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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

ACR/EULAR classification criteria for systemic sclerosis:
A total score of 9 or more is required for classification as systemic sclerosis.
1. Skin thickening of the fingers:
   - Proximal to the metacarpophalangeal joints (9 points).

2. Fingertip lesions:
   - Digital tip ulcers (2 points).
   - Fingertip pitting scars (3 points).

3. Telangiectasia (2 points).

4. Abnormal nailfold capillaries (2 points).

5. Pulmonary involvement:
   - Interstitial lung disease or pulmonary arterial hypertension (2 points).

6. Raynaud's phenomenon (3 points).

7. SSc-specific autoantibodies:
   - Anti-centromere, anti-topoisomerase I (Scl-70), or anti-RNA polymerase III (3 points).

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

American Rheumatism Association revised criteria
1)Morning stiffness (lasting at least 1 hr)
2)Arthritis (soft tissue swelling or fluid) of 3 or more joints (PIP, MCP,wrist, elbow, knee, ankle, MTP joints)
3)Arthritis of hand joints (swelling of at least 1 wrist, MCP, or PIP joint)
4)Symmetrical arthritis (i.e., simultaneous arthritis of the same joints on both sides of the body)
5)Rheumatoid nodules
6)Serum rheumatoid factor positivity (at a level such that < 5% of normal controls are positive)
7)Radiographic hand or wrist changes typical of rheumatoid arthritis
At least 4 criteria for a minimum of 6 weeks

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