Acute stridor: differential
ABCDEFGH:
*With fever:
- Abscess
- Bacterial tracheitis
- Croup
- Diphtheria
- Epiglottitis
*Without fever:
ARDS: diagnostic criteria
ARDS:
- Acute onset
- Ratio (PaO2/FiO2) less than 200
- Diffuse infiltration
- Swan-Ganz Wedge pressure less than 19 mmHg
ARDS: full differential
CARDS? HOPE ITS NOT ARDS:
- CNS disorders
- Aspiration (gastric)
- Radiation
- Drugs (heroin, morphine, barbiturates, etc)
- Smoke, toxic gas inhalation
- Hypotension, shock
- Oxygen toxicity
- Pancreatitis
- Emboli
- Infection, sepsis
- Transfusion reaction
- Surgery (esp. cardiac)
- Near drowning
- Obstetrical emergencies (eg eclampsia, HELLP)
- Thermal injuries/ burns
- Altitude sickness
- Renal failure
- DIC
- SLE
Asthma drugs: leukotriene inhibitor action
zAfirlukast: Antagonist of lipoxygenase
zIlueton: Inhibitor of LT receptor
Asthma: management of acute severe
"O SHIT":
- Oxygen (high dose: >60%)
- Salbutamol (5mg via oxygen-driven nebuliser)
- Hydrocortisone (or prednisolone)
- Ipratropium bromide (if life threatening)
- Theophylline (or preferably aminophylline-if life threatening)
Atropine use: tachycardia or bradycardia ?
- "A goes with B":
- Atropine used clinically to treat Bradycardia.
Bronchial obstruction: consequences
APPLE BABE:
- Atelectasis
- Pleural adhesions
- Pleuritis
- Lipid pneumonia
- Effusion->organisation->fibrosis
- Bronchiectasis
- Abscess
- Broncho and lobar pneumonia
- Emphysema
Bronchi: which is more vertical
"Right on Red":
- Many places allow making a right hand turn at a red light, if you first come to a complete stop.
- A child swallowing a red penny is more likely to get it stopped down the right bronchus, since it is more vertical.
Bronchi: which one is more vertical
- "Inhale a bite, goes down the right":
- Inhaled objects more likely to lodge in right bronchus, since it is the one that is more vertical.
Bronchiectasis: causes
A SICK AIRWAY:
- Airway lesion, chronic obstruction
- Sequestration
- Infection, inflamation
- Cystic fibrosis
- Kartagners syndrome
- Allergic brochopulmonary aspergilliosis
- Immunodeficiencies (hypogammaglobinaemia, myeloma, lymphoma)
- Reflux, inhalation injury
- William Campbell syndrome (and other congenitals)
- Aspiration
- Yellow nail syndrome/ Young syndrome
Bronchiectasis: differential
BRONCHIECTASIS:
- Bronchial cyst
- Repeated gastric acid aspiration
- Or due to foreign bodies
- Necrotizing pneumonia
- Chemical corrosive substances
- Hypogammaglobulinemia
- Immotile cilia syndrome
- Eosinophilia (pulmonary)
- Cystic fibrosis
- Tuberculosis (primary)
- Atopic bronchial asthma
- Streptococcal pneumonia
- In Young's syndrome
- Staphylococcal pneumonia
Bronchopulmonary segments of the left lung
"Astute Anatomists Share Inside Secrets About Lungs":
- Apicoposterior (S1+2)
- Anterior (S3)
- Superior (S4)
- Inferior (S5)
- Superior (S6)
- Anteromedial basal (S7+8)
- Lateral basal (S9)
Bronchopulmonary segments of right lung
"A PALM Seed Makes Another Little Palm":
*In order from superior to inferior:
- Apical
- Posterior
- Anterior
- Lateral
- Medial
- Superior
- Medial basal
- Anterior basal
- Lateral basal
- Posterior basal
Carcinoid syndrome: components
CARCinoid:
- Cutaneous flushing
- Asthmatic wheezing
- Right sided valvular heart lesions
- Cramping and diarrhea
Carcinomas having tendency to metastasize to bone
"Particular Tumours Love Killing Bone":
- Prostate
- Thyroid
- Lung
- Kidney
- Breast
Chest pain: treatment
"MOVE your patient!":
- Monitor: put patient on cardiac monitor
- Oxygen: put patient on O2
- Venous: gain large bore venous access
- EKG: 12 lead EKG
Compliance of lungs: factors
COMPLIANCE:
- Collagen deposition (fibrosis)
- Ossification of costal cartilages
- Major obesity
- Pulmonary venous congestion
- Lung size
- Increased expanding pressure
- Age
- No surfactant
- Chest wall scarring
- Emphysema
*All but L/A/E decrease compliance.
Corticosteroids: adverse side effects
CUSHINGS BAD MD:
- Cataracts
- Up all night (sleep disturbances)
- Suppression of HPA axis
- Hypertension/ buffalo Hump
- Infections
- Necrosis (avascular)
- Gain weight
- Striae
- Bone loss (osteoporosis)
- Acne
- Diabetes
- Myopathy, moon faces
- Depression and emotional changes
COPD: 4 types and hallmark
ABCDE:
- Asthma
- Brochiectasis
- Chronic bronchitis
- Dyspnea [hallmark of group]
- Emphysema
*Alternatively: replace Dyspnea with Decreased FEV1/FVC ratio.
COPD: blue bloater vs. pink puffer diseases
- emPhysema has letter P (and not B) so Pink Puffer.
- chronic Bronchitis has letter B (and not P) so Blue Bloater.
Chronic cough: full differential
GASPS AND COUGH:
- GORD
- Asthma
- Smoking, chronic bronchitis
- Post-infection
- Sinusitis, post-nasal drip
- ACE inhibitor
- Neoplasm
- Diverticulum
- Congestive heart failure
- Outer ear
- Upper airway obstruction
- GI-airway fistula
- Hypersensitivity
Clubbing: respiratory causes
ABCDEF:
- Abcess (lung)
- Bronchiectasis (including CF)
- Cancer (lung)
- Decreased oxygen (hypoxia)
- Empyaema
- Fibrosing alveolitis
Deep venous thrombosis: diagnosis
DVT:
- Dilated superficial veins/ Discoloration/ Doppler ultrasound
- Venography is gold standard
- Tenderness of Thigh and calf
Deep venous thrombosis: genetic causes
ALASCA:
- Antithrombin III
- Leiden (Factor V)
- APC (Activated Protein C)
- S-protein deficiency
- C-protein deficiency
- Antiphospholipid antibody
Dyspnea: causes
SHE PANTS:
- Stress, anxiety
- Heart disease
- Emboli
- Pulmonary disease
- Anaemia
- Neuromuscular disease
- Trachea obstruction
- Sleep disorder
Dyspnea: differential
- 3A's: Three Airways: Airway obstruction, Anaphylaxis, Asthma
- 3P's: Three Pulmonary's: Pneumothorax, PE, Pulmonary edema
- 3C's: Three Cardiacs: Cardiogenic pulmonary edema, Cardiac ischemia, Cardiac tamponade
- 3M's: Three Metabolics: (DOC) DKA, Organophosphates, Carbon monoxide poisoning
Emphysema: types, most important feature of each
"Cigarettes Is Primary Problem":
*Types:
- Centrilobular
- Irregular
- Pancinar
- Paraseptal
*Most important feature for each type (in order as above):
Cigarrettes
Inflammation healed to scar
Protease inhibitor deficiency (a1-antitrypsin)
Pneumothorax
*"Cigarettes is primary problem" used since cigarettes is most common cause of emphysema.
*Keeping P's straight: Pan is antitrypsin.
Hemoptysis: causes
HEMOPTYSIS:
- Haemorrhagic diathesis
- Edema [LVF due to mitral stenosis]
- Malignancy
- Others [eg: vasculitis]
- Pulmonary vascular abnormalities
- Trauma
- Your treatment [anticoagulants]
- SLE
- Infarction in lungs
- Septic
Hemoptysis: causes
CAVITATES:
- CHF
- Airway disease, bronchiectasis
- Vasculitis/ Vascular malformations
- Infection (eg TB)
- Trauma
- Anticoagulation
- Tumour
- Embolism
- Stomach
Interstitial lung disease: causes
SARCOIDI:
- Sarcoidosis
- Allergic reaction
- Radiation
- Connective tissue disease
- Occupational exposure
- Infection
- Drugs
- Idiopathic
Lung cancer: presentation
ABCDE:
- Snowball turned to Avalanche
- Blood: hemoptysis
- Cough
- Distruption to airway in bronchus-->pneumonia
- whEEzing
Lung lobe numbers: right vs. left
- Tricuspid heart valve and tri-lobed lung both on the right side.
- Bicuspid and bi-lobed lung both on the left side
Lung lobes: one having lingula, lobe numbers
- Lingula is on Left.
- The lingula is like an atrophied lobe, so the left lung must have 2 "other" lobes, and therefore right lung has 3 lobes.
Lung lobes: segments of right middle lobe
"ML=ML":
- Segments of Middle Lobe are Medial & Lateral.
Morphine: Side effects
MORPHINES:
- Miosis
- Orthostatic hypotension
- Respiratory depression
- Pain supression/Pneumonia (aspiration)
- Histamine release/ Hormonal alterations/Hypotension
- Increased ICT/Infrequency (Constipation, urinary retention)
- Nausea
- Euphoria/Euphoria
- Sedation
Pancoast tumor: relationship with Horner's syndrome
"Horner has a MAP of the Coast":
- A panCoast tumor is a cancer of the lung apex that compresses the cervical sympathetic plexus, causing Horner's syndrome, which is MAP:
- Miosis
- Anhidrosis
- Ptosis
Pleural effusion: investigations
PLEURA:
- Pleural fluid (thoracentesis)
- Lung, pleural biopsy
- ESR
- Ultrasound
- Radiogram
- Analysis of blood
Pleura surface markings
"All the even ribs, in order: 2,4,6,8,10,12 show its route":
- Rib2: sharp angle inferiorly
- Rib4: the left pleura does a lateral shift to accommodate heart
- Rib6: both diverge laterally
- Rib8: midclavicular line
- Rib10: midaxillary line
- Rib12: the back
Pneumothorax: causes
SIT, 3 A's, 3 C's:
- Spontaneous (often tall thin men)
- Iatrogenic
- Trauma
- Asthma
- Alveolitis
- AIDS
- COPD
- Carcinoma
- Cystic fibrosis
Pneumothorax: presentation
P-THORAX:
- Pleuretic pain
- Trachea deviation
- Hyperresonance
- Onset sudden
- Reduced breath sounds (& dypsnea)
- Absent fremitus
- X-ray shows collapse
Pulmonary edema: treatment
LMNOP:
- Lasix
- Morphine
- Nitrates (NTG)
- Oxygen
- Position (upright vs. flat)
Pulmonary edema: treatments
MAD DOG:
- Morphine
- Aminophylline
- Digitalis
- Diuretics
- Oxygen
- Gases in blood (ABG's)
Pulmonary embolism: risk factors
TOM SCHREPFER:
- Trauma
- Obesity
- Malignancy
- Surgery
- Cardiac disease
- Hospitalization
- Rest [bed-ridden]
- Elderly
- Past history
- Fracture
- Estrogen [pregnancy, post-partum]
- Road trip
Pulmonary fibrosis: differential of both upper and lower lobes
BREAST SCAR:
*Upper lobe:
- Beryliosis
- Radiation
- Extrinsic allergic alveolitis
- Ankylosing spondylitis
- Sarcoidosis
- TB
*Lower lobe:
- Systemic sclerosis
- Cryptogenic fibrosing alveolitis
- Asbestosis
- Radiation
Pulmonary fibrosis: causes
SCAR:
*Upper lobe:
- Silicosis/ Sarcoidosis
- Coal worker pneumonconiosis
- Ankylosing spondylitis
- Radiation
*Lower lobe:
- Systemic sclerosis
- Cyptogenic fibrosing alveolitis
- Asbetosis
- Rheumatoid arthritis
Pulmonary infiltrations: inducing drugs
"Go BAN Me!":
- Gold
- Bleomycin/ Busulphan/ BCNU
- Amiodarone/ Acyclovir/ Azathioprine
- Nitrofurantoin
- Melphalan/ Methotrexate/ Methysergide
Respiratory depression: inducing drugs
"STOP breathing":
- Sedatives and hypnotics
- Trimethoprim
- Opiates
- Polymyxins
Respiratory disease: hand signs
CASH:
- Clubbing
- Asterixis
- Small muscle wasting
- HPOA
Respiratory distress syndrome in infants: major risk factors
PCD (Primary Ciliary Dyskinesia, a cause of Respiratory distress syndrome):
- Prematurity
- Cesarean section
- Diabetic mother
Sarcoidosis summarized
SARCOIDOISIS:
- Schaumann calcifications
- Asteroid bodies/ [ACE] increase/ Anergy
- Respiratory complications/ Renal calculi/ Restrictive lung disease/ Restrictive cardiomyopathy
- Calcium increase in serum and urine/ CD4 helper cells
- Ocular lesions
- Immune mediated noncaseating granulomas/ [Ig] increase
- Diabetes insipidus/ [D vit.] increase/ Dyspnea
- Osteopathy
- Skin (Subcutaneous nodules, erythema nodosum)
- Interstitial lung fibrosis/ IL-1
- Seventh CN palsy
Steroid: side effects
CUSHINGOID:
- Cataracts
- Ulcers
- Skin: striae, thinning, bruising
- Hypertension/ Hirsutism/ Hyperglycemia
- Infections
- Necrosis, avascular necrosis of the femoral head
- Glycosuria
- Osteoporosis, obesity
- Immunosuppression
- Diabetes
Steroids: side effects
BECLOMETHASONE:
- Buffalo hump
- Easy bruising
- Cataracts
- Larger appetite
- Obesity
- Moonface
- Euphoria
- Thin arms & legs
- Hypertension/ Hyperglycaemia
- Avascular necrosis of femoral head
- Skin thinning
- Osteoporosis
- Negative nitrogen balance
- Emotional liability
Superior mediastinum: contents
"BATS & TENT":
- Brachiocephalic veins
- Arch of aorta
- Thymus
- Superior vena cava
- Trachea
- Esophagus
- Nerves (vagus & phrenic)
- Thoracic duct
Superior mediastinum: contents
PVT Left BATTLE:
- Phrenic nerve
- Vagus nerve
- Thoracic duct
- Left recurrent laryngeal nerve (not the right)
- Brachiocephalic veins
- Aortic arch (and its 3 branches)
- Thymus
- Trachea
- Lymph nodes
- Esophagus
TB: features
TB is characterised by 4 C's:
- Caseation
- Calcification
- Cavitation
- Cicatrization
TB: antibiotics used
STRIPE:
- STreptomycin
- Rifampicin
- Isoniazid
- Pyrizinamide
- Ethambutol
V/Q gradient in lung
- Infinity, a lung and a zero stack nicely.
- V/Q is lowest at bottom, highest at top.
- VO2 normal value is 250 mL/min
- "V02" is the numbers, just need to rearrange the order.
- V is roman numeral for 5, so rearrange to 2V0, or 250 mL/min.
Wheezing: causes
ASTHMA:
- Asthma
- Small airways disease
- Tracheal obstruction
- Heart failure
- Mastocytosis or carcinoid
- Anaphylaxis or allergy
