Causes of impalpable Apical impulse

  -overweight

-hyperinflated lungs

-behind the rib

-pericardial effusion 

-dextrocardia

Definition of PUO

 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 of C to F

 Conversion from farenheit to celsius = (F-32)*5/9

Conversion from celsius to farenheit = (C*9/5)+32

Acute,Subacute,Chronic

  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

Cor pulmonale

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.

Indications for steroids in Sarcoidosis

  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

Pleuroscopy guidelines

 Pleuroscopy guidelines- click on the link

TIDAL PERCUSSION

 REFERENCE : MANUAL OF CLINICAL METHODS BY P.S.SHANKAR

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Cough reflex

 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