Essential Investigations in Respiratory Diseases – A Clinical Guide

Types of Investigations:

  • Pulmonary Function Tests (PFTs) → Spirometry.
  • Sputum & Fluid Analysis → Sputum Test, Gastric Lavage, Pleural Fluid Analysis.
  • Blood Tests → CBC, Serology, Skin Tests.
  • Radiological Tests → X-ray, CT, MRI, Angiography.
  • Endoscopic Tests → Bronchoscopy, Mediastinoscopy.
  • Biopsy & Other Procedures → Pleural Biopsy, Lung Biopsy, Thoracoscopy.

Mnemonic: "P.S.B.R.E.B. = Pulmonary, Sputum, Blood, Radiology, Endoscopy, Biopsy"


1. PULMONARY FUNCTION TESTS (PFTs)

SPIROMETRY (Lung Function Test)

Measures:
    Lung Volume & Airflow Speed.
    Used for Asthma, COPD, Pulmonary Fibrosis.

Graph Interpretation:
    Obstructive Pattern → ↓ Expiratory Flow (Asthma, COPD).
    Restrictive Pattern → ↓ Lung Volume (Fibrosis, TB).

- Mnemonic: "S.O.R. = Spirometry for Obstructive & Restrictive"


2. SPUTUM & FLUID ANALYSIS

SPUTUM EXAMINATION

Used for:

  • TB (Ziehl-Neelsen Stain for AFB).
  • Bacterial Infections (Gram Stain, Culture).
  • Fungal Infections (KOH Stain).
  • Cancer Cells (Cytology, Papanicolaou Stain).

Mnemonic: "T.B.F.C. = TB, Bacteria, Fungus, Cancer"

OTHER SECRETIONS TESTS

  • Gastric Lavage → Used for TB Diagnosis in Children.
  • Transtracheal Aspiration → Used for Pneumonia, Bronchiectasis.

- Mnemonic: "G.T. = Gastric Lavage for TB, Transtracheal for Pneumonia"


3. BLOOD TESTS

HEMATOLOGY TESTS (CBC, ESR, Eosinophils)

  • Anemia → Seen in Chronic Lung Diseases.
  • Leukocytosis → Bacterial Infections.
  • Eosinophilia → Allergic Lung Diseases (Asthma).
  • Raised ESR → TB, Lung Cancer.

Mnemonic: "A.L.E.R. = Anemia, Leukocytosis, Eosinophilia, Raised ESR"

SEROLOGY (Blood Antibody Tests)

  • Used for Fungal & Viral Infections.
  • Diagnoses TB, Histoplasmosis, Aspergillosis.

- Mnemonic: "S.F.V. = Serology for Fungal & Viral"

SKIN TESTS (Allergy & TB Tests)

  • Immediate Skin Test (Scratch Test) → For Asthma, Allergies.
  • Delayed Skin Test (Mantoux Test) → For TB.

Mnemonic: "I.D. = Immediate for Allergy, Delayed for TB"


4. RADIOLOGICAL INVESTIGATIONS

X-RAY (Most Common Test)

Findings:

  • White Patch → Pneumonia, TB.
  • Black Air Space → Pneumothorax.
  • Fluid Level → Pleural Effusion.

Mnemonic: "W.B.F. = White Patch (TB), Black Air (Pneumothorax), Fluid (Effusion)"

CT SCAN (Detailed Lung Imaging)

  • Used for Lung Cancer Staging, Fibrosis, TB.

MRI (Magnetic Imaging for Lungs)

  • Used for Mediastinal Tumors, Vascular Diseases.
  • Mnemonic: "X.C.M. = X-ray, CT, MRI"

PULMONARY ANGIOGRAPHY (Gold Standard for Pulmonary Embolism)

  • Dye Injection to Detect Clots.
  • Mnemonic: "A.C.T. = Angiography for Clots, CT for Tumors"

LUNG SCAN (Ventilation-Perfusion Scan for Embolism)

  • Ventilation Scan → Xenon Gas Inhalation.
  • Perfusion Scan → Injected Radioisotope.

Mnemonic: "V.X.P.I. = Ventilation (Xenon), Perfusion (Isotope)"


5. ENDOSCOPIC TESTS

BRONCHOSCOPY (Lung Endoscopy)

Uses:

  • Detects Tumors, TB, Foreign Body.
  • Takes Biopsy Samples.

Mnemonic: "B.T.F. = Bronchoscopy for Tumor, TB, Foreign Body"

MEDIASTINOSCOPY (Mediastinal Biopsy Test)

  • Used for Lung Cancer Staging, TB.
  • Mnemonic: "M.T. = Mediastinoscopy for TB"


6. BIOPSY & OTHER PROCEDURES

PLEURAL FLUID ANALYSIS (Thoracentesis Test)

  • Used for Pleural Effusion.
  • Determines Transudate vs Exudate.

Mnemonic: "P.T.E. = Pleural Test for Transudate & Exudate"

PLEURAL BIOPSY

  • Used in TB & Cancer Diagnosis.
  • Mnemonic: "P.B. = Pleural Biopsy for TB"

LUNG BIOPSY (5 Types)

  • Transbronchial Biopsy → Via Bronchoscope.
  • Needle Biopsy → For Small Lesions.
  • Open Lung Biopsy → Gold Standard for Fibrosis.

- Mnemonic: "T.N.O. = Transbronchial, Needle, Open Biopsy"

THORACOSCOPY (Video-Assisted Chest Surgery)

  • Used for TB, Cancer, Pleural Disease.
  • Mnemonic: "T.C.P. = Thoracoscopy for Cancer & Pleura"


HOMOEOPATHIC MANAGEMENT OF RESPIRATORY DISEASES

  • For Asthma & Allergy:
  • Blatta Orientalis, Ipecac, Arsenicum Album.
  • For Tuberculosis & Lung Infections:
  • Tuberculinum, Bacillinum, Phosphorus.

  • For Chronic Bronchitis & COPD:
  • Antimonium Tart, Carbo Veg, Senega.

Mnemonic: "B.I.A. = Blatta, Ipecac, Arsenicum for Asthma"


FINAL REVISION WITH MNEMONICS

  • Investigations = "P.S.B.R.E.B." (Pulmonary, Sputum, Blood, Radiology, Endoscopy, Biopsy)
  • Spirometry = "S.O.R." (Spirometry for Obstructive & Restrictive)
  • Sputum Test = "T.B.F.C." (TB, Bacteria, Fungus, Cancer)
  • Hematology = "A.L.E.R." (Anemia, Leukocytosis, Eosinophilia, Raised ESR)
  • X-ray Findings = "W.B.F." (White Patch, Black Air, Fluid)
  • Angiography = "A.C.T." (Angiography for Clots, CT for Tumors)
  • Ventilation-Perfusion Scan = "V.X.P.I." (Ventilation Xenon, Perfusion Isotope)
  • Bronchoscopy = "B.T.F." (Tumor, TB, Foreign Body)
  • Pleural Fluid = "P.T.E." (Pleural Test for Transudate & Exudate)
  • Lung Biopsy = "T.N.O." (Transbronchial, Needle, Open Biopsy)
  • Homeopathy = "B.I.A." (Blatta, Ipecac, Arsenicum for Asthma)


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