Pulmonology Mnemonics

TB SMEAR (+) CULTURE (–): 4 Ds

D: DEAD: continued expectoration of dead organisms

D: DEGENERATE: non-cultivable non-TB mycobacteria, unable to proliferate on a standard AFB culture

D: DELAY: excessive > 5 days between collection & inoculation

D: DRUGS: sufficient anti TB levels to suppress growth in vitro

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TB RISK FACTORS: SHE LOVED RICHES

S: Silicosis

H: HIV & Head and neck cancer

E: ESKD

L: Lupus, Lymphoma, Low BMI

O: Operations (gastrectomy) Organ Transplant

V: VDU

E: EtOH

D: DM

R: Recent TB

I: Incarcerated

C: Closed contact

H: Homeless

E: Emigrants

S: Staying in nursing homes

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RISK FACTORS FOR LUNG CANCER: RARITIES

• R: Radon
• A: Asbestos
• R: Radiation (breast cancer)
• I: Ingestion of beta carotene (diet)
• T: Tobacco smoking
• I: Inhaled coal, nickel and vinyl chloride
• E: Exhaust Diesel
• S: Shit Metals & other materials: arsenic, beryllium, cadmium, chromium

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MILLIARY OPACITIES DIFFERENTIALS – MILIARY

• M: Metastases [thyroid, renal cell, breast, malignant melanoma, pancreatic, osteosarcoma, trophoblastic.], Multifocal micronodular pneumocytes hyperplasia MMPH [occurs in Tuberous sclerosis; the other one is LAM]
• I: Infections: TB, fungal, Chicken pox (don’t forget the KFC]
• L: Langerhans cell histiocytosis (LCH) ma
• I: Inhalation: silicosis and CWP Coal Worker Pneumoconiosis
• A: Autoimmune: Hypersensitivity pneumonitis
• R: Reaction to BCG, BCGosis
• Y: Why?
  • Mitral stenosis
  • Pulmonary hemosiderosis
  • Sarcoidosis: miliary sarcoidosis

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BRONCHIECTASIS COMPLICATIONS    

C: Cor pulmonale

O: On top: brain abscess

M: Massive hemoptysis

P: Pleural effusion

L: Lung abscess

I: Infection – empyema

C: Crash – respiratory failure

A: Amyloidosis

T: Tension, pulmonary HTN

I: Inflammation – pleurisy

O: Omas, Aspergillomas

N: Neumothorax

S: Secondary infection – PNM

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RULE OF 50’S: PULMONARY FUNCTION CRITERIA SUGGESTING HIGH RISK IN RESECTIVE SURGERY [LUNG CA]

• FVC < 50% predicted
• FEV₁ < 50% of FVC or < 2L
• DLCO < 50% predicted
• MVV maximal voluntary ventilation < 50%
• RV/TLC > 50%

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THE C’S DDx OF ASTHMA

• Cord dysfunction (vocal cord: this is an exam question)
• Compression: goiter, other mass
• CCF (cardiac asthma)
• Carvedilol and b-blockers (cause bronchoconstriction)
• Chemicals: diisocyanates, persulfates, aldehydes and amines
• Caca: ascariasis
• Crop: animal dung and wood burn (biomass fuel)
• Common allergens: mold (hypersensitivity PNMitis: precipitins from Micropolyspora faenii – Moldy Hay; Malt workers Aspergillus clavatus)
• Colonization with Aspergillus fumigatus
• Cotton mill: byssinosis
• Carcinoid: Kulchitsky’s cells
• Cancer
• Cold & Cold (cold environment and flues)
• COPD
• Chronic bronchitis
• Cough post infectious
• Constrictive bronchiolitis: Iraqi and Afghanistan burn pit combustion and explosion blasts
• Complicated exercise
• Converting enzyme: ACEI (causes angioneurotic edema)
• C₁ esterase inhibitor deficiency (congenital & acquired lymphoproliferative disorders; Rx FFP)
• Ca²⁺ ­increase

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ASTHMA PHENOTYPES: high risk P11 RULE = admit the px please

• P: Patient Phenotypes.
  • FAB: Female (á30 xs) Adult (á7xs) Black
  • IBM: Inner-city Black Male
• P: Pediatric < 5 years
• P: Poor perceiver
• P: Presenting at night (á 10 xs)
• P: Previous ICU or intubation
• P: Past month: > 1H/ED, > 2MDI
• P: Past year: > 2H, > 3ED visits
• P: Prednisone
• P: PNM or other complication
• P: Persistent asthma (>1 week)
• P: Pumpkin like: leptin resistance (obesity) is associated with poor steroid response

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COPD CONTROL (DYSPNEA)

	Controlled	Partial control	Uncontrolled
DaY time	< 2 wk	> 2 wk	3 out of 6 criteria
SABA	< 2 wk	> 2 wk
PEF (i.e. FEV1)	> 80%	< 80%
Night time	0 / month	any
Exacerbation	0 / year	> 1 / year
ADL limitations	0	any

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DISGRACE DIFFERENCES BETWEEN BRONCHITIS & EMPHYSEMA

	BRONCHITIS	EMPHYSEMA
Dyspnea DLCO	Mild late Normal	Severe early Decreased
Infections	common	occasional
Symptoms	Copious cough early	Scanty sputum late
Gamma, ie X Rays	Large heart	Small heart
Respiratory insufficiency	repeated	terminal
Age Airway resistance	40-45 Increased	50-75 Normal/slight increased
Cor pulmonale	Common	Rare Terminal
Elastic recoil	Normal	Decreased

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SARCOIDOSIS EYE/FUNDI CHANGES: remember Land, Bock & Mutton

• Landers sign: retinal granulomas
• Busacca nodules (over the iris)
• Optic disc granulomas
• Candle wax dripping [periphlebitis]
• Koeppe nodules (pupil margins)
• Mutton fat keratic precipitates appearing on Arlt’s triangle (anterior segment of the eye; not on the fundi)

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INTERSTITIAL LUNG DISEASES

6 Is of ILDs

• I: Inherited: Neurofibromatosis, tuberous sclerosis, lymphangiomyomatosis
• I: Iatrogenic: DXT, meds (MTX, nitrofurantoin, amiodarone, Chemio: bleomycin)
• I: Infections: TB
• I: Inhaled: Asbestos, Silicosis, Berylliosis, EAA [Farmer’s lung or Mold hay, etc.]
• I: Immunological: RA, SLE, SS, Sjögren’s, Dermatomyositis, Sarcoid
• I: Idiopathic (Inside circle): cause unknown [IPF: UIP, NSIP, DIP, COP, RB, AIP, LIP]

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Visual mnemonic for 6 Basic Causes