Factitious Asthma

 - seen mostly in females

-more common in Hysteric women

-Bronchoscopy findings:

   -abnormal adduction of the Vocal cords during inspiration

Treatment- Psychological counselling and reassurance

Indication of 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

 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