MED2 – Diagnostics in Pulmonary Medicine

History
 Comprehensive
 Most prominent symptom
 Temporal profile
 Inventory of substances that can harm the lungs
 Personal habits/social history
 Medication and allergies
 Family history
 Travel history
 Occupational history

Major Pulmonary Symptoms

 Shortness of breath / dyspnea
 Cough
o  Cardinal symptom of respiratory disease
 Cheat pain (pleuritic)
 Hemoptysis

Dyspnea
 Time course
o Acute
o Subacute
o Chronic
 Pulmonary fibrosis
 Pattern of presentation
o Exacerbation and remission
o Progressive
 Or if improving
o Triggers

Age/Sex, Risk Factors  Chief Complaint

 Acute
o Disease 1
o Disease 2
o Disease 3
o Disease 4
 Chronic
o Disease 1
o Disease 2
o Disease 3
o Disease 4
  DDx
 History
 PE
 Clinical Impression
o Couple with diagnostic tests

Diagnostics in Respiratory Medicine

 Imaging modalities
 Techniques in acquiring specimens
 Direct visualization of the Respiratory System
 Pulmonary Function Tests
 Gas Exchange

When viewing a Chest X-Ray

 Get a good history
 Ask about old chest X-Rays
 Check on the quality of the film
 Examine the film and correlate with your history and PE

Types of Chest X-Ray Findings

 Diseases the increase lung density
 Diseases that decrease lung density
 Pleural disease

… with clinical associations

 Px with respiratory complaint and with an abnormal CXR
 Abnormal CXR

Imaging Studies
 Routine radiology

Probing the Plate

 Preliminaries
o Patient information
o Quality/technical considerations
 Proper
o Reading/interpreting the film
o Systematic review (mnemonics)
 Penetration
o Amount of radiation required for a quality image
o PA film: should barely…
 Inspiration
o Image should be at full inspiration
  Diaphragm at level of 8-10th rib
 Allows reader to see intrapulmonary structures

Cardiothoracic ratio:
CR should be less than 0.5 i.e., A+B/C<0.5
A CR ratio >0.5 suggests cardiomegaly in adults
>0.6 cardiomegaly in newborn

 Pulmonary vascular markings appear prominent inferiorly and medially, tapers

peripherally

Air Bronchogram

Silhouette Sign
 Loss of the normal radiographic silhouette (contour)
 When areas of same densities are in contact together

CT Scan
 Use of cross sectional images
o Allows distinction between densities superimposed on plain film
o Accurate size assessment of lesions
o Assessment of hilar and mediastinal findings
o Assess chest wall and spine
o Identify fat deposits and/or calcifications in nodule
o With contrast studied: vascular vs nonvascular, distinguish lymph nodes from
masses and vascular structures

MRI
 Uses non-ionizing magnetic radiation

PET Scan
 Identify malignant lesions using increased uptake and metabolism of glucose
 Injection of a radiolabeled glucose analogue, 18F-fluoro-2-deoxyglucose (FDG)
