I need to rule out some diseases, this is for our classroom presentation.your help would be highly appreciated

2 Comments

1. orange7770 says:

   May 12, 2010 at 11:13 am

   I would start with the simple one, the upper airway obstruction and then move to other, I only know that COPD can cause those symp. I dont know what the others are though. Start simple and cheap then work your way up…
2. greg.house48 says:

   May 12, 2010 at 11:44 am

   Hey, Mike – I’ll apologize in advance for the really long response – it’s just that I sometimes miss teaching my interns, 2nd- and 3rd year residents in the Emergency Department. I tried to keep it brief, but I didn’t want to miss anything pertinent. So, anyway, here goes …

   All of these conditions need a pulse oximetry eval. and spirometry to evaluate air movement. On room air (without supplemental oxygen), pulse oximetry should be within 95%-100%, and respiratory rate should be between 10 and 16 breaths per minute – if it’s faster, your patient is having difficulty breathing. Depending on the patient’s oxygenation status, an arterial blood gas (ABG) may help to determine the severity of the gas-exchange impairment. Upper Airway Obstruction can be ruled out by either direct visualization of the airway or a plain X-ray of the soft tissues of the C-spine – this X-ray series helps visualize the airway overylying the bony spine; Plain film Chest X-ray (CXR) is also useful and relatively inexpensive; COPD and acute asthma will show hyperinflation with bilateral flattened diaphragms and decreased lung markings (COPD only); wheezes (“whistling”) on auscultation (whether expiratory or inspiratory/expiratory, depending on the degree of small airway obstruction) may be present in Acute asthma and viral bronchiolitis/bacterial bronchiolitis; Acute Bronchitis may likely show bilateral perihilar air bronchograms (thin dark lines indicating air space against thickened / inflamed tissue and / or mucus); with PTB, a PPD is necessary, even though it takes 48-72 hours for a good “read” (evaluation of response at the injection site); with established PTB, a CXR will most likely show an annular/circular density in one of the lungs’ apices (upper lobe near the clavicle), and may even show cavitary lesions; CAP and CHF will most likely show a unilateral or possible bilateral pulmonary fluid level, maybe even pleural effusions; rales (light “gurgling” sounds) or even rhonchi (deep “gurgling”, like exhaling underwater) may be heard on auscultation; a diagnosis of CHF may also be supported with an elevated BNP (B-type natriuritec peptide), although there are no globally accepted diagnostic ranges, as of yet; a dx of CAP may be supported by serial sputum cultures, and perihilar opacification and/or fluid levels may be seen on CXR, as well; if you can get a CBC (Complete Blood Count), most CAP, bronchitis (bacterial) and bronchiolitis (viral) infections will show a relatively elevated WBC (white blood cell) count. Obstructive Sleep Apnea (OSA) needs a spirometry study, CXR, and a monitored sleep study; body habitus (the size and condition of the patient’s physique) may help with OSA diagnosis, although not pathognemonic – obese / morbidly obese patient’s are prone to developing OSA (this is more incidental, but may steer you toward the diagnosis if you’ve ruled out most of the other dx’s in your differential list). Patients with OSA also typically snore heavily – very **heavily**.

   I’m sure I’ve left out a good bit of stuff, but maybe this limited list will help get you and your group started on the right foot – I truly hope so. If you find it even a bit useful, and I can be of further assistance, please feel free to email me via Yahoo Answers, OK? I hope your presentation goes well !!

   Good luck.