Upper lobe pulmonary fibrosis (mnemonic)

Dr Bruno Di Muzio and Radswiki et al.

.

Conditions which lead to predominantly upper lobe pulmonary fibrosis can be

remembered using the mnemonics:
CASSET P
ST CASH
BREASTS

Mnemonic

CASSET P
C: cystic fibrosis
A: ankylosing spondylitis
S: silicosis
S: sarcoidosis
E: eosinophilic granuloma (Langerhans cell histiocytosis)
T: tuberculosis
P: PCP - PJP

ST CASH
S: sarcoidosis
T: tuberculosis
C: cystic fibrosis

 A: ankylosing spondylitis
S: silicosis
H: histiocytosis X

BREASTS
B: berylliosis
R: radiation
E: eosinophilic granuloma (Langerhans cell histiocytosis) or EAA
A: ankylosing spondylitis
S: sarcoidosis
T: tuberculosis
S: silicosis

Stridor causes
February 10, 2012

Stridor is A Very WELSH Condition

Acute epiglotitis (acute stridor)

Vocal cord paralysis (chronic stridor)
Web, laryngeal (chronic)
External compression e.g. vascular ring (chronic)
Laryngomalacia (chronic)
Subglottic stenosis (chronic)
Hypocalcaemia (chronic)
Croup (acute)

Sarcoidosis features
February 15, 2012

SARCOID
Skin erythema nodosum
Arthritis esp. of feet, hands
Respiratory bilateral hilar lymphadenopathy, pulmonary infiltrates
Cardiac heart block, VT, heart failure
Ocular anterior uveitis, can lead to blindness
Intracranial (brain) chronic meningitis, seizures, neuropathy
Derangement of liver and renal function hepatic granuloma (70% patients),
hypercalcaemia (can lead to kidney stones and nephrocalcinosis)

Acute asthma management

February 24, 2012

O SHIT!
Oxygen
Salbutamol nebuliser
Hydrocortisone IV
Ipratropium bromide
Theophylline

Clubbing respiratory causes

February 27, 2012

Newly Sprouted Fingers

Neoplasia bronchial carcinoma, mesothelioma
Suppurative lung disease cystic fibrosis, bronchiectasis, abscess, empyema
Fibrotic lung disease cryptogenic fibrosing alveolitis, connective tissue disease
(e.g. RA, SLE)

Fine crackles causes

March 1, 2012

Fine crackles, the 2 Fs:

Fibrosis
Failure (cariac)

Coarse crackles may indicate airway pathology e.g. pneumonia/bronchiectasis.

Life-threatening breathing injuries

April 21, 2012

Important to rule out the following during primary survey

ATOM FC

Airway obstruction
Tension pneumothorax
Open pneumothorax
Massive haemorrhage (>1500ml)
Flail chest abnormal breathing within lung tissue

 Cardiac tamponade

Hypoxaemia causes
April 23, 2012

LAVISH
Low inspired O2 ( decreased PiO2)
Alveolar hypoventillation
Ventilation/perfusion (V/Q) mismatch
Impaired diffusion
SHunt e.g. pulmonary AV shunt, pneumonia, oedema

Restrictive lung disease causes

April 24, 2012

SPICE
Space-occupying lesion e.g. tumour, cyst
Pleural disease e.g. effusion, pneumothorax
Interstitial lung disease e.g. fibrosis, oedema
Chest wall disease e.g. kyphosis, neuromuscular disease
Extrathoracic conditions e.g. obesity, ascites, pregnancy
Pneumonia complications
June 8, 2012

SLAP HER
Septicaemia spread from lung parenchyma, can lead to metastatic infection e.g.
endocarditis

 Lung abcess look for swinging fever, foul-smelling sputum, weight loss,
haemoptysis, pleuritic chest pain
Atrial fibrilation esp. in elderly, may require beta-blocker
Pericarditis/myocarditis may complicate pneumonia
Hypotension may be due to dehydration and sepsis-induced vasodilatation
Empyema if recurrent fever, yellowish pleural effusion aspirated
Respiratory failure type 1 is common, act if PaCO2 >6kPa

Respiratory history
July 17, 2012

CAPTION
Cough +/- sputum, purulent, blood
Atopy or allergy
Pain site and if pleuritic
Timing of breathlessness e.g. nocturnal / acute
Infective prodrome or not including gastrointestinal symptoms
Other similar episodes
Normal state and treatment usual morbidity / co-morbidity

Causes of upper zone pulmonary fibrosis (A TEA SHOP)

ABPA
TB
Extrinsic allergic alveolitis
Ankylosing Spondylitis
Sarcoidosis

Histiocytosis
Occupational (silicosis, berylliosis)
Pneumoconiosis (coal-workers)

Aspiration of foreign body (which bronchus is more vertical)

Inhale a bite, goes down right

Features of a life-threatening asthma attack (A CHEST)

Arrhythmia/ Altered conscious level
Cyanosis, PaCO2 normal
Hypotension, Hypoxia (PaO2<8kPa, SpO2 <92%)
Exhaustion
Silent chest
Threatening PEF < 33% best or predicted (in those >5yrs old)

Definition of Acute Respiratory Distress Syndrome (ARDS)

Mnemonic: ROAR
R
O

Reduced lung compliance

Oedema, non-cardiogenic pulmonary

Acute respiratory failure

Refractory hypoxaemia

Causes of Acute Respiratory Distress Syndrome (ARDS)

Mnemonic: ARDS
A

Aspiration-gastric/Acute pancreatitis/Amniotic fluid embolus

Raised ICP/Respiratory tract infection pneumonia

DKA/DIC/Drugs

Sepsis/Shock/Smoke inhalation/Severe burns

Risk factors of asthma

Mnemonic: FEAR UP
F

Family history

Eczema

Acid reflux

Rhinitis (allergic)

Urticaria

Polyps (nasal)

History of asthma
Mnemonic: WIND
W

Wheeze

Interferes with schooling, exercise, sleep and work

Nocturnal cough, or early morning cough

Dyspnoea

Clinical manifestations of influenza infection

Mnemonic: FLU
F

Fever

Lethargy

Upset appetite (nausea and vomiting)

Features of Tuberculosis (TB)

Mnemonic: 4 Cs
C

Cough

Caseation

Calcification

Cavitation