Cystic fibrosis differential diagnosis: Difference between revisions

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==Overview==
==Overview==
[Disease name] must be differentiated from other diseases that cause [clinical feature 1], [clinical feature 2], and [clinical feature 3], such as [differential dx1], [differential dx2], and [differential dx3].
OR
[Disease name] must be differentiated from [[differential dx1], [differential dx2], and [differential dx3].


==Differentiating X from other Diseases==
==Differentiating X from other Diseases==
*[Disease name] must be differentiated from other diseases that cause [clinical feature 1], [clinical feature 2], and [clinical feature 3], such as [differential dx1], [differential dx2], and [differential dx3].
*[Disease name] must be differentiated from [[differential dx1], [differential dx2], and [differential dx3].


*As [disease name] manifests in a variety of clinical forms, differentiation must be established in accordance with the particular subtype. [Subtype name 1] must be differentiated from other diseases that cause [clinical feature 1], such as [differential dx1] and [differential dx2]. In contrast, [subtype name 2] must be differentiated from other diseases that cause [clinical feature 2], such as [differential dx3] and [differential dx4].
[[Differential diagnosis]] of [[cough]] with [[Wheezing|wheezes]] is :
 
{| class="wikitable"
===Preferred Table===
{|
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
! rowspan="2" |Diseases
! rowspan="2" |Diseases
! colspan="4" |History and Symptoms
! colspan="2" |Symptoms
! colspan="4" |Physical Examination
!
! colspan="4" |Laboratory Findings
! colspan="3" |Signs
! rowspan="2" |Other Findings
! colspan="2" |Diagosis
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
!Finding
1
!Finding 2
!Finding 3
!Finding
4
!Physical Finding 1
!Physical Finding 2
!Physical Finding 3
!Physical Finding 4
!Lab Test 1
!Lab Test 2
!Lab Test 3
!Lab Test 4
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Differential Diagnosis 1
!Fever
| style="background: #F5F5F5; padding: 5px;" |
!Cough
| style="background: #F5F5F5; padding: 5px;" |
!Chest pain
| style="background: #F5F5F5; padding: 5px;" |<nowiki>+</nowiki>
!Wheezes
| style="background: #F5F5F5; padding: 5px;" |
!Crackles
| style="background: #F5F5F5; padding: 5px;" |
!Tachypnea
| style="background: #F5F5F5; padding: 5px;" |
!Lab tests
| style="background: #F5F5F5; padding: 5px;" |
!Imaging
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Differential Diagnosis 2
|[[Asthma]]
| style="background: #F5F5F5; padding: 5px;" |'''↑'''
|<nowiki>-</nowiki>
| style="background: #F5F5F5; padding: 5px;" |
|Dry/Productive
| style="background: #F5F5F5; padding: 5px;" |
| -
| style="background: #F5F5F5; padding: 5px;" | -
|<nowiki>+</nowiki>
| style="background: #F5F5F5; padding: 5px;" |
| -
| style="background: #F5F5F5; padding: 5px;" |
| +
| style="background: #F5F5F5; padding: 5px;" |
|
| style="background: #F5F5F5; padding: 5px;" |
* Lab tests to exclude other [[Disease|diseases]].
| style="background: #F5F5F5; padding: 5px;" |
* Serum examination shows elevated level of [[Eosinophil|eosinophils]] due to [[allergy]]. 
| style="background: #F5F5F5; padding: 5px;" |
|
| style="background: #F5F5F5; padding: 5px;" |
* [[CT scan]] shows:  
| style="background: #F5F5F5; padding: 5px;" |
** Dilated [[bronchi]].
| style="background: #F5F5F5; padding: 5px;" |
** Bronchial wall thickening.
** Air trapping.
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Differential Diagnosis 3
|[[Bronchiolitis]]
| style="background: #F5F5F5; padding: 5px;" |
| +/-
| style="background: #F5F5F5; padding: 5px;" |↓
|Dry
| style="background: #F5F5F5; padding: 5px;" |
|<nowiki>-</nowiki>
| style="background: #F5F5F5; padding: 5px;" |
|<nowiki>+</nowiki>
| style="background: #F5F5F5; padding: 5px;" |
| +
| style="background: #F5F5F5; padding: 5px;" |
| +/-
| style="background: #F5F5F5; padding: 5px;" |
|
| style="background: #F5F5F5; padding: 5px;" |
* [[ELISA]] and [[immunoassays]] may be done in case of [[RSV]] [[infection]].
| style="background: #F5F5F5; padding: 5px;" |
* [[Pulmonary function test]] to exclude other [[lung diseases]].<ref name="pmid18339530">{{cite journal| author=Ghanei M, Tazelaar HD, Chilosi M, Harandi AA, Peyman M, Akbari HM et al.| title=An international collaborative pathologic study of surgical lung biopsies from mustard gas-exposed patients. | journal=Respir Med | year= 2008 | volume= 102 | issue= 6 | pages= 825-30 | pmid=18339530 | doi=10.1016/j.rmed.2008.01.016 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18339530  }} </ref>
| style="background: #F5F5F5; padding: 5px;" |
|
| style="background: #F5F5F5; padding: 5px;" |
* [[CT scan]] shows:
| style="background: #F5F5F5; padding: 5px;" |
** Intense [[Bronchiolar epithelium|bronchiolar]] mural [[inflammation]]. 
| style="background: #F5F5F5; padding: 5px;" |
** [[bronchial]] wall thickening.
** Centrilobular [[nodules]] with tree-in-bud pattern. 
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Differential Diagnosis 4
|[[COPD]]
| style="background: #F5F5F5; padding: 5px;" |
|<nowiki>+</nowiki>
| style="background: #F5F5F5; padding: 5px;" |
|Productive
| style="background: #F5F5F5; padding: 5px;" |
|<nowiki>-</nowiki>
| style="background: #F5F5F5; padding: 5px;" |
| +
| style="background: #F5F5F5; padding: 5px;" |
| +
| style="background: #F5F5F5; padding: 5px;" |
| +
| style="background: #F5F5F5; padding: 5px;" |
|
| style="background: #F5F5F5; padding: 5px;" |
* [[Spirometry]]: [[FEV1/FVC ratio|FEV1/FVC]] < 70%.
| style="background: #F5F5F5; padding: 5px;" |
* Arterial blood gases: [[hypoxemia]] and [[hypercapnia]].
| style="background: #F5F5F5; padding: 5px;" |
* [[Sputum culture]]. 
| style="background: #F5F5F5; padding: 5px;" |
|
| style="background: #F5F5F5; padding: 5px;" |
* EKG may show:
| style="background: #F5F5F5; padding: 5px;" |
** [[P pulmonale]].
** [[right ventricular hypertrophy]].
** Narrow QRS.<ref name="pmid23653989">{{cite journal| author=Lazović B, Svenda MZ, Mazić S, Stajić Z, Delić M| title=Analysis of electrocardiogram in chronic obstructive pulmonary disease patients. | journal=Med Pregl | year= 2013 | volume= 66 | issue= 3-4 | pages= 126-9 | pmid=23653989 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23653989  }} </ref>
* CT scan is more sensitive in diagnosing COPD than X ray. 
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Differential Diagnosis 5
|[[Bacterial pneumonia]]
| style="background: #F5F5F5; padding: 5px;" |
|<nowiki>+</nowiki>
| style="background: #F5F5F5; padding: 5px;" |
|[[Productive cough|Productive]]
| style="background: #F5F5F5; padding: 5px;" |
| +
| style="background: #F5F5F5; padding: 5px;" |
| +
| style="background: #F5F5F5; padding: 5px;" |
| +
| style="background: #F5F5F5; padding: 5px;" |
| +/-
| style="background: #F5F5F5; padding: 5px;" |
|
| style="background: #F5F5F5; padding: 5px;" |
* Diagnosis depends on presentation and physical examination.
| style="background: #F5F5F5; padding: 5px;" |
* Laboratory tests:
| style="background: #F5F5F5; padding: 5px;" |
** [[arterial blood gases]] may show [[hypoxia]] and [[acidosis]].
| style="background: #F5F5F5; padding: 5px;" |
** [[Sputum culture]].
| style="background: #F5F5F5; padding: 5px;" |
|
| style="background: #F5F5F5; padding: 5px;" |
* X ray is performed to detect:
|}
** [[pleural effusion]].
** Inflitrates within the [[lungs]].
* CT scan shows:  
** [[Consolidation (medicine)|Consolidation]].
** Ground glass appearance.
|-
|[[Cystic Fibrosis]]
| +/-
|[[Productive cough|Productive]]
| +/-
| -
| -
| +
|[[Cystic fibrosis]] transmembrane conductance regulator (CFTR) dysfunction evidenced by :
* Elevated [[Sweat chloride test|sweat chloride]] ≥60 mmol/L (on two occasions).


===Use if the above table can not be made===
* Presence of two disease-causing [[mutations]] in CFTR, one from each [[Allele|parental allele]].
{| style="border: 0px; font-size: 90%; margin: 3px; width: 1000px" align="center"
| valign="top" |
|+
! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Differential Diagnosis}}
! style="background: #4479BA; width: 300px;" | {{fontcolor|#FFF|Similar Features}}
! style="background: #4479BA; width: 300px;" | {{fontcolor|#FFF|Differentiating Features}}
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |Differential 1
| style="padding: 5px 5px; background: #F5F5F5;" |
* On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] also observed in [disease name].
| style="padding: 5px 5px; background: #F5F5F5;" |
* On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] that distinguish it from [disease name].
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |Differential 2
| style="padding: 5px 5px; background: #F5F5F5;" |
* On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] also observed in [disease name].
| style="padding: 5px 5px; background: #F5F5F5;" |
* On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] that distinguish it from [disease name].
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |Differential 3
| style="padding: 5px 5px; background: #F5F5F5;" |
* On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] also observed in [disease name].
| style="padding: 5px 5px; background: #F5F5F5;" |
* On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] that distinguish it from [disease name].
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |Differential 4
| style="padding: 5px 5px; background: #F5F5F5;" |
* On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] also observed in [disease name].
| style="padding: 5px 5px; background: #F5F5F5;" |
* On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] that distinguish it from [disease name].
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |Differential 5
| style="padding: 5px 5px; background: #F5F5F5;" |
* On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] also observed in [disease name].
| style="padding: 5px 5px; background: #F5F5F5;" |
* On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] that distinguish it from [disease name].
|}


==References==
==References==

Revision as of 19:17, 2 March 2018

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Shaghayegh Habibi, M.D.[2]

Overview

Differentiating X from other Diseases

Differential diagnosis of cough with wheezes is :

Diseases Symptoms Signs Diagosis
Fever Cough Chest pain Wheezes Crackles Tachypnea Lab tests Imaging
Asthma - Dry/Productive - + - +
  • CT scan shows:
    • Dilated bronchi.
    • Bronchial wall thickening.
    • Air trapping.
Bronchiolitis +/- Dry - + + +/-
COPD + Productive - + + +
Bacterial pneumonia + Productive + + + +/-
Cystic Fibrosis +/- Productive +/- - - + Cystic fibrosis transmembrane conductance regulator (CFTR) dysfunction evidenced by :

References

  1. ↑ Ghanei M, Tazelaar HD, Chilosi M, Harandi AA, Peyman M, Akbari HM; et al. (2008). "An international collaborative pathologic study of surgical lung biopsies from mustard gas-exposed patients". Respir Med. 102 (6): 825–30. doi:10.1016/j.rmed.2008.01.016. PMID 18339530.
  2. ↑ Lazović B, Svenda MZ, Mazić S, Stajić Z, Delić M (2013). "Analysis of electrocardiogram in chronic obstructive pulmonary disease patients". Med Pregl. 66 (3–4): 126–9. PMID 23653989.

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