Acute <3 weeks

Subacute 3-8 weeks

Chronic > 8 weeks

Significant colony count in BAL

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

 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 

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

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

weight band in FDC

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.

Pyrexia of unknown origin

 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.

Causes of impalpable apical impulse

 -overweight

-hyperinflated lungs

-behind the rib

-pericardial effusion 

-dextrocardia

AE - COPD

1.  An exacerbation of chronic obstructive pulmonary disease (COPD) is defined as

 "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).

1.  This generally includes an acute change in one or more of the following cardinal symptoms:

●Cough increases in frequency and severity

●Sputum production increases in volume and/or changes character

●Dyspnea increases

CLUBBING

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.

Unilateral clubbing :-

Anomalous aortic arch 
Aortic or subclavian artery aneurysm 
Pulmonary hypertension with patent ductus arteriosus 
Brachial arteriovenous aneurysm or fistula 
Recurrent shoulder dislocation 
Superior sulcus (Pancoast) tumor 

Unidigital :- 
Median nerve injury 
Sarcoidosis 

Clubbing of toes without fingers (differential clubbing) :- 
Coarctation of aorta

From LUNG INDIAMalay Sarkar¹, DM Mahesh², Irappa Madabhavi^3
1 Department of Pulmonary Medicine, Indira Gandhi Medical College, Shimla, India

ORTHOSTATIC HYPOTENSION

 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