how would you investigate the patient Flashcards
Asthma
FENO (fractional exhaled nitric oxide)- biomarker for asthma
Spirometry with bronchodilator reversibility (fancy version of peak flow)
If diagnostic uncertainty, follow up with:
- Peak flow variability
- Direct bronchial challenge test with histamine or methacoline
COPD
CXR to exclude other pathology
FBC (polycythaemia/anaemia)
BMI (to assess if weight loss)
Sputum culture (asses for chronic infection)
ECG & echo
CT thorax (alternative diagnoses)
Serum alpha-1-antitrypsin
Transfer factor for carbon monoxide
Pulmonary Embolism
ECG
Blood tests
Imaging
Well’s Score:
- <4 = measure D-dimer (only useful is clinical suspicion is low). Low D-dimer excludes PE
- >4 = CT Pulmonary Angiogram
CTPA or VQ scan for establishing a definitive diagnosis
Pneumothorax
Erect chest x-ray: line demarcating the edge of the lungs and no lung markings
CT thorax if small pneumothorax
Pleural Effusion
Bloods:
- FBC (raised WCC), U&E show raised creatinine,
- LFTs show low albumin and raised ALT/AST (cirrhosis)
Imaging:
- CXR shows blunting of costophrenic angle
Pleural fluid analysis - pH, glucose, amylase
Bronchial carcinoma
Sputum cytology (microscope for abnormal cells)
Chest X-ray: abnormalities that may be seen include nodules, lung collapse, pleural effusion, consolidation, and bony metastases.
Contrast-enhanced CT scan: used to further confirm the diagnosis and stage (TNM classification) the disease. The CT scan should also include both the adrenals and liver to look for sites of metastases.
Bronchoscopy: used to obtain a sample for histology
Endobronchial ultrasound transbronchial needle aspiration (EBUS-TBNA): allows biopsy of lymph nodes, paratracheal and bronchial lung lesions for histology
Cardiovascular review and lung function tests should also be performed to assess patient’s suitability for treatment options.
Pneumonia
Chest X Ray (consolidation in part of the lung)
CBC (raised WBCs, CRP, ESR)
Pulse oximetry for O2 sats
