Sandbox:iqra

1. SOB 2. Chest pain 3. Cough 4. Cyanosis

Bradypnea

Diseases	Clinical manifestations										Diagnosis					Associated features
	Symptoms						Physical exam
	Chest pain	Dyspnea	Orthopnea	Fever	Palpitations	Poor quality sleep	Cyanosis	JVD	Peripheral edema	Auscultation	ABGs	Lab findings	Imaging	Spirometry	Gold standard
Central hypoventilation syndrome CHS	-	+	+	-	+/-	+	+	+/-	+/-	Normal	↓O2, ↑CO2	PHOX2B screening testing via fragment analysis or sequencing tests  Polysomnography	Brain MRI (exclude other brainstem lesions)	Normal	Molecular testing for PHOX2B mutations	Hirschsprung disease Neural crest tumors Box-shaped face Meiosis Strabismus
Asphyxia	-	+	+/-	-	+/-	+	+	+/-	+/-	Systolic murmur	↓O2, ↑CO2	Abnormal renal function tests Cardiac troponin T and I ↑	CXR typically shows cardiomegaly Echocardiography (to exclude other structural heart diseases)	Normal	The fetal biophysical profile score (BPS) shows loss of accelerations of the fetal heart rate, decreased body movement, breathing, hypotonia and decreased amniotic fluid volume	Acute respiratory distress syndrome (RDS) Meconium aspiration syndrome (MAS) Necrotizing enterocolitis
Chiari II malformation (Arnold-Chiari)	-	+	+	-	+	+	-	-	-	Stridor	Normal	_	CT Scan of Brain (hydrocephalus, herniated cerebellar tonsils, and a flattened spinal cord)	_	MRI Brain	Myelomeningocele Hydrocephalus
Spinal muscular atrophy	-	+	+	-	+/-	+	+	-	-	Stridor	_	Electromyography shows fibrillations and positive sharp waves	_	_	Molecular genetic testing  by detection of homozygous deletions of exons 7 of the SMN1 gene	Progressive muscle weakness and atrophy
Guillain-Barré syndrome	-	+	+/-	-	+	+/-	-	-	-	Diminished breath sounds Absence of bowel sound	↓O2, ↑CO2	Albuminocytologic dissociation on CSF analysis	MRI shows selective anterior nerve root enhancement	↓FEV1 ↓FVC ↓TLC	Nerve conduction studies (NCS) and needle electromyography (EMG)	Preceded by mild respiratory or GIT infection Ascending fashion of weakness
Phrenic nerve injury	+/-	+	+	+/-	-	+/-	-	-	-	Normal	Normal	CBC (to rule out anemia as the cause of dyspnea) Thyroid function tests	CXR shows unilateral or bilateral diaphragmatic flattening	↓Vt, ↑RV (anatomical)	Fluoroscopic "sniff" test (diaphragmatic movement is observed fluoroscopically while the patient sniffs forcefully)	Respiratory insufficiency
Myasthenia gravis	-	+	+/-	-	-	+	-	-	-	Paradoxical abdominal breathing	↓O2, ↑CO2	Anti-AChR ab Anti–striated muscle ab Anti-MuSK ab	CT may show anterior mediastinal mass (thymoma)	↓FEV1,↓FVC ↓TLC	Anti–acetylcholine receptor antibody test	Ptosis Diplopia Fatigue
Muscular dystrophy	+/-	+	+/-	-	+/-	+/-	-	+/-	+/-	Mid-systolic murmur	↓O2, ↑CO2	Elevated CPK levels ECG shows right ventricular strain	Ultrasonography shows increased echogenicity in the affected muscles	↓FVC, ↓PEF	Genetic testing for mutation of the dystrophin gene (DMD)	Waddling, wide- based gait  Gower sign
Pneumonia	+	+	+/-	+	+/-	+/-	-	-	-	Wheeze, Rhonchi and Crackles	Normal	↑WBC (neutrophilia)	Lobar consolidation	Normal	Normal	Productive cough
Aspiration	+/-	+	+/-	+	+/-	+/-	+	-	-	Diminished breath sounds	Normal	↑WBC Blood cultures	CXR shows atelectasis	↓Vt, ↑RV	Bronchoscopy	Choking
Obstructive sleep apnea	+	+	+/-	-	+/-	+	+/-	+/-	+/-	Wheeze Systolic ejection murmur	↓O2, ↑CO2	Polysomnography	MRI shows enlarged adenoids, tonsils and soft palate	↑FRC	Polysomnography	Loud snoring Depression Hypertension Coronary artery disease
Pulmonary hypoplasia	-	+	+/-	-	+/-	+/-	+	-	-	Breath sounds may be decreased or absent on the side of hypoplasia	↓O2, ↑CO2	Abnormal BMP Echocardiography is done to rule out cardiac complications	CXR shows crowded ribs and low thoracic-to- abdominal ratio CT scan of chest	↑RV	_	Myopathic facies
Metabolic alkalosis	-	+	+/-	-	+/-	+/-	-	+/-	+/-	_	↓O2, ↑CO2	Serum Anion Gap is elevated Abnormal Urine Sodium Ion Concentration	_	_	_	Hypokalemia
Sepsis	-	+	-	+	+/-	+/-	-	-	-	Normal	↓O2, ↑CO2	CBC shows ↑WBC (neutrophilia)	Normal	Normal	SIRS criteria	Chills Confusion
ROHHAD	-	+	+/-	-	+/-	+	+/-	-	-	Displaced cardiac impulse Loud pulmonic second heart sound	↓O2, ↑CO2	Abnormal Serum bicarbonate levels Attended laboratory nocturnal polysomnography	Lateral neck radiographs shows airway narrowing CXR shows chest wall deformity	↓Vt	_	Hypothalamic endocrine manifestations Tumors of neural crest origin