CONGESTIVE HEART FAILURE

RULE-IN:
At risk: > 65 years old, DM, HTN
Exertional -> Dyspnea at rest
Orthopnea
Fatigue
Tachycardia

RULE-OUT:
Pleural effusion: unilateral, Left
(-) Symmetric dependent leg edema
(-) Associated congestive hepatomegaly

(-) PND
Not displaced apex
Not sustained and enlarged apical impulse
No S3 nor S4 heard
(-) Bilateral rales

TUBERCULOUS PLEURITIS

RULE-IN:
History of TB
Chronic exertional dyspnea
Cough
Orthopnea
Weight loss
 PARAPNEUMONIC EFFUSION

RULE-IN:
Chronic exertional dyspnea
Productive cough
Weight loss

RULE-OUT:
(-) Fever
(-) Chest pain
(-) Thick yellow-green sputum

IDIOPATHIC PULMONARY FIBROSIS

RULE-IN:
At risk: > 60 years old, antineoplastic agents
Chronic with gradual onset exertional dyspnea
Dry cough

RULE-OUT:
Not exposed to smoke
(-) Rales at lung bases
(-) Digital clubbing
 PULMONARY LYMPHANGITIC CARCINOMATOSIS

RULE-IN:
Diagnosis of breast cancer
Chronic progressive dyspnea
Cough

RULE-OUT:
Did not develop in < 10 months after diagnosis of CA
(-) Pain
(-) Persistent coughing out of blood

COPD

RULE-IN:
Chronic progressive exertional dyspnea
Productive cough
Weight loss

RULE-OUT:
No history of smoking, recent infection, occupational exposure
Not specifically aggravated by overhead arm activities
Not relieved by bracing arms
Not relieved with salbutamol
(-) Expiratory wheezing
(-) cyanosis nor labored breathing with accessory muscle use
No sign of hyperinflation (barrel chest)