RESPI DIFFERENTIAL DX AND TESTS
13 important questions on RESPI DIFFERENTIAL DX AND TESTS
What investigations are appropriate for detecting infections like pneumonia or exacerbation of COPD?
- Chest X-ray: Consolidation in pneumonia
- O₂ saturation or ABG: Respiratory failure assessment
- Sputum and blood culture: Causal infection
- Respiratory function: COPD quantification
- WCC, CRP: Inflammation degree
What are the suggestive features on history and examination for acute bronchitis?
- History:
- Wheeze
- Cough
- Sputum
- Examination:
- Wheeze
- Hyperinflation
How is malignancy in the respiratory system assessed?
- Chest X-ray
- CT scan thorax + abdomen
- Bronchoscopy (central)
- CT-guided biopsy (peripheral)
- Respiratory function
- Masses identification
- Staging extent
- Pathology diagnosis
- Radical therapies fitness
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Describe the features of pneumonia on history and examination.
- History:
- Pleuritic pain
- Rusty sputum
- Rigors
- Examination:
- If lobar, dull to percussion
- Bronchial breathing
What are the initial investigations for pulmonary fibrosis or interstitial lung disease?
- Chest X-ray: Bi-basal reticular shadows
- High-resolution CT thorax: Extent/type of disease
- Respiratory function: Quantification, restrictive patterns
- Autoantibodies: Connective tissue disease identification
What are the suggestive features of malignancy related to respiratory problems?
- History:
- Insidious onset
- Weight loss
- Persisting pain or cough
- Examination:
- Cervical lymphadenopathy
- Clubbing
- Signs of lobar/lung collapse ± effusion
How is pleural effusion initially investigated?
- Chest X-ray
- Ultrasound-guided aspiration
- Dense basal fluid pool
- Infection culture
- Empyema pH
- Infection low glucose
- Malignancy cytology
- Transudate/exudate protein
- Underyling tumor identification
Explain the features on history and examination of pulmonary fibrosis.
- History:
- Progressive dyspnoea
- Examination:
- Tachypnoea
- Inspiratory fine crackles at bases
- Cyanosis
What diagnostic tools are used for pulmonary embolism?
- d-Dimer: Negative if no embolism
- CT pulmonary angiogram: Emboli detection
- Echocardiogram: Right ventricular strain
- O₂ saturation or ABG: Respiratory failure assessment
What are the suggestive features on history for pleural effusion?
- History:
- Progressive dyspnoea
- Examination:
- Unilateral basal dullness
- Reduced breath sounds
How is asthma evaluated in initial investigations?
- Respiratory function: Variable obstruction
- Peak flow diary
- FEV₁ reversibility: Obstruction reversibility
- O₂ saturation or ABG: Respiratory failure assessment
- IgE, allergen skin tests: Allergy stimuli detection
Describe the features of pulmonary embolism.
- History:
- Large: Sudden, severe dyspnoea
- Medium: Pleural pain, haemoptysis
- Multiple small: Progressive dyspnoea
- Examination:
- Large: Normal breath sounds
- Medium: Pleural rub, swollen leg
- Small: Raised jugular venous pressure, right ventricular heave, loud pulmonary second sound
What features are suggestive of asthma on history and examination?
- History:
- Atopy
- Hay fever
- Pet ownership
- Variable wheeze
- Disturbance of sleep
- Examination:
- Polyphonic expiratory wheeze
- Eczema
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