In a coin test, a coin held against the chest is tapped by another coin on the side where the hydropneumothroax is suspected.
A stethoscope is placed on the back to listen to breath sounds and the sound of the coins.
If a tinkling sound is heard, test is positive for hydropneumothorax
Polysomnography is type of sleep study.Its a level 1 sleep study.
It is done in sleep lab and observed in real time by Registered Polysomnography Technologist.
Fishman's 5 th edition
Split pleura sign is a Contrast enhanced CT finding in which there is enhancement of the thickened inner visceral pleura and outer parietal pleura separated by pleural fluid
It is seen with Empyema in a setting of bacterial pneumonia
This is due to fibrin deposition in the visceral and parietal pleura as empyema progresses
References:
Kraus G. The Split Pleura Sign. Radiology. 2007;243(1):297-8.
This test can be done in sitting or supine position. The diaphragm of the stethoscope is placed at the midpoint of the sternum. The chest wall at point equidistant to the left and right of the instrument is scratched with fingers. When the side containing pneumothorax is scratched, the sound is heard louder.
Massive hemoptysis is blood loss of 400 mL in 24 hours or 100–150 mL expectorated at one time.
The causes of massive hemoptysis are Bronchiectasis, Bronchogenic Carcinoma,Eroding Tuberculous cavity,Rasmussen's aneurysm,mycetoma
Reference: Harrison's principles of internal medicine(20th edition)
1)Pleuritic pain
It is caused by inflammation of pleura commonly by infection of underlying pleura.Sharp and stabbing pain aggrevated on deep breathing or coughing
2) Musculoskeletal pain
Pain can occur after prolonged bouts of coughing.
Referance :Hutchison 24 th edition
Bronchovesicular breath sounds are medium pitched.
Both inspiration and expiration heard.
No pause in between.
Often heard over upper third of anterior chest wall.
Measurement of distance between the inferior angle of scapula and the closest horizontal spinous process of the thoracic spine
Skodaic resonance is a high pitched sound elicited by percussion over a cavity just above the level of pleural effusion.
A.Chest wall
-Boils, Lipoma, Fibroma
B.Ribs and Cartilage
-Osteomyelitis, Costochondritis
C.Pleura
-Encysted pleural effusion, Epyema necessitans
D.CVS
-Enlargement of cardiac chamber, Aortic aneurysm
E.Lungs
-Actinomycosis of lung and chest wall
F.Swelling in pectoral area
-Subpectoral abcess, Pectoral major tendon rupture, Post pectoral implant procedure, Post pacemaker implantation, Pectoral muscle rupture with hematoma
G.Others
-Bony prominence, Surgical emphysema
HISTORY:
1.Duration
2.Mode of onset
3.Associated symptoms
4.Pain
5.Progression
6.Exact site
7.Fever
8.Other lumps
9.Secondary changes
10.Impairment of function
11.Recurrence of swelling
12.Loss of body weight
EXAMINATION:
I.INSPECTION:
1.Site
2.Colour
3.Shape
4.Size
5.Surface
6.Edge
7.Number
8.Pulsation
9.Peristalsis
10.Movement with respiration
11.Impulse on Coughing
12.Movement on deglutition
13.Movement with protrusion of tongue
14.Skin over the swelling
15.Any pressure effect
B.PALPITATION:
1.Temperature
2.Tenderness
3.Size,Shape,Extent
4.Surface
5.Edge
6.Consistency
7.Fluctuation
8.Fluid thrill
9.Translucency
10.Impulse on coughing
11.Reducibility
12.Compressibility
13.Pulsatility
14.Fixity to the overlying skin
15.Relation to surrounding structures
C.STATE OF REGIONAL LYMPH NODES
D.PERCUSSION
F.AUSCULTATION
G.MEASUREMENTS
H.MOVEMENTS
S- Site
O- Onset
C- Character
R- Radiation
A- Associated Symptoms
T- Timing (Duration,Course,Pattern)
E- Exacerbating and Relieving Factors
S- Severity
Are thin walled, air filled structures that often develop early in the course of staphylococcal pneumonia, particularly in infants and young children, and usually disappear over the course of a few months. These cystic spaces are believed to be the consequence of check valve opening between a peribronchial abcess and an adjacent bronchus.
Effusions first become apparent on lateral upright radiographs with blunting of the posterior costophrenic angle. An accumulation of 200 ml of fluid is necessary for the effusion tp affect the lateral angles of frontal standing radiographs. Lateral decubitus radiograph with the affected side down is the more sensible view to identify an effusion of 5 to 15 ml.
-overweight
-hyperinflated lungs
-behind the rib
-pericardial effusion
-dextrocardia
PUO is defined as a temperature persistently above 38 degree celcius for more than 3 weeks, without diagnosis, despite initial investigations during 3 days of inpatient care or after more than 2 outpatient visits.
Conversion from farenheit to celsius = (F-32)*5/9
Conversion from celsius to farenheit = (C*9/5)+32
Acute <3 weeks Harrison's principles of internal medicine, 21st edition
Subacute 3-8 weeks
Chronic > 8 weeks
Reference: Harrison's principles of internal medicine, 21st edition
Clinical/pathological definition:-
Right ventricular hypertrophy and/or dilation occuring as a result of an abnormality of lung structure or function.
Radiological definition:-
The combination of pulmonary artery hypertension and chronic lung disease with /without evidence of enlargement of right heart chambers.
Reference from Fraser.
1.Threatened Organ failure -severe ocular/neurologic/cardiac disease
2.Progressive or persistent pulmonary disease
3.Uveitis unresponsive to topical corticosteroids
4.Persistent Hypercalcemia/ renal or hepatic dysfunction
5.Palpable splenomegaly or hypersplenism
6.Severe myopathy
7.Disfiguring skin disease
8.Painful lymphadenopathy
9.Severe fatigue and weight loss
Afferent nerves:
1. Vagus N
2. Glossopharyngeal N
3. Trigeminal N
4. Phrenic N
Cough centre: Medulla- Nucleus tractus solitarius
Efferent nerves:
1. Spinomotor N
2. Phrenic N
3. Vagus N
- seen mostly in females
-more common in Hysteric women
-Bronchoscopy findings:
-abnormal adduction of the Vocal cords during inspiration
Treatment- Psychological counselling and reassurance
1.Threatened Organ failure -severe ocular/neurologic/cardiac disease
2.Progressive or persistent pulmonary disease
3.Uveitis unresponsive to topical corticosteroids
4.Persistent Hypercalcemia/ renal or hepatic dysfunction
5.Palpable splenomegaly or hypersplenism
6.Severe myopathy
7.Disfiguring skin disease
8.Painful lymphadenopathy
9.Severe fatigue and weight loss
Significant colony count in bal should be greater than 10,000 cfu/ml, whereas in urine it is greater than 10(5) cfu/ml
Fever of Unknown origin[FUO] is now defined as
1. Fever >= 38.3°C (>101°F) on at least two occasions.
2. Illness duration of more than or equal to 3weeks.
3.No known immunocompromised state.
4. Diagnosis that remain uncertain after thorough history taking , physical examination, and the following obligatory investigations:
ESR, C reactive protein (CRP) ;
platelet count; leukocyte count and differential; hemoglobin,
electrolytes, creatinine,
total protein, alkaline phosphatase, alanine aminotransferase, aspartate aminotransferase,
lactate dehydrogenase, creatine kinase,
ferritin, antinuclear antibodies, and rheumatoid factor;
protein electrophoresis; urinalysis;
blood cultures (n = 3); urine culture;
chest x-ray; abdominal ultrasonography; and
tuberculin skin test (TST) or interferon γ release assay (IGRA).
Reference: Harrison
For adults more than 18years and children weighing more than 39kgs :
weight band in FDC
(H75 / R150 / Z400 / E275 )
25kg to 34 kg - 2 FDC
35kg to 49kg - 3FDC
50kg to 64kg - 4FDC
65kg to 75kg - 5FDC
>75kg - 6FDC
if during the course of treatment, weight increases to next weight band, FDC should be increased.
PUO is defined as a temperature persistently above 38 degree celcius for more than 3 weeks, without diagnosis, despite initial investigations during 3 days of inpatient care or after more than 2 outpatient visits.
-overweight
-hyperinflated lungs
-behind the rib
-pericardial effusion
-dextrocardia
"an acute event characterized by a worsening of the patient's respiratory symptoms that is beyond normal day-to-day variations and leads to a change in medication"
by the Global Initiative for Chronic Obstructive Lung Disease (GOLD), a report produced by the National Heart, Lung, and Blood Institute (NHLBI) and the World Health Organization (WHO).
●Cough increases in frequency and severity
●Sputum production increases in volume and/or changes character
●Dyspnea increases
Definition :
Clubbing of the fingers designates the selective bulbous enlargement of the distal segments of the digits due to an increase in soft tissue.
Mechanism :
1.The circulating megakaryocytes and large platelet particles present in the venous circulation normally break up in the pulmonary vascular bed. Megakaryocyte or platelet clusters, lodged in the peripheral vasculature of the digits, release platelet-derived growth factor (PDGF) and lead to the increased vascularity, permeability, and connective tissue changes that are the hallmark of clubbing.
Release of VEGF and PDGF occurred after platelet impaction and is enhanced by hypoxia. VEGF along with PDGF induces the pathological changes of digital clubbing.
From LUNG INDIAMalay Sarkar1, DM Mahesh2, Irappa Madabhavi3
1 Department of Pulmonary Medicine, Indira Gandhi Medical College, Shimla, India
DEFINITION :
reduction in systolic blood pressure of at least 20 mmHg or
diastolic blood pressure of at least 10 mmHg
within 3 min of standing or head-up tilt on a tilt table,
It is a manifestation of sympathetic vasoconstrictor (autonomic) failure.
Ref : Harrison
The first place for pleural fluid to accumulate in an erect patient is the space between the inferior surface of the lower lobe and the diaphragm. Only after filling this space, it will spill over into the costophrenic angles.
In CXR, the subpulmonic effusion stimulates diaphragmatic elevation thus called as pseudo diaphragmatic contour.
1. PA view :-The peak of pseudo diaphragmatic configuration is lateral to that normal hemidiaphragm being situated near the junction of middle and lateral third of diaphragm.
2.PA view :-On the left side, subpulmonic effusion is suspected if the distance between the gastric air bubble shadow and pseudo diaphragmatic shadow is more than 2cm.
3.Lateral view ;-upper margin of fluid meets the major fissure.
4.PA view: thin triangular opacity in the left paramediastinal zone with apex half way upto the mediastinum and its base continuous with pseudo diaphragmatic shadow.
5.PA view : The pulmonary vessels normally visible below the diaphragmatic contour, cannot be seen through the pseudo diaphragmatic contour of the subpulmonic effusion.
Ref : Fraser
According to Fleischner Society,
pulmonary cavities are defined as "a gas-filled space, seen as a lucency or low-attenuation area, creating wall thickness >2-4 mm , within pulmonary consolidation, a mass, or a nodule"
Bleb Bulla Cyst
Site : Within visceral pleura Arises within secondary lobule Lung parenchyma or mediastinum
Size : 1–2 cm 1 cm to 75% of a lung 2–10 cm
Lining :Elastic laminae of pleura Connective tissue septa Epithelium
Associated: Spontaneous pneumothorax Bronchogenic carcinoma Respiratory infection
condition
BULLA:
A bulla is an air-containing space within the lung parenchyma that
arises from destruction, dilatation, and confluence of airspaces
distal to terminal bronchioles and is larger than 1 cm in diameter
BLEB:
A bleb is an accumulation of air between the two layers of the
visceral pleura that arises when the thin covering of the bleb ruptures
and permits entry of air.
CYST:
Cysts are epithelial-lined cavities that may resemble bullae on radiographs
(FISHMAN)
Effusions first become apparent on lateral upright radiographs with blunting of the posterior costophrenic angle. An accumulation of 200 ml of fluid is necessary for the effusion tp affect the lateral angles of frontal standing radiographs. Lateral decubitus radiograph with the affected side down is the more sensible view to identify an effusion of 5 to 15 ml.
Are thin walled, air filled structures that often develop early in the course of staphylococcal pneumonia, particularly in infants and young children, and usually disappear over the course of a few months. These cystic spaces are believed to be the consequence of check valve opening between a peribronchial abcess and an adjacent bronchus.
The right bronchial artery usually (78% of people) arises within a common stem, with the first aortic intercostal (inter-costobronchial artery) from the posteromedial aspect of the descending aorta.
On the left side, there is generally a superior and an inferior branch, both arising from the anterior aspect of the descending thoracic aorta.
The bronchial arteries run into the hilum, where they branch in a parallel manner and close to the bronchus to the peripheral airways.
The diameters of these arteries are small, usually 1–1.5 mm at its origin within the mediastinum.
Leukoplakia
Oral thrush
Atypical kaposi sarcoma.
Oral hairy leukoplakia.
White coated tongue
It is due to the indrawing of ribs to
form symmetrical horizontal grooves above the
costal margin, along the line of attachment of
diaphragm due to hyperinflation of the lungs and
repeated strong contraction of the diaphragm as
occurs in chronic respiratory disease in childhood,
childhood asthma, rickets and blocked nasopharynx
due to adenoid enlargement
Pre renal AKI
BUN/ Creat ratio >20
FeNa < 1%
Urine specific gravity> 1.018
Urine osmolality >500mOsm/kg
|
Right atrium |
0-4 |
|
Right ventricle |
25 systolic; 4
diastolic |
|
Pulmonary artery |
25 systolic; 10
diastolic |
|
Left atrium |
8-10 |
|
Left ventricle |
120 systolic; 10
diastolic |
|
Aorta |
120 systolic; 80
diastolic |
Presence of pus in pleural space is defined as empyema thoracis.
If this empyema is left undrained or untreated, it may extend beyond the pleural cavity with pointing occurring in the intercostal space close to the sternum where chest wall is thinnest.
Empyema necessitans denotes lesion that has ruptured through the chest wall to the subcutaneous tissue ultimately reaching the surface through the skin to form a discharging sinus. It is seen in tuberculosis and actinomycetes.
Treatment:-
Surgical dilatation of fistulous tract may assist drainage which can be collected in colostomy bags followed by decortication.
Ref : Crofton
Pyrexia of unknown origin (PUO) is defined as a temperature persistently above 38.0°C for more than 3 weeks, without diagnosis, despite initial investigation during 3 days of inpatient care or after more than two outpatient visits (DAVIDSON)
Yellow sputum- Presence of leukocytes
Green sputum - Due to stagnation of sputum, liberation of green enzyme- Verdoperoxidase or myeloperoxidase
Yellow and green- usually due to infection, can be occasionally seen in early morning sputum in chronic bronchitis (due to nocturnal accumulation)
Rusty sputum- pneumococcal pneumonia
Anchovy sauce- Ruptured amebic abscess
Meloptysis(black sputum)- Necrotic massive fibrosis of Coal miners
Reg- Crofton and Douglas
A parasternal heave is detected by placing the heel of the hand over the left parasternal region. In the presence of a heave the heel of the hand is lifted off the chest wall with each systole.
A parasternal heave is caused by:
Emphysema is a condition of the lung characterized
by abnormal, permanent enlargement of the airspaces distal to
the terminal bronchiole, accompanied by destruction of their walls.
COPD is a common preventable and treatable disease that is characterized by persistent respiratory symptoms and airflow limitation, due to airway/alveolar abnormalities, usually caused by significant exposure to noxious particles or gases and influenced by host factors like abnormal lung development.
Bronchovesicular breath sounds are medium pitched.
Both inspiration and expiration heard.
No pause in between.
Often heard over upper third of anterior chest wall.
Measurement of distance between the inferior angle of scapula and the closest horizontal spinous process of the thoracic spine.
Skodaic resonance is a high pitched sound elicited by percussion over a cavity just above the level of pleural effusion.
A.Chest wall
-Boils, Lipoma, Fibroma
B.Ribs and Cartilage
-Osteomyelitis, Costochondritis
C.Pleura
-Encysted pleural effusion, Epyema necessitans
D.CVS
-Enlargement of cardiac chamber, Aortic aneurysm
E.Lungs
-Actinomycosis of lung and chest wall
F.Swelling in pectoral area
-Subpectoral abcess, Pectoral major tendon rupture, Post pectoral implant procedure, Post pacemaker implantation, Pectoral muscle rupture with hematoma
G.Others
-Bony prominence, Surgical emphysema
Bronchophony, is the abnormal transmission of sounds from the lungs or bronchii. It is a general sign, detected by auscultation. The patient is requested to repeat a word several times while the physician auscultes symmetrical areas of each lung. Normally, the sound of the patient's voice becomes less distinct as the auscultation moves peripherally; bronchophony is the phenomenon of the patient's voice remaining loud at the periphery of the lungs or sounding louder than usual over a disctinct area of consolidation...seen in conditions like consolidation, cavity communicating with a bronchus,above the level of pleural effusion
TERMINAL RESPIRATORY UNIT
It consists of all alveolar ducts and all of the accompanying alveoli that stem from the proximal respiratory bronchiole.
In human, one unit contains approximately 100 alveolar ducts and 2000 alveoli. It measures about 5mm diameter and 0.02ml volume at FRC. An acinus contains 10-12 Terminal Respiratory Unit(TRU).
The gas exchange amongst the structures in TRU occurs more rapidly. All parts of the TRU participate in volume changes in respiration.
Alveoli is a complex structure with flat walls and sharp curvature at the junctions between the walls. The wall of the alveoli are predominately made of pulmonary capillaries.
The inner lining of the alveoli are made up of cuboidal type II cells and flattened type I cells. The type I cells occupy all surface area of the lung though their number is less than Type II cells.
Ref : Murray
Pleural effusion that remains in the infrapulmonary location without spilling into the costophrenic sulci or extending up the chest wall.
Characteristics in CXR:
a) apparent elevation of one or both diaphragms
b) Apex of the diaphragm is more lateral than usual
c) Apparent diaphragm slopes much more sharply towards lateral costophrenic angle
d) if subpulmonic effusion is on left side- lower border of lung is separated farther at its junction with infrapulmonary effusion
e) lower lobe vessels may not be seen
Bronchial breath sounds
1. Character - harsh and loud, may be high pitched ( consolidation) or low pitched
2. Expiration - all of expiration heard
3. Gap - clear pause between inspiratory sound and expiratory sound
1. MMRC SCALE, 2.TRANSITION DYSPNEA INDEX(TDI), 3.VISUAL ANALOGUE SCALE, 4. BORG SCALE, 5. Baseline Dyspnea Index
Radiological signs of atelectasis
Direct signs
1. Displacement of interlobar fissures
2. Crowding of vessels and bronchi
Indirect signs
1. Local increase in opacity
2. Elevation of hemidiaphragm
3. Displacement of mediastinum
4. Compensatory overinflation
5. Displacement of hila
6. Approximation of ribs
7. Absence of air bronchogram
8. Absence of visiblity of the interlobar artery
Four types of atelectasis
1. Resorption atelectasis
2. Relaxation atelectasis
3. Adhesive atelectasis
4. Cicatrization atelectasis
Fever is an elevation of body temperature that exceeds normal daily variation and occurs in conjunction with an increase in hypothalamic set point.
Temperature(oral) > 37.2 or > 98.9 at AM or
>37.7 or > 99.9 at PM
Reg- Harrison
Apical Impulse :- outermost and lower most point of definite cardiac impulse in the precordium.
Impalpable Apical Impulse is seen in
-overweight
-hyperinflated lungs (eg: COPD)
-behind the rib.
-pericardial effusion
-dextrocardia.
Mycoplasma pneumoniae
Chlamydophila--C.psittaci,C.pneumoniae
Bacteria--legionella,F.tularensis,Y.pestis,B.anthracis
Fungi--histoplasma,blastomyces,coccidioides,pneumocystis
Aspiration pneumonitis
Viral-influenza, adenovirus,RSV,parainfluenza,metapneumovirus,varicella-zoster,measles,EBV,CMV,hantavirus
Rickettsia-q fever
Local
1.Haemoptysis
2.Post-tuberculosis bronchiectasis
3.Fungal ball [aspergilloma]
4.Tuberculosis endobronchitis and tracheitis
5.Spontaneous pneumothorax
6.Scar carcinoma
7.Disseminated calcification of the lungs
8.Pulmonary function changes, obstructive airways disease
9.Secondary pyogenic infections
Systemic
1.Secondary amyloidosis
2.Chronic respiratory failure
3.Chronic cor-pulmonale
The upper limit of dullness is at least a space higher in the axilla compared to the limits of dullness anteriorly and posteriorly. Because of the shape of upper border of dullness , this is called Ellis''S'' curve, a phenomenon, which can also be observed radiologically.This is a radiological illusion and occurs as a medial radiological density due to the presence of partially aerated lung between the anterior and posterior fluid layers whereas the laterally the density is higher due to the presence of fluid only
The sensation appears to have two primary peripheral sensors—chemoreceptors and vagal C fibers; the chemoreceptors probably include the aortic and carotid bodies and/or vagal C fibers. Additional afferent information is provided by chest wall mechanoreceptors and vagal stretch receptors.
Afferent neural information is conveyed to the NTS in the medulla and from there, probably via the thalamus, to the insular cortex and limbic system, especially the anterior insula, and the sensorimotor cortex.
Thus, it can be speculated that dyspnea occurs when there is an increase above usual levels of reflex afferent information from the peripheral sensors, which is processed in the insula and cortical network and generates a neural output to the respiratory system; afferent feedback on the effects of this neural output (pulmonary volume change, airflow, and ventilation), is provided by the pulmonary stretch and other receptors innervated by the vagal nerves and by chest wall mechanoreceptors.
If central neural output does not produce the expected result (airflow or ventilation), either because of muscle paralysis or abnormal lung mechanics (eg, in COPD, asthma or restrictive lung disease), a sensation of dyspnea is generated.
In asthma and COPD the relationship between inspiratory neural drive and ventilatory output, and therefore dyspnea, may worsen (increased functional residual capacity) on exercise and improves with bronchodilation.
This assumes that the cortical centers have a pre-existing memory of “normal” afferent input and “normal” respiratory system response, in terms of effort required to achieve a given airflow or ventilation.
The extent of the mismatch between the new afferent/efferent information and preexisting memory, (“a change in the relationship between central respiratory drive and output, ie, ventilation or effort”) determines the intensity of dyspnea.
HISTORY:
1.Duration
2.Mode of onset
3.Associated symptoms
4.Pain
5.Progression
6.Exact site
7.Fever
8.Other lumps
9.Secondary changes
10.Impairment of function
11.Recurrence of swelling
12.Loss of body weight
EXAMINATION:
I.INSPECTION:
1.Site
2.Colour
3.Shape
4.Size
5.Surface
6.Edge
7.Number
8.Pulsation
9.Peristalsis
10.Movement with respiration
11.Impulse on Coughing
12.Movement on deglutition
13.Movement with protrusion of tongue
14.Skin over the swelling
15.Any pressure effect
B.PALPITATION:
1.Temperature
2.Tenderness
3.Size,Shape,Extent
4.Surface
5.Edge
6.Consistency
7.Fluctuation
8.Fluid thrill
9.Translucency
10.Impulse on coughing
11.Reducibility
12.Compressibility
13.Pulsatility
14.Fixity to the overlying skin
15.Relation to surrounding structures
C.STATE OF REGIONAL LYMPH NODES
D.PERCUSSION
F.AUSCULTATION
G.MEASUREMENTS
H.MOVEMENTS
S- Site
O- Onset
C- Character
R- Radiation
A- Associated Symptoms
T- Timing (Duration,Course,Pattern)
E- Exacerbating and Relieving Factors
S- Severity
- Definition:-
Inspiratory decline in systolic pressure greater than 10mm of Hg.
- Measurement :-
Step 1 : inflate blood pressure cuff until no sounds are heard.
Step 2 : slowly decrease the pressure until systolic sound are heard during expiration but not during inspiration. Note this pressure
Step 3 : decrease the pressure further until sounds are heard through out the respiratory cycle. Note this pressure.
Step 4 : if pressure difference between the two is greater than 10mm Hg, it is called as Pulsus Paradoxus.
- Seen in :-
Acute severe Asthma.
Cardiac tamponade.
Pericardial constriction.
- Mechanism :-
Normally, during inspiration, there is a decrease in intra thoracic pressure which results in increased venous return. This causes increased right ventricular filling and stroke volume, but the left ventricular stroke volume falls slightly.
But in Cardiac tamponade and pericardial constriction, the increased inspiratory right ventricular stroke volume reduces the left ventricular compliance, resulting in pronounced fall in systolic pressure during the inspiration.
In case of acute severe asthma, the negative pleural pressure increasing the afterload and thereby impedance to left ventricular filling.
BODY MASS INDEX.
It is a simple index of weight for height that is commonly used to classify underweight, over weight and obesity in adults.
It is defined as weight in Kgs divided by square of the height in meters.(kg/m^2).
It is age and sex independent.
WHO classification :
BMI :-
<18.5 = underweight.
18.5 - 24.9 = normal range.
25 - 29.99 = pre obese.
30 - 34.99 = obese class I.
35 - 39.99 = obese class II.
>= 40 = obese class III.
Drawback :-
BMI does not distinguish between weight associated with muscle and weight associated with fat.
So, increased BMI need not imply increased fat content in the body.
