ReMAP09
Blog for Respiratory-Medicine-Post-Graduates of Apollo Hospitals,Chennai,India - Diplomate National Board(DNB), started in the Year 2009 October ,by PGs & the Academic Co-Ordinator of Department - Dr.R.P.Ilangho - for enabling these Young PGs to INTER_CONNECT ideally for becoming better Pulmonologists.The word~ REMAP09 ~ was coined thus:RE= RE spiratory M=M edicine A=Apollo P= P ostGraduate 09= 2009 - thus meaning "Respiratory Medicine Apollo PostGraduate 2009 batch"
Snap Your Fingers ! Slap Your face ! & Wake Up !!!
FUN is the most Sacred Word in all the religious texts put together - in Life !
Snap Your Fingers ! Slap Your Face ! & Wake Up !!!
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- .ATS GUIDELINES OF TB DEFAULT AND RELAPSE (1)
- 1.WHY FASCIAL PUFFINESS OCCURS FIRST IN RENAL EDEMA (1)
- Acute (2)
- ACUTE EXACERBATION OF COPD CRITERIA (2)
- ACUTE EXACERBATION OF ILD CRITERIA (1)
- ACUTE EXACERBATION OF IPF criteria (1)
- AE COPD (1)
- Air crescent sign and Monod sign (1)
- Alveolar arterial oxygen gradient (1)
- Aminophylline in asthma (1)
- Amphoric breathing (1)
- Anuria and oliguria definition (1)
- apical cap (1)
- Apical impulse (1)
- Assessment of respiratory muscle strength (1)
- Asthma PEF variablity (1)
- Att in hepatotoxicity (1)
- ATT weight band recent (1)
- Austin flint murmur and Graham steel murmur (1)
- BEQ (1)
- BMI (1)
- Borg dyspnoea score (1)
- Breathlessness - Aggravating relieving factors (1)
- breathlessness-sherwood jones (1)
- Bronchiectasis- Definition (1)
- BRONCHOPULMONARY SEGMENTS (1)
- Cardinal symptoms: aggravating and relieving facto (1)
- Causes of chest pain aggrevated by cough (1)
- Causes of localised bulging of chest wall (1)
- Causes of orthopnea (1)
- Causes of palpitation (1)
- Causes of Unilateral pedal edema (1)
- Cavity (1)
- check post (1)
- Chest physiotherapy (1)
- Chromogranin A (1)
- Chronic (2)
- Classification (1)
- Clubbing (1)
- clubbing -mechanism of (1)
- Clubbing Unilateral (1)
- CLUBBING-PATHOGENESIS PDGF (1)
- cobb's angle-In Kyphoscoliosis Cobb's angle above which can be operated (1)
- Cobbs angle (1)
- Complications of Tuberculosis (1)
- Cor pulmonale (1)
- Cough reflex (2)
- Cough- aggravating factors (1)
- Cultures- significant colony count (1)
- Cyst/Bulla/Bleb (1)
- Cystic Fibrosis- Female infertility (1)
- DD of Orthopnoea (1)
- definition (1)
- DNB question bank (1)
- Drugs causing breathlessness (1)
- dysphagia - approach (1)
- Dyspnea - Causes of acute dyspnea (1)
- ECG FEATURES OF DEXTROCARDIA (1)
- Emphysema (1)
- Emphysema and chronic bronchitis definition (1)
- Empyema necessitans (1)
- Exacerbation of ILD (1)
- Factitious asthma (1)
- Fever of unknown origin (1)
- fibrinolytics in plef (1)
- FORMOTEROL (1)
- Gastro Intestinal Tract and abdominal symptoms (1)
- Gram negative cocci & gram positive bacilli (1)
- HAM (1)
- Hemothorax (1)
- Honeycombing in HRCT (1)
- Hydropneumothorax- sound of Coin test (1)
- Hyperventilation syndrome (1)
- IDSA sinusitis management (1)
- ILD CLASSIFICATION (1)
- ILO classification for pneumoconiotic opacities (1)
- Impalpable apical impulse (2)
- INDICATIONS FOR NIV IN COPD (1)
- Indications for steroids in Sarcoidosis (2)
- Krogg constant (1)
- Lung areas sensitive to pain (1)
- lung cancer- age group (1)
- Lung cancers-ALK inhibitors (1)
- MARKERS OF ILD (1)
- Massive hemoptysis (1)
- Massive hemoptysis criteria (1)
- Mines in Tamil Nadu (1)
- Muscles of respiration (2)
- Name reason for Potts spine (1)
- Nephrotic syndrome (1)
- NORMAL BREATH SOUNDS - mechanism (1)
- NORMAL THYMUS IN CT (1)
- NYHA (1)
- Orthopnea (1)
- Orthostatic hypotension (1)
- Pain- CRPS (1)
- Paracetamol -MOA (1)
- Pathophysiology of breath sounds (1)
- Pedal edema Aggravating and relieving factors (1)
- Penetration and exposure in Chest Xray (1)
- Perception of Dyspnoea (1)
- Pleuroscopy guidelines (1)
- PND causes (1)
- Pneumatocele (1)
- pneumonia phases of (1)
- Positional variation in chest pain (1)
- Puddle sign (1)
- Pulmonary embolism (1)
- Pulsations in different areas- causes (1)
- Pulsus paradoxus (1)
- Pulsus paradoxus - Measuremen (2)
- RADS-Definition and Criteria (1)
- Respiratory system clinical examination (1)
- Rheumatoid arthritis - diagnostic criteria (1)
- S3 (1)
- S4 HEART SOUNDS (1)
- Serum cortisol (1)
- Sherwood jones classification (1)
- Shivering (1)
- Silhouette sign (1)
- Six minute walk test (1)
- Skodaic resonance (1)
- SLE Criteria (1)
- Sleep study and polysomnography (1)
- Spinoscapular distance (1)
- Split pleura sign (1)
- Subacute (2)
- Subpulmonic effusion (1)
- Swellin (1)
- SYSTEMIC SCLEROSIS - Diagnostic criteria (1)
- Terminal respiratory unit (1)
- Test (1)
- Tidal percussion (1)
- Tongue in HIV (1)
- Upper respiratory tract (1)
- Velcro crackles (1)
- Vesicular breath sounds - Physiology (1)
- weight loss (1)
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Tuesday, April 1, 2025
SYSTEMIC SCLEROSIS - Diagnostic criteria
SLE
SLE (American College of Rheumatology criteria )
1)Malar rash
2)Discoid rash
3)Photosensitivity skin rash
4)Oral or nasopharyngeal ulceration
5)Non erosive arthritis involving ≥ 2 peripheral joints
6)Serositis (pleuritis or pericarditis)
7)Renal disorder (persistent proteinuria or cellular casts)
8)Neurologic disorder (unexplained seizures or psychosis)
9)Hematologic disorder (hemolytic anemia, leukopenia, lymphopenia,or thrombocytopenia)
10)Immunologic disorder (positive LE cell, anti-DNA antibody, anti-Sm antibody, false-positive syphilis serology)
11)Elevated antinuclear antibodies
*Minimum of 4 criteria required
SJÖGREN SYNDROME
sicca symptoms are mandatory
supportive evidence including ocular signs (positive Schirmer test testing reduced tear formation, rose bengal score > 3 for staining of conjunction and cornea)
typical histologic appearances salivary gland biopsy
antibodies to Ro (SS-A) or La (SS-B) or
reduced salivary flow.
RHEUMATOID ARTHRITIS - Diagnostic criteria
Sjogren's syndrome
Classification criteria for sjogren's syndrome
1) Labial salivary gland with focal lymphocytic sialadenitis and focus score of > 1 foci/4mm²
3 points
2) Anti-SS-A/Ro positive
3 points
3) Ocular Staining Score 5 (or van Bijsterveld score > 4) in at least one eye
1 point
4) Schirmer's test < 5 mm/5 minutes in at least one eye
1 point
5) Unstimulated whole saliva flow rate < 0.1 ml/minute
1 point
A score of 4 classifies a patient who meets the inclusion criteria:
⁃ ocular and/or oral dryness or suspicion of SjS according to EULAR SjS Disease Activity Index (ESSDAI)
and does not have any of the exclusion criteria:
⁃ history of head and neck radiation, active HCV infection, AIDS, sarcoidosis, amyloidosis, graft-versus-host disease, IgG4-related disease.
* ACR/EULAR classification criteria
Wednesday, March 26, 2025
AGGRAVATING FACTORS OF CARDINAL SYMPTOMS- MNEMONICS:
COUGH:
PDFCE
Pollution, Pollen, Posture
Drugs, Diurnal, Dry air
Food
Cold weather, Common cold
Exercise
SPUTUM
"DRIVE DUST"
D – Dust exposure
R – Respiratory infections
I – Irritants (e.g., smoke, fumes)
V – Viral infections
E – Exercise or exertion
D – Dry air
U – Upper respiratory tract conditions (e.g., postnasal drip)
S – Smoking
T – Temperature changes (cold air or sudden temperature drops)
Breathlessness:
"BREATHE HARD"
B – Body position (e.g., lying flat in orthopnea)
R – Respiratory infections
E – Exercise or exertion
A – Anxiety or emotional stress
T – Temperature extremes (cold or heat)
H – Hypoxia or high altitude
E – Environmental triggers (allergens, pollutants)
H – Heart failure or fluid overload
A – Anemia
R – Reflux (gastroesophageal reflux disease)
D – Drugs (e.g., beta-blockers,
WHEEZE:
“BREATHE WHEEZE”
B – Bronchial irritants (smoke, pollution)
R – Respiratory infections (viral or bacterial)
E – Exercise
A – Allergens (pollen, dust mites, animal dander)
T – Temperature changes (cold air)
H – Hormonal changes (pregnancy, menstruation)
E – Emotions (stress, anxiety)
W – Workplace irritants (occupational exposures)
H – Household triggers (perfumes, cleaning agents)
E – Environmental changes (high altitude)
E – Exposure to drugs (NSAIDs, beta-blockers)
Z – Zzz… sleep (nocturnal asthma triggers)
E – Eating (GERD-induced wheeze)
CHEST PAIN:
“CHEST PAINS”
C – Coughing or deep breathing (pleuritic pain)
H – Heat or cold exposure (vasospastic angina)
E – Emotion or stress (psychogenic pain, angina)
S – Swallowing (esophageal causes like GERD or spasm)
T – Trauma or movement (musculoskeletal pain, costochondritis)
P – Physical exertion (angina, cardiac ischemia)
A – Alcohol or large meals (GERD or esophageal spasm)
I – Infections (pleuritis, pericarditis, pneumonia)
N – Nighttime (GERD-related pain due to supine position)
S – Specific postures (pericarditis, GERD, musculoskeletal pain)
HEMOPTYSIS:
“COUGH BLOOD”
C – Coughing (increases airway pressure, ruptures small vessels)
O – Overexertion (exacerbates vascular stress)
U – Upper respiratory tract infections
G – GERD or vomiting (irritation of airways)
H – High altitude (pulmonary hypertension)
B – Bronchial infections (bronchitis, bronchiectasis)
L – Lung malignancy (coughing or irritation)
O – Operations (post-procedural bleeding, e.g., bronchoscopy)
O – Oral anticoagulants (worsen bleeding)
D – Deep breaths or physical strain (ruptures fragile capillaries)
Monday, March 10, 2025
Aggravating and relieving factors for cough , breathlessness, chest pain:
1. COUGH
Aggravating factors:
Pollution, Pollen, Posture
Drugs, Diurnal, Dry air
Cold weather, Common cold
Food, Exercise
Relieving Factors:
Using cough suppressants or expectorants
Drinking warm fluids, Humidified air or steam inhalation
Avoiding triggers, Rest
2. BREATHLESSNESS:
Aggravating factors:
Exercise,
Pollens,dust,smoke,cold air
Drugs- Aspirin,NSAIDs can aggravate breathlessness in asthmatics
Orthopnea- LV failure, large pleural effusion,massive ascites, morbid obesity and any severe lung disease.
Platypnea- ASD, patent foramen ovale, large intrapulmonary shunt,hepatopulmonary syndrome
Trepopnea- Due to large unilateral lung disease(patient prefers healthy lung down), dilated cardiomyopathy (pt prefers right side down)
Tumors compressing major airways/blood vessels
Relieving Factors:
Rest or reducing physical activity
Oxygen therapy
Bronchodilators
Calm breathing techniques
Elevating the head or upper body in severe cases
3. CHEST PAIN
Aggravating Factors:
Deep breathing, coughing, sneezing (if pleuritic)
Physical exertion (if cardiac in nature)
Stress or anxiety
Movement or pressure on the chest area
acid reflux
Relieving Factors:
Rest
Pain medication
Positioning (e.g., lying on one side for pleuritic pain)
Relaxation or stress-reduction techniques
Oxygen therapy
Tuesday, March 4, 2025
Aggravating and relieving factors for pedal edema
Aggravating and relieving factors for pedal edema
Aggravating factor
Prolonged immobility
Dietary- excess fluid
Reliving factor
Compression
Limb elevation
Diet- fluid and sodium restriction
Reference: Hutchison and macleod
Tuesday, February 25, 2025
Causes of orthopnoea
CAUSES OF ORTHOPNEA :
1. Left ventricular failure.
2. Asthma
3. COPD
4. Bilateral diaphragmatic paralysis in the absence of heart disease.
Ref : Fraser 4th edition page no. 388
Friday, February 21, 2025
Breathlessness aggravating and relieving factors
Breathlessness aggravated by exercise - exercise induced asthma
Aggravated by Pollens,dust,smoke,cold air, drugs, animals - Asthma
Drugs- Aspirin,NSAIDs can aggravate breathlessness in asthmatics
Aggravated by lying down- orthopnea(relieved by sitting)- LV failure, large pleural effusion,massive ascites, morbid obesity and any severe lung disease.
Aggravated by sitting up- platypnea (relieved by lying down)- ASD, patent foramen ovale, large intrapulmonary shunt,hepatopulmonary syndrome
Aggravated by lying on oneside - trepopnea
Due to large unilateral lung disease(patient prefers healthy lung down), dilated cardiomyopathy (pt prefers right side down)
Tumors compressing major airways/blood vessels
Referrence - Macleod's 13 th edition
Respiratory system page no-142
Wednesday, February 19, 2025
Monkey pox -etiology and drug of choice
Monkey pox
Etiology :Poxviruses are a family of double-stranded DNA viruses whose genomic structure is generally conserved across subfamilies, genera, and species.
Most poxviruses that infect humans are spread through contact, not by respiratory route
Patient usually presents with nodular or vesicopustular lesions ,fever ,followed by rash,centrifugal distributionprominet in palms and soles
Treatment :mainly supportive and prevent secondary bacterial infection
Recently u.s FDA approved the anti viral drug Tecovirmat (Tpoxx) has been used.
Brincidofovir (tembexa)also approved by FDA
Ref : Harrison principal of internal medicine