a gradient	Leukocytosis with eosinophilia (> 250/µL)	Interstitial or diffuse nodular densities	Determines extent and distribution of the disease Interstitial infiltrates Cysts and nodules	↓	Biopsy of lesion (skin or lung)