Pulmonology Mnemonics

TB SMEAR (+) CULTURE (–): 4 Ds

DDEAD: continued expectoration of dead organisms

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

DDELAY: excessive > 5 days between collection & inoculation

DDRUGS: sufficient anti TB levels to suppress growth in vitro


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


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

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

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


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%

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

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

COPD CONTROL (DYSPNEA)

ControlledPartial controlUncontrolled
Datime< 2 wk> 2 wk3 out of 6 criteria
SABA< 2 wk> 2 wk
PEF (i.e. FEV1)> 80%< 80%
Night time0 / monthany
Exacerbation0 / year> 1 / year
ADL limitations0any

DISGRACE DIFFERENCES BETWEEN BRONCHITIS & EMPHYSEMA

BRONCHITISEMPHYSEMA
Dyspnea
DLCO
Mild late
Normal
Severe early
Decreased
Infectionscommonoccasional
SymptomsCopious cough earlyScanty sputum late
Gamma, ie X RaysLarge heartSmall heart
Respiratory insufficiencyrepeatedterminal
Age
Airway resistance
40-45
Increased
50-75
Normal/slight increased
Cor pulmonaleCommonRare Terminal
Elastic recoilNormalDecreased

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)

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]

Visual mnemonic for 6 Basic Causes

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