DIFFERENTIAL ASTHMA COPD PNEUMONIA PNEUMOTHORAX

DIAGNOSIS
CLINICAL • Dyspnoea • Progressive • Fever with • Sudden
FEATURES varies within and persistent chills and dyspnea
hours to days dyspnea rigors • Dry cough
• Wheezing • Chronic • Productive • Cyanosis
• Chest tightness productive cough • Chest
• Nocturnal cough • Dyspnea tightness/
cough • History of • Pleuritic chest pain
• Family history smoking chest pain
of atopy • Wheeze
• Aggravated by
cold air,
exercise and
allergens

EXAMINATION • Decreased • Pursed lips • Reduced • Asymmetrical

FINDINGS chest breathing chest chest wall
expansion • Central expansion movement
symmetrically cyanosis on affected • Tracheal
• Prolonged • Accessory site deviation away
expiratory muscle usage • Dull on from the
phase • Barrel chest percussion affected side
• Rhonchi • Flapping • Increased • Reduced chest
• Hyperinflated tremor vocal expansion on
chest • Reduced chest resonance affected site
expansion • Bronchial • Hyperresonanc
• Reduced air breath e
entry sounds • Tachycardia
• Hyperresonanc • Bi-basal • dyspnea
e /Resonance Crepitations • Cyanosis
• Rhonchi

INVESTIGATIO • ABG : • ABG • CXR : shows • CXR : shows

N decreased • ECG consolidatio hyperlucency,
PaCO2 and • Spirometry n loss of lung
PaO2 (FEV/FVC <0.7) (heterogeno markings,
• PEFR (<33%) • CXR : shows us opacity) mediastinal
• CXR : shows hyperinflated • Sputum shift away
hyperinflated lungs with culture from the
lungs flattening of affected side,
diaphragm, depressed
hyperlucency diaphragm
MANAGEMENT • Oxygen • Oxygen • Oxygen • Chest tube
• Bronchodilators • Nebulized therapy insertion
• Corticosteroids bronchodilator • Antibiotics • Immediate
s needle
• Systemic compression
steroids for tension
pneumothorax

DIFFERENTIAL HEART FAILURE PULMONARY PLEURAL DKA

DIAGNOSIS EMBOLISM EFFUSION
CLINICAL • Exertional • Acute • Pleuritic chest • Type 1 DM
FEATURES dyspnea breathlessness pain • Hyperventilation
• Orthopnea • Pleuritic chest • Dyspnea with ketone
• PND pain • Cough breath
• Bilateral lower • Hemoptysis • Polyuria,
limb swelling • Syncope polydipsia,
• Fatigue nocturia
• Vomiting
• Abdominal pain
• Blurred vision
• Dehydration
• Drowsiness

EXAMINATION • Elevated JVP • Tachypnea • Reduced chest • Signs of

FINDINGS • Bilateral pitting • Tachycardia expansion dehydration
edema • Hypotension • Stony dull • Hypotension
• Ascites • Cyanosis percussion • Tachycardia
• Hepatomegaly • Pleural rub • Diminished • Cold extremities
• Apex beat • Raised JVP breath sounds and peripheries
displaced • Signs of DVT on the • Kussmaul
• Bibasal affected side breathing
crepitations • Crepitations
• Pleural rub

INVESTIGATION • ECG • ECG • CXR : blunting • Blood glucose

• CXR • CXR of • Venous blood
• Echo • ABG costophrenic gas
• Echo angle, dense • Urinalysis
• CT pulmonary homogenous
angiography shadows
• Pleural
 aspiration and
biopsy

MANAGEMENT • Diuretics • Anticoagulation • Aspiration • Correct

• ACEi with low • Treatment of hypovolemia
molecular underlying • Insulin therapy
weight heparin/ cause • Potassium
warfarin replacement
• Thrombolysis • Bicarbonate
for massive PE replacement
• Bicarbonate
therapy
• Replace
phosphate
• Treat
precipitating
factors
• Long term
management of
DM