Acute stridor: differential

Acute stridor: differential

ABCDEFGH:

*With fever:

Abscess
Bacterial tracheitis
Croup
Diphtheria
Epiglottitis

*Without fever:

Foreign body
Gas (Toxic Gas)
Hypersensitivity

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.

Image result for blue bloater and pink puffer

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