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Symptoms and Sign – Differential Diagnosis Costochondritis
• Cardiovascular disease
• Cervical disk syndrome
• GI disease
• Osteoarthritis
• Pulmonary disease
• Tietze’s syndrome
• Cardiovascular disease
• Cervical disk syndrome
• GI disease
• Osteoarthritis
• Pulmonary disease
• Tietze’s syndrome
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Symptoms and Sign – Differential Diagnosis of Cough
• “Smoker’s cough”
• Anxiety
• Asthma
• Bronchiectasis
• Cardiac (congestive heart failure, pulmonary edema, mitral stenosis, pericardial inflammation)
• Cystic fibrosis
• Drug induced (especially angiotensin-converting enzyme [ACE] inhibitors, b-blockers)
• Exposure to irritants (noxious fumes, smoke, cold air)
• Gastroesophageal reflux disease (GERD)
• Infectious process (viral, bacterial)
• Inflammation of larynx, pleura, diaphragm, mediastinum
• Interstitial lung disease
• Lung neoplasms
• Lymphomas, mediastinal neoplasms
• Other: pulmonary embolism, foreign body inhalation, aortic aneurysm, Zenker’s diverticulum, osteophytes, substernal thyroid, thyroiditis, polymyalgia rheumatica (PMR)
• Postinfectious
• Recurrent aspiration
• Rhinitis (allergic, vasomotor, postinfectious)
• “Smoker’s cough”
• Anxiety
• Asthma
• Bronchiectasis
• Cardiac (congestive heart failure, pulmonary edema, mitral stenosis, pericardial inflammation)
• Cystic fibrosis
• Drug induced (especially angiotensin-converting enzyme [ACE] inhibitors, b-blockers)
• Exposure to irritants (noxious fumes, smoke, cold air)
• Gastroesophageal reflux disease (GERD)
• Infectious process (viral, bacterial)
• Inflammation of larynx, pleura, diaphragm, mediastinum
• Interstitial lung disease
• Lung neoplasms
• Lymphomas, mediastinal neoplasms
• Other: pulmonary embolism, foreign body inhalation, aortic aneurysm, Zenker’s diverticulum, osteophytes, substernal thyroid, thyroiditis, polymyalgia rheumatica (PMR)
• Postinfectious
• Recurrent aspiration
• Rhinitis (allergic, vasomotor, postinfectious)
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Symptoms and Sign – Differential Diagnosis of Craniopharyngioma
• Cerebral aneurysm
• Empty sella syndrome
• Metastatic brain tumors
• Other brain tumors
• Pituitary adenoma
• Pituitary failure of any cause
• Primary brain tumors (e.g., meningiomas, astrocytomas)
• Cerebral aneurysm
• Empty sella syndrome
• Metastatic brain tumors
• Other brain tumors
• Pituitary adenoma
• Pituitary failure of any cause
• Primary brain tumors (e.g., meningiomas, astrocytomas)
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Symptoms and Sign – Differential Diagnosis of Creutzfeldt-Jakob Disease
• Alzheimer’s disease
• Frontotemporal dementia
• Lewy body disease
• Others (hydrocephalus, infectious, vitamin deficiency, endocrine)
• Vascular dementia
• Alzheimer’s disease
• Frontotemporal dementia
• Lewy body disease
• Others (hydrocephalus, infectious, vitamin deficiency, endocrine)
• Vascular dementia
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Pathology - Congenital Pyloric Stenosis
This is a congenital anomaly that follows a multifactorial inheritance pattern. It is frequently linked to Turner syndrome or polyhydramnios.
Exhibits a higher prevalence in males compared to females.
Pylorus: Enlargement and increased cell growth of the muscle layer
Onset of projectile vomiting commencing at 2 weeks of age.
A physical examination reveals a palpable lump resembling an olive in the upper abdominal region.
Treatment involves performing a surgical procedure to make an incision in the enlarged muscle (myotomy).
Diaphragmatic hernia refers to the underdeveloped diaphragm, which leads to the protrusion of abdominal contents through the malformed diaphragm. This compression affects the growth of lung buds, resulting in pulmonary hypoplasia. The clinical presentation includes dyspnea. The newborn exhibits cyanosis and an abnormally flat belly. Surgical intervention can rectify this condition.
This is a congenital anomaly that follows a multifactorial inheritance pattern. It is frequently linked to Turner syndrome or polyhydramnios.
Exhibits a higher prevalence in males compared to females.
Pylorus: Enlargement and increased cell growth of the muscle layer
Onset of projectile vomiting commencing at 2 weeks of age.
A physical examination reveals a palpable lump resembling an olive in the upper abdominal region.
Treatment involves performing a surgical procedure to make an incision in the enlarged muscle (myotomy).
Diaphragmatic hernia refers to the underdeveloped diaphragm, which leads to the protrusion of abdominal contents through the malformed diaphragm. This compression affects the growth of lung buds, resulting in pulmonary hypoplasia. The clinical presentation includes dyspnea. The newborn exhibits cyanosis and an abnormally flat belly. Surgical intervention can rectify this condition.
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Pathology - Atypical Pneumonia
Mycoplasma pneumonia; influenza, rhinovirus, and adenovirus infections: The organisms mentioned are Chlamydia psittaci and Coxiella burnetii. Legionella pneumophila
Lung: Frequently involving multiple lobes: characterized by scattered infiltration of mononuclear inflammatory exudate inside the walls of the alveoli; it is possible to observe pink hyaline membranes lining the alveoli.
Symptoms and signs
Symptoms of malaise include fever and muscle aches. The clinical presentation of malaise, including occasional cough, is generally milder compared to bacterial pneumonias.
Imaging: Chest X-ray shows irregular areas of infiltration.
Laboratory results: Abnormally high white blood cell count. Increased amounts of cold agglutinins in Mycoplasma pneumoniae infection.
Therapy
Treatment with antibiotics involves providing supportive care.
Pneumocystis carinii pneumonia (PCP) is the predominant opportunistic illness observed in individuals with AIDS. The condition has an interstitial pattern of lung disease and can be diagnosed with the use of a silver stain on a bronchial lavage sample.
Cryptogenic organizing pneumonia can occur following atypical pneumonias or exposure to toxins through inhalation. The patient exhibits symptoms such as weight loss, fever, cough, hypoxemia, and dyspnea. The chest X-ray reveals scattered infiltration that resembles atypical pneumonias. The treatment involves the administration of steroids or cyclophosphamide if steroids prove to be unsuccessful.
Mycoplasma pneumonia; influenza, rhinovirus, and adenovirus infections: The organisms mentioned are Chlamydia psittaci and Coxiella burnetii. Legionella pneumophila
Lung: Frequently involving multiple lobes: characterized by scattered infiltration of mononuclear inflammatory exudate inside the walls of the alveoli; it is possible to observe pink hyaline membranes lining the alveoli.
Symptoms and signs
Symptoms of malaise include fever and muscle aches. The clinical presentation of malaise, including occasional cough, is generally milder compared to bacterial pneumonias.
Imaging: Chest X-ray shows irregular areas of infiltration.
Laboratory results: Abnormally high white blood cell count. Increased amounts of cold agglutinins in Mycoplasma pneumoniae infection.
Therapy
Treatment with antibiotics involves providing supportive care.
Pneumocystis carinii pneumonia (PCP) is the predominant opportunistic illness observed in individuals with AIDS. The condition has an interstitial pattern of lung disease and can be diagnosed with the use of a silver stain on a bronchial lavage sample.
Cryptogenic organizing pneumonia can occur following atypical pneumonias or exposure to toxins through inhalation. The patient exhibits symptoms such as weight loss, fever, cough, hypoxemia, and dyspnea. The chest X-ray reveals scattered infiltration that resembles atypical pneumonias. The treatment involves the administration of steroids or cyclophosphamide if steroids prove to be unsuccessful.
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Pathology - Tuberculosis
inhalation of mycobacterium tuberculosis-containing droplets
Pathophysiology: Alveolar macrophages phagocytose tuberculosis (TB) bacilli. triggering an immunological response mediated by T cells. The majority of bacilli are destroyed by macrophages and T lymphocytes, but some remain and lie latent in the Ghon complex (primary TB). The activation of these organisms occurs through immunosuppression or reinfection (secondary TB).Meningitis and Pott disease of the spine are examples of extrapulmonary TB symptoms. Tuberculosis (TB) can also spread through lymphatics or blood, resulting in miliary TB, or the seeding of distal organs.
First-line TB: Ghon complex: increased caseous hilar vmph nodes (calcified lesion in upper half of lower lobe).
Secondary tuberculosis (TB): Caseating granuloma composed of epithelioid cells; tubercle development (cavitary lesion) at lung apex or hilar lymph nodes. Giant cells and fibroblasts
While secondary TB causes constitutive symptoms such fatigue, weight loss, and fever, primary TB is asymptomatic. along with a productive cough and hemoptysis Lab results: Sputum with acid-fast bacilli, calcified Ghon complex on CXR, and positive PPD test that was validated by culture.
Treatment
Four-drug TB regimen: ethambutol/streptomycin, pyrazinamide, rifampin, and INH; add two more medications at a time if the strains are resistant to the first two.
PPD test: Indicates post-primary tuberculosis delayed hypersensitivity.
inhalation of mycobacterium tuberculosis-containing droplets
Pathophysiology: Alveolar macrophages phagocytose tuberculosis (TB) bacilli. triggering an immunological response mediated by T cells. The majority of bacilli are destroyed by macrophages and T lymphocytes, but some remain and lie latent in the Ghon complex (primary TB). The activation of these organisms occurs through immunosuppression or reinfection (secondary TB).Meningitis and Pott disease of the spine are examples of extrapulmonary TB symptoms. Tuberculosis (TB) can also spread through lymphatics or blood, resulting in miliary TB, or the seeding of distal organs.
First-line TB: Ghon complex: increased caseous hilar vmph nodes (calcified lesion in upper half of lower lobe).
Secondary tuberculosis (TB): Caseating granuloma composed of epithelioid cells; tubercle development (cavitary lesion) at lung apex or hilar lymph nodes. Giant cells and fibroblasts
While secondary TB causes constitutive symptoms such fatigue, weight loss, and fever, primary TB is asymptomatic. along with a productive cough and hemoptysis Lab results: Sputum with acid-fast bacilli, calcified Ghon complex on CXR, and positive PPD test that was validated by culture.
Treatment
Four-drug TB regimen: ethambutol/streptomycin, pyrazinamide, rifampin, and INH; add two more medications at a time if the strains are resistant to the first two.
PPD test: Indicates post-primary tuberculosis delayed hypersensitivity.
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Pathology - Bronchogenic Carcinoma
Smoking cigarettes (particularly associated with small and squamous cell carcinomas); air pollution; ionizing radiation; asbestos; nickel; exposure to chromium
Squamous cell: Squamous cells are centralized, have a hilar mass that is cavitated, and become keratinized.
Adenocarcinoma: Found in the periphery, comes in two varieties: First, bronchial derived: forms on glandular elements with mucin cells at the scar site; second, bronchioalveolar: many mucinous nodules (that show up on CXR) and tall columnar epithelial cells lining the alveolar walls
tiny cell: located in the center; these are spherical, basophilic, and low in cytoplasm cells (oat cell is a neoplasm of neuroendocrine Kulchitsky cells).
Large cell: Large polygonal undifferentiated cells (pleomorphic gigantic cells with pieces of leukocytes) located in the periphery within the cytoplasm.
Often, all forms of metastases affect the adrenal glands, brain, liver, and bones.
Compared to primary lung cancer, metastases of other malignancies to the lung are more frequent and can occur hematogenously through lymphatics or contiguous growth.
Lung cancerous tumors can also arise.
Clinical Signs and Symptoms
symptoms include hemoptysis, dyspnea, coughing, weight loss, pleural effusion (typically bloody), and hoarseness due to paralysis of the recurrent laryngeal nerve.
Pancoast tumor: Apical lung tumor that involves the cervical sympathetic plexus and causes Horner syndrome (ptosis, miosis, and anhidrosis).
Superior vena cava syndrome: Tumor compression of the SVC causes facial edema and dilated veins in the head and upper extremities.
Small cell carcinoma is associated with Cushing syndrome (induced by the synthesis of ACTH-like proteins), SIADH (caused by the production of ADH-like proteins), and Lambert-Eaton Syndrome (mvastenia gravis-like sickness resulting from a deficiency in acetyicholine release).
Visualization: Pneumonic coin lesion seen in CXR
Results from the lab: PTH-like protein synthesis results in hypercalcemia, which is observed in squamous cell cancer.
Treatment
For non-small cell lung cancer, surgery, radiation, and chemotherapy are used; for small cell carcinoma, radiation and chemotherapy are used.
The 5-year survival rate is 10%–15% overall.
Smoking cigarettes (particularly associated with small and squamous cell carcinomas); air pollution; ionizing radiation; asbestos; nickel; exposure to chromium
Squamous cell: Squamous cells are centralized, have a hilar mass that is cavitated, and become keratinized.
Adenocarcinoma: Found in the periphery, comes in two varieties: First, bronchial derived: forms on glandular elements with mucin cells at the scar site; second, bronchioalveolar: many mucinous nodules (that show up on CXR) and tall columnar epithelial cells lining the alveolar walls
tiny cell: located in the center; these are spherical, basophilic, and low in cytoplasm cells (oat cell is a neoplasm of neuroendocrine Kulchitsky cells).
Large cell: Large polygonal undifferentiated cells (pleomorphic gigantic cells with pieces of leukocytes) located in the periphery within the cytoplasm.
Often, all forms of metastases affect the adrenal glands, brain, liver, and bones.
Compared to primary lung cancer, metastases of other malignancies to the lung are more frequent and can occur hematogenously through lymphatics or contiguous growth.
Lung cancerous tumors can also arise.
Clinical Signs and Symptoms
symptoms include hemoptysis, dyspnea, coughing, weight loss, pleural effusion (typically bloody), and hoarseness due to paralysis of the recurrent laryngeal nerve.
Pancoast tumor: Apical lung tumor that involves the cervical sympathetic plexus and causes Horner syndrome (ptosis, miosis, and anhidrosis).
Superior vena cava syndrome: Tumor compression of the SVC causes facial edema and dilated veins in the head and upper extremities.
Small cell carcinoma is associated with Cushing syndrome (induced by the synthesis of ACTH-like proteins), SIADH (caused by the production of ADH-like proteins), and Lambert-Eaton Syndrome (mvastenia gravis-like sickness resulting from a deficiency in acetyicholine release).
Visualization: Pneumonic coin lesion seen in CXR
Results from the lab: PTH-like protein synthesis results in hypercalcemia, which is observed in squamous cell cancer.
Treatment
For non-small cell lung cancer, surgery, radiation, and chemotherapy are used; for small cell carcinoma, radiation and chemotherapy are used.
The 5-year survival rate is 10%–15% overall.
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Pathology - Pneumothorax
Etiology
Primary spontaneous: Blunt or penetrating trauma resulting in subpleural bleb rupture
A secondary spontaneous complication (PCP, TB, CF, COPD) is a result of an earlier lung disease.
Tension lung infection; positive-pressure mechanical ventilation
The majority of spontaneous pneumothorax cases are in tall, skinny males who smoke.
Air in the pleural space causes the lung to compress and collapse.
Patients arrive with hypoxia, dyspnea, and chest pain.
Reduced breath sounds, less tactile fremitus, and lung hyperresonance to percussion on the pneumothorax side are all seen on physical examination.
Imaging features include deep sulcus sign (abnormally radiolucent costophrenic sulcus) on supine CXR, visceral pleural line on upright CXR, and tracheal deviation away from the side of the pneumothorax.
Handling
Aspiration needles or chest tubes to drain pleural air; oxygen; stopping smoking; and, if necessary, surgical bleb resection to avoid future recurrence
In addition to air, other substances that can fill the pleural space include lymphatic fluid (chylothorax), inflammatory exudate (empyema), blood (hemothorax), and serous fluid (hydrothorax).
To reduce respiratory distress, these fluids might need to be emptied and the triggering circumstances addressed.
Etiology
Primary spontaneous: Blunt or penetrating trauma resulting in subpleural bleb rupture
A secondary spontaneous complication (PCP, TB, CF, COPD) is a result of an earlier lung disease.
Tension lung infection; positive-pressure mechanical ventilation
The majority of spontaneous pneumothorax cases are in tall, skinny males who smoke.
Air in the pleural space causes the lung to compress and collapse.
Patients arrive with hypoxia, dyspnea, and chest pain.
Reduced breath sounds, less tactile fremitus, and lung hyperresonance to percussion on the pneumothorax side are all seen on physical examination.
Imaging features include deep sulcus sign (abnormally radiolucent costophrenic sulcus) on supine CXR, visceral pleural line on upright CXR, and tracheal deviation away from the side of the pneumothorax.
Handling
Aspiration needles or chest tubes to drain pleural air; oxygen; stopping smoking; and, if necessary, surgical bleb resection to avoid future recurrence
In addition to air, other substances that can fill the pleural space include lymphatic fluid (chylothorax), inflammatory exudate (empyema), blood (hemothorax), and serous fluid (hydrothorax).
To reduce respiratory distress, these fluids might need to be emptied and the triggering circumstances addressed.
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Pathology - Obstructive Sleep Apnea
Obesity, hypothyroidism, cigarette smoking, and hypertension are all risk factors.
Primarily afflicts males in their middle age.
The lack of normal pharyngeal muscular tone causes the pharynx to collapse during inhaling, leading to a blockage in the upper airway during sleep.
Medical Presentation
Davtime sleepiness and cognitive impairment are characterized by the occurrence of thrashing movements and loud snoring during sleep.
Complications encompass pulmonary hypertension accompanied by right heart failure, systemic hypertension, and cardiac arrhythmias.
Laboratory results: Episodes of apnea observed during the sleep study (polysomnogram), accompanied by an increase in red blood cell count (erythrocytosis).
Treatment options include weight loss, continuous positive airway pressure (CPAP), and surgical removal of pharyngeal soft tissue (uvulopalatopharyngoplasty) in some situations.
Central sleep apnea occurs when breathing is disrupted due to a lack of effort.
Obesity, hypothyroidism, cigarette smoking, and hypertension are all risk factors.
Primarily afflicts males in their middle age.
The lack of normal pharyngeal muscular tone causes the pharynx to collapse during inhaling, leading to a blockage in the upper airway during sleep.
Medical Presentation
Davtime sleepiness and cognitive impairment are characterized by the occurrence of thrashing movements and loud snoring during sleep.
Complications encompass pulmonary hypertension accompanied by right heart failure, systemic hypertension, and cardiac arrhythmias.
Laboratory results: Episodes of apnea observed during the sleep study (polysomnogram), accompanied by an increase in red blood cell count (erythrocytosis).
Treatment options include weight loss, continuous positive airway pressure (CPAP), and surgical removal of pharyngeal soft tissue (uvulopalatopharyngoplasty) in some situations.
Central sleep apnea occurs when breathing is disrupted due to a lack of effort.
