Respiratory System Diagnosis

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Respiratory System Diagnosis

  1. 1. RESPIRATORY DIAGNOSIS<br />DR. S. ASWINI KUMAR. MD.<br />PROFESSOR OF MEDICINE<br />THIRUVANANTHAPURAM<br />1<br />
  2. 2. List of Respiratory Diagnosis being discussed <br />Acute Rhinitis<br />Allergic Rhinitis<br />Acute Sinusitis<br />Acute Pharyngitis<br />Acute Tonsillitis<br />Acute Laryngitis<br />Acute Bronchitis<br />Chronic Bronchitis<br />COPD Emphysema<br />Bronchial Asthma<br />Lobar Pneumonia<br />Bronchopneumonia<br />Interstitial Pneumonia<br />Acute Viral Pleurisy<br /><ul><li>Pleural Effusion - Synpneumonic
  3. 3. Pleural Effusion –Tuberculous
  4. 4. Pneumothorax – Spontaneous
  5. 5. Hydro/hemo-pneumothorax
  6. 6. Tuberculosis – Cavity Upper Lobe
  7. 7. Tuberculosis – Fibrosis Upper
  8. 8. Tuberculosis - Miliary
  9. 9. Suppurative – Bronchiectasis
  10. 10. Suppurative – Lung Abscess
  11. 11. Suppurative – Empyema
  12. 12. Pulmonary Collapse
  13. 13. Pulmonary Embolism
  14. 14. Bronchogenic Carcinoma
  15. 15. Interstitial Lung Disease</li></ul>2<br />
  16. 16. Upper Respiratory Infection - Acute Rhinitis<br />Running nose<br />Sneezing <br />Nasal block<br />Low grade fever<br />Headaches<br />Dry cough<br />O/E Nasal Congestion<br />Common cold<br />Viral etiology<br />Diagnosis is clinical<br />Lasts for 7 days if untreated<br />Lasts for 1 week if treated<br />Cough may linger for 2 weeks<br /><ul><li>Symptomatic treatment
  17. 17. Steam inhalation - Conzo
  18. 18. Antipyretics - Acetaminophen
  19. 19. Antihistamines - CPM
  20. 20. Nasal decongestant - PPA
  21. 21. No antibiotics required</li></ul>3<br />
  22. 22. Upper Respiratory Affection - Allergic Rhinitis<br />Running nose<br />Sneezing<br />Nasal block<br />No fever <br />No headaches<br />Dry cough – post nasal drip<br />O/E Nasal drip and congestion<br />Exposure to allergens<br />Dust, dander, pollen, cotton<br />Sensitized immune system<br />Antibodies to allergens<br />Production of histamine<br />Diagnosis - again clinical<br /><ul><li>Symptomatic treatment
  23. 23. Steam inhalation - Karvol
  24. 24. Antipyretics – Not required
  25. 25. Antihistamines - CPM
  26. 26. Non-sedative - Cetrizine
  27. 27. Nasal sprays - Flohale</li></ul>4<br />
  28. 28. Upper Respiratory Infection - Acute Sinusitis<br />Purulent nasal discharge<br />Sneezing<br />Nasal block<br />Low grade fever<br />Headaches<br />Dry cough – post nasal drip<br />O/E Sinus tenderness<br />Secondary bacterial infection<br />Bifrontal head or facial pain<br />Early morning stooping -<br />Nasal discharge – not must<br />X-Ray PNS - Haziness<br />CT Scan PNS – Tumor if any<br /><ul><li>Antibiotics needed
  29. 29. Cap Amoxiclav 375mg TID
  30. 30. Anti-inflammatory drugs
  31. 31. Antipyretics - Acetaminophen
  32. 32. Antihistamines - CPM
  33. 33. Steam inhalation mandatory</li></ul>5<br />
  34. 34. Upper Respiratory Infection - Acute pharyngitis<br />Low grade fever<br />Throat irritation<br />Throat pain<br />Painful swallowing<br />Phlegm from throat<br />Dry cough & Headaches<br />O/E Red congested pharynx<br />Common URTI<br />Viral etiology<br />Sec. bacterial infection<br />Primary streptococcal<br />Recurrent sore throat<br />Indication or penicillin<br /><ul><li>Sips of hot liquids, Lozenges
  35. 35. Viral - Warm saline gargles
  36. 36. Bacterial - Amoxycillin 500 TID
  37. 37. Antipyretics - Acetaminophen
  38. 38. Antiinflammatory - Diclofenac
  39. 39. B complex tablets 1 OD</li></ul>6<br />
  40. 40. Upper Respiratory Infection - Acute Tonsillitis<br />Low grade fever<br />Throat irritation<br />Throat pain<br />Painful swallowing<br />Dry cough and headaches<br />Sputum from throat<br />O/E Tonsils enlarged & red<br />Bacterial infection<br />Streptococcal etiology<br />Enlarged tender cervical LNs<br />Throat swab confirmatory<br />Chronic recurrent tonsilitis<br />Indication for surgery<br /><ul><li>Cap Amoxicillin 500mg TID or
  41. 41. Tab Roxithromycin 150mg BID
  42. 42. Diclofenac 50mg BID
  43. 43. Acetaminophen 500mg TID
  44. 44. B complex tablets 1 OD
  45. 45. Betadine throat gargles</li></ul>7<br />
  46. 46. Upper Respiratory Infection - Acute Laryngitis<br />Hoarseness of voice<br />Reduction or loss of voice<br />Low grade fever, throat pain<br />Dry hawking cough<br />Attempts to speak cause pain<br />Unaccostomed overuse voice<br />Stridor in children (croup)<br />Often complicates coryza<br />Talking/teaching profession <br />Diagnosis is clinical<br />Direct visualization - No<br />Indirect laryngoscopy<br />Vocal cord inflammed<br /><ul><li>Warm saline gargles
  47. 47. Steam inhalation of value
  48. 48. Tab Diclofenac 50mg BID
  49. 49. Tab Acetaminophen 500 TID
  50. 50. Cap B complex forte 1 OD
  51. 51. Complete voice rest</li></ul>8<br />
  52. 52. Lower Respiratory Infection - Acute Bronchitis<br />Low grade fever<br />Dry irritant cough<br />Mucoid sputum  purulent<br />Retrosternal discomfort<br />Tightness of chest<br />Breathlessness and wheeze<br />O/E Bilateral rhonchi<br />Often complicates coryza<br />May supersede C/C Bronchitis <br />Diagnosis is clinical<br />Bilateral chest signs<br />Neutrophilleucocytosis<br />CXR Not necessary for <br /><ul><li>Cap Amoxycillin 500mg TID
  53. 53. Tab Acetaminophen 500 TID
  54. 54. Tab Deriphyllin100mg TID
  55. 55. Steam inhalation twice daily
  56. 56. Cap B Complex forte OD
  57. 57. SypLinctusCodiene 1 tsp TID</li></ul>9<br />
  58. 58. COPD - Chronic Bronchitis<br />Chronic cough<br />Male smoker<br />Cough &gt; 3 months<br />For &gt; 2 consecutive years<br />Mucoid sputum most of times<br />Turning purulent at times<br />Breathlessness at rest<br />Obese male smoker<br />“Blue blotters”<br />Bilateral pitting edema<br />No mediastinal shift<br />Chest – Bilateral rhonchi<br />Few crepitationsoccassionaly<br /><ul><li>STOP Smoking
  59. 59. Short acting B2 agonists
  60. 60. Long acting B2 agonists
  61. 61. Anticholinergic drugs
  62. 62. Xanthine derivatives
  63. 63. Inhaled corticosteroids by MDI</li></ul>10<br />
  64. 64. COPD - Emphysema<br />Chronic dyspnoea &gt; cough<br />Male smoker may be<br />Always symptomatic<br />Frequent exacerbations<br />Breathlessness at rest<br />Mucoid sputum<br />O/E Chest emphysematous<br />Lean habitus male or female<br />“Pink puffer”<br />Expansion grossly educed<br />Silent chest late in the course<br />Chest X-Ray Elongated chest<br />CT Chest – Dilated alveoli<br /><ul><li>Initial treatment same C/c B
  65. 65. Treat acute exacerbation
  66. 66. Appropriate antibiotics
  67. 67. Increased dose of drugs
  68. 68. Short course oral steroids
  69. 69. Nebulization with salbutamol</li></ul>11<br />
  70. 70. COPD – Chronic Bronchial Asthma<br />Chronic history<br />Childhood onset<br />Sex irrespective<br />Cough and wheezing<br />Breathlessness at rest<br />Seasonal/tidal variation<br />Symptom free intervals<br />Diagnosis clinical<br />History of allergy or atopy<br />Allergiic rhinitis or drug allergy<br />Eczematoid dermatitis ankles<br />Wheezing and rhonchi<br />Response to B agonists<br /><ul><li>Xanthines
  71. 71. Beta agonists
  72. 72. Corticosteroids
  73. 73. Rotacap devices
  74. 74. Metered dose inhalers
  75. 75. Nebulization in hospital</li></ul>12<br />
  76. 76. LRTI - Lobar Pneumonia<br />Acute onset of fever<br />High grade continuous <br />Chills and rigor characteristic<br />Initial pleuritic chest pain<br />Dry cough initially<br />Expectorate mucoid sputum<br />Rusty sputum/hemoptysis<br />Dramatic presentation<br />Febrile patient<br />Tachycardia & Tachypnoea<br />Unilateral localized lung signs<br />CXR Homogenous opacity<br />Sputum Gram stain culture<br /><ul><li>Hospitalization if indicated
  77. 77. Temp. Pulse, BP monitoring
  78. 78. Inj. Benzyl Penicillin 10L IVQ6
  79. 79. Tab.Clarithromycin 500mg BID
  80. 80. Tab Azithromycin 500mg BID
  81. 81. Tab Levofloxacin 500mg BID</li></ul>13<br />
  82. 82. LRTI - Brochopneumonia<br />Acute onset of fever<br />High grade continuous <br />Chills and rigor not much<br />More dyspnoeic than lobar<br />Initial pleuritic chest pain<br />Expectorate mucoid sputum<br />O/E Bilateral lung signs<br />Dramatic presentation<br />Febrile patient<br />Tachycardia and Tachypnoea<br />Bilateral difuse lung signs<br />Viral or tuberculous etiology<br />Stapylococcalpneumatoceles<br /><ul><li>Hospitalization indicated
  83. 83. ICU admission required
  84. 84. Temp. Pulse, BP monitoring
  85. 85. Inj. Amoxiclav 500mg TID
  86. 86. Tab Levofloxacin 500mg BID
  87. 87. Watch for complication ARDS</li></ul>14<br />
  88. 88. LRTI - Interstitial Pneumonia<br />Subacute onset of fever<br />Low grade continuous <br />No chills and rigor <br />Initial pleuritic chest pain<br />Dry cough initially<br />Expectoration mucoid<br />Rusty sputum/hemoptysis<br />Non-dramatic presentation<br />Afebrile patient<br />Tachycardia & Tachypnoea<br />Bilateral and diffuse lung signs<br />CXR Reticulonodular shadows<br />Viral or mycoplasma etiology<br /><ul><li>Hospitalization is a must
  89. 89. Often life threatening illness
  90. 90. Intensive medical care
  91. 91. Inj Methyl Prednisolone 0.5g
  92. 92. Tab.Clarithromycin 500mg BID
  93. 93. Tab Levofloxacin 500mg BID</li></ul>15<br />
  94. 94. Acute Pleurisy<br />Acute onset fever<br />Low grade continuous <br />No Chills and rigor <br />Typical pleuritic chest pain<br />Continuing pain<br />Dry cough initially<br />No progressive dyspnoea<br />Acute presentation<br />Viral etiology – Coxackie B<br />Bornholm’s disease<br />Plain pleurisy, no effusion<br />U/L pleural rub diagnostic<br />Chest Xray may be normal<br /><ul><li>OP treatment
  95. 95. Antibiotics not needed
  96. 96. Analgesics needed
  97. 97. Acetaminophen high dose
  98. 98. Splinting of the chest
  99. 99. Watch for complications</li></ul>16<br />
  100. 100. Syn-pneumonic Pleural Effusion<br />Acute onset of fever<br />High grade continuous <br />Chills and rigor characteristic<br />Pleuritic chest pain<br />Dry cough without dyspnoea<br />Later progressive dyspnoea<br />Evolves over few days<br />Dramatic presentation again<br />Febrile and toxic patient<br />Delayed progressive dyspnea<br />Tachycardia and tachypnoea<br />Mediastinal shift  opposite<br />Unilateral localized lung signs<br /><ul><li>Hospitalization if indicated
  101. 101. Temp. Pulse BP monitoring
  102. 102. Inj. Benzyl Penicillin 10L IVQ6
  103. 103. Tab.Clarithromycin 500mg BID
  104. 104. Therapeutic aspiration
  105. 105. Chest tube drainage</li></ul>17<br />
  106. 106. Tuberculous Pleural Effusion<br />Low grade fever<br />Evening rise of temperature<br />Dry non-productive cough<br />Pleuritic chest pain<br />Slowly progressive dyspnoea<br />Evolves over 3-4 weeks<br />Even asymptomatic<br />Non-dramatic presentation<br />Febrile and ill looking patient<br />Usually a uncontrolled diabetic <br />History of contact with PTB<br />Spread from underlying focus<br />Pleural fluid study diagnostic<br /><ul><li>Hospitalization if indicated
  107. 107. Therapeutic aspiration
  108. 108. Anti-tuberculous treatment
  109. 109. Corticosteroid - Prednisolone
  110. 110. Respiratory physiotherapy
  111. 111. Watch for complications</li></ul>18<br />
  112. 112. Pneumothorax<br />Pleuritic chest pain<br />Acute onset dyspnoea<br />Steadily progressive in nature<br />Dry non-productive cough<br />Feeling - something giving way<br />Fever not likely to occur<br />Even partial and asymptomatic<br />Dramatic presentation<br />Afebrile but acutely dyspnoeic<br />Percussion diagnostic<br />Immediate DD Acute LVF<br />History of previous PTB<br />Chest X-Ray diagnostic<br /><ul><li>Hospitalization indicated
  113. 113. Therapeutic aspiration
  114. 114. Closed pleural aspiration
  115. 115. Intercostal tube drain
  116. 116. Anti-tuberculous treatment
  117. 117. Watch for complications</li></ul>19<br />
  118. 118. Hydro-Pneumothorax<br />Pleuritic chest pain<br />Subacute onset dyspnoea<br />Steadily progressive in nature<br />Dry non-productive cough<br />Fever likely but low grade<br />Rupture Pul lesion, aspiration<br />H/o L Abscess, Br Ca, trauma <br />Febrile not acutely dyspnoeic<br />Horizontal upper level dullness<br />Shifting dullness, S splash<br />History of previous PTB<br />CXR Horizontal upper level<br />Pleural fluid study diagnostic<br /><ul><li>Hospitalization indicated
  119. 119. Therapeutic aspiration
  120. 120. Intercostal tube drain
  121. 121. Mediciser breath exercises
  122. 122. Antibiotics needed
  123. 123. Anti-tuberculous treatment</li></ul>20<br />
  124. 124. Tuberculosis – Cavity upper lobe<br />Subacute onset<br />Low grade fever<br />Evening rise of temperature<br />Dry non-productive cough<br />Mucoid sputum - small amount<br />Blood stained or Hemoptysis<br />Loss of appetite and weight<br />Low profile presentation<br />Febrile but not acutely ill<br />Usually a uncontrolled diabetic <br />History of contact with PTB<br />+veMx and +ve Sputum<br />X-Ray chest with cavity AFL<br /><ul><li>Hospitalization not indicated
  125. 125. Confirmation of Diagnosis
  126. 126. Anti-tuberculous treatment
  127. 127. Register in RNTCP
  128. 128. Administer Category 1 ATT
  129. 129. Review with Sputum AFB</li></ul>21<br />Isoniazid<br />Pyrazinamide<br />Ethambutol<br />Rifampicin<br />
  130. 130. Tuberculosis - Fibrosis Upper Lobe<br />Subacute onset<br />Low grade fever<br />Evening rise of temperature<br />Dry non-productive cough<br />Mucoid sputum - small amount<br />Blood stained or Hemoptysis<br />Dyspnoea if massive fibrosis<br />Low profile presentation<br />Febrile but not acutely <br />Usually a uncontrolled diabetic <br />History of contact with PTB<br />+veMx and +ve Sputum<br />X-Ray chest with cavity AFL<br /><ul><li>Hospitalization indicated
  131. 131. Therapeutic aspiration
  132. 132. Intercostal tube drain
  133. 133. Mediciser breath exercises
  134. 134. Antibiotics needed
  135. 135. Anti-tuberculous treatment</li></ul>22<br />
  136. 136. Tuberculosis - Miliary<br />Subacute onset<br />Low grade fever<br />Evening rise of temperature<br />Dry non-productive cough<br />Mucoid sputum - small amount<br />Blood stained or Hemoptysis<br />Loss of appetite and weight<br />Low profile presentation<br />Febrile and acutely ill looking<br />Usually a uncontrolled diabetic <br />History of contact with PTB<br />-veMx and +ve Sputum<br />X-Ray chest - miliary mottling<br /><ul><li>Hospitalization indicated
  137. 137. Life threatening illness
  138. 138. Intensive medical care needed
  139. 139. Anti-tuberculous treatment
  140. 140. Corticosteroids
  141. 141. Anti-tuberculous treatment</li></ul>23<br />
  142. 142. Suppurative Lung Disease - Bronchiectasis<br />Subacute onset chronic course<br />Low grade fever and ill health<br />Expectoration purulent sputum<br />Foul smelling large quantity<br />Postural variation in quantity<br />Blood stained or Hemoptysis<br />Loss of appetite and weight<br />Low profile presentation<br />Febrile but not acutely <br />History of measles / W cough<br />History of contact with PTB<br />Coarse leathery crepirations<br />HRCT – Gold standard<br /><ul><li>Hospitalization not required
  143. 143. Steam inhalation
  144. 144. Lung physiotherapy
  145. 145. Postural drainage
  146. 146. Appropriate Antibiotics needed
  147. 147. As per culture reports obtained</li></ul>24<br />
  148. 148. Suppurative Lung Disease – Lung Abscess<br />Acute onset <br />High grade fever and ill health<br />Expectoration purulent sputum<br />Foul smelling large quantity<br />Postural variation in quantity<br />Blood stained or Hemoptysis<br />Not if not communicating<br />High profile presentation<br />Febrile and acutely ill toxic<br />H/o unresolved pneumonia<br />H/o foreign body aspiration<br />Variable physical signs<br />CXR and CT chest diagnostic<br /><ul><li>Hospitalization
  149. 149. Steam inhalation
  150. 150. Lung physiotherapy
  151. 151. Postural drainage
  152. 152. Appropriate Antibiotics needed
  153. 153. As per culture reports obtained</li></ul>25<br />
  154. 154. Suppurative Lung Disease – Empyema<br />History similar to effusion <br />But more acute onset <br />High grade fever and ill health<br />If communicating to bronchus<br />Expectoration purulent sputum<br />Foul smelling large quantity<br />Postural variation in quantity<br />Picture-Synpneumonic effusion<br />Febrile and acutely ill toxic<br />History unresolved pneumonia<br />Diabetes, lung abscess, PTB<br />Intercostal edema / tenderness<br />CXR and CT chest diagnostic<br /><ul><li>Hospitalization required
  155. 155. Intercostal tube drainage
  156. 156. Under water seal ensured
  157. 157. Appropriate Antibiotics needed
  158. 158. As per culture reports obtained
  159. 159. Decortication of the pleura</li></ul>26<br />
  160. 160. Pulmonary Collapse - Atelectasis<br />History insignificant <br />May be foreign body<br />No fever or cough<br />Chest discomfort on side<br />Breathlessness if severe<br />Expectoration minimal<br />Loss of appetite and weight<br />High index of suspicion<br />Foreign body aspiration<br />Feature of lung mass<br />Features of volume loss<br />CXR diagnostic<br />CT Scan mandatory<br /><ul><li>Encourage Coughing
  161. 161. Lung physiotherapy/suction
  162. 162. Bronchoscopic aspiration
  163. 163. Foreign body/mass removal
  164. 164. Continuous positive pressure
  165. 165. Mechanical ventilation</li></ul>27<br />
  166. 166. Pulmonary Embolism Infarction<br />Difficulty in breathing<br />Pain or discomfort in chest<br />Cough and hemoptysis<br />Sudden collapse or death<br />Background venous thrombus<br />Prolonged bed rest / coma<br />O/E Tachypnoea Tachycardia<br />Typical clinical presentation<br />Need - high index of suspicion <br />S1 Q3 T3 in ECG may be clue<br />D Dimer test only to exclude <br />CXR and CT chest diagnostic<br />Gold standard - Angiography<br /><ul><li>Anticoagulant medication
  167. 167. Inj. Heparin or Warfarin
  168. 168. Thrombolyitic Therapy
  169. 169. Inferior venacaval Filter
  170. 170. Pulmonary Thrombectomy
  171. 171. Prevention is better than cure</li></ul>28<br />
  172. 172. Bronchogenic Carcinoma<br />Chronic dry cough <br />Blood tinge or hemoptysis<br />Dysphonia and dysphagia<br />Loss of appetite and weight<br />Collapse consolidation / mass<br />Paraneoplastic manifestations<br />Presentation with secondaries<br />Subacute illness male smoker <br />Ill looking emaciation L nodes<br />Horners / Brachial Neuralgia<br />CXR – Obvious mass/widening<br />Atelectsis/consolidation/LNs<br />CT Chest and guided biopsy<br /><ul><li>SCLC respond chemotherapy
  173. 173. Brachitherapy /radiotherapy
  174. 174. SCLC -Cisplatin and Etoposide
  175. 175. NSCLC respond to surgery
  176. 176. Wedge or segment resection
  177. 177. Lobectomy or Pneumonectomy</li></ul>29<br />
  178. 178. Interstitial Lung Disease<br />Chronic disabling dyspnoea<br />Low grade fever & hemoptysis<br />Exposure to organic/inorganic<br />Underlying Connective Tissue <br />Current & previous medication<br />Infection or malignancy related<br />O/E Diffuse Parenchymal LD<br />Prolonged disabling illness<br />Underlying cause determined<br />CXR – suggest not diagnostic<br />PFT – Restrictive pattern<br />HRCT usually diagnostic<br />Lung biopsy to exclude cancer<br /><ul><li>Different Pathological causes
  179. 179. Different for each disease
  180. 180. Avoid occupational exposure
  181. 181. Corticosteroids Prednisolone
  182. 182. Immunosuppressant drugs
  183. 183. Hypoxemia - Supplement O2</li></ul>30<br />
  184. 184. Summary<br />31<br />
  185. 185. Thank You<br />32<br />

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