RESPIRATORY SYSTEM MNEMONICS | INTERNAL MEDICINE

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Acute Respiratory Distress Syndrome (ARDS) Definition : "ROAR"
R - Reduced lung compliance
O - Oedema, non-cardiogenic pulmonary
A - Acute respiratory failure
R - Refractory hypoxaemia

Acute asthma management : "O SHIT!"
O - Oxygen
S - Salbutamol nebuliser
H - Hydrocortisone IV
I - Ipratropium bromide
T - Theophylline

Adult Respiratory Distress Syndrome (ARDS) causes: "ARDS"
A - Aspiration/Acute pancreatitis/Air embolism/Amniotic embolism
R - Radiation
D - DIC/Drugs/Drowning/Dialysis/Diffuse lung infection
S - Shock/Sepsis/Smoke inhalation

Asthma History: "WIND"
W - Wheeze
I - Interferes with schooling, exercise, sleep and work
N - Nocturnal cough, or early morning cough
D - Dyspnoea

Asthma risk factors : "FEAR UP"
F - Family history
E - Eczema
A - Acid reflux
R - Rhinitis (allergic)
U - Urticaria
P - Polyps (nasal)

Bronchial obstruction consequences: "APPLE BABE"
A - Atelectasis
P - Pleural adhesions
P - Pleuritis
L - Lipid pneumonia
E - Effusion->organisation->fibrosis
B - Bronchiectasis
A - Abscess
B - Broncho and lobar pneumonia
E - Emphysema

Buerger's disease features : "burger SCRAPS"
S - Segmenting thrombosing vasculitis
C - Claudication (intermittent)
R - Raynauds phenomenon
A - Associated with smoking
P - Pain, even at rest
S - Superficial nodular phlebitis

COPD 4 types and hallmark : "ABCDE"
A - Asthma
B - Brochiectasis
C - Chronic bronchitis
D - Dyspnea (hallmark of group)
E - Emphysema

Alternatively : replace Dyspnea with Decreased FEV1/FVC ratio.

Clubbing respiratory causes : "Not For Sale"

Neoplasia , bronchial carcinoma, mesothelioma.

Fibrotic lung disease , cryptogenic fibrosing alveolitis, connective tissue disease (e.g. RA, SLE).

Suppurative lung disease , cystic fibrosis, bronchiectasis, abscess, empyema.

Crackles: Fine crackles causes:
"2 Fs"
Fibrosis
Failure (cariac)

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

Crackles always occur during inspiration.

Emphysema types, most important feature of each : "Cigarettes Is Primary Problem"
Types:
• Centrilobular
• Irregular
• Pancinar
• Paraseptal

Most important feature for each type (in order as above):
• Cigarrettes
• Inflammation healed to scar
• Protease inhibitor deficiency (a1-antitrypsin)
• Pneumothorax
"Cigarettes is primary problem" used since cigarettes is most common cause of emphysema.
Keeping Ps straight: Pan is antitrypsin.

Hypoxaemia causes : "MAVISH"
M - Minimum(low) inspired O2 ( decreased PiO2)
A - Alveolar hypoventillation
V - Ventilation/perfusion (V/Q) mismatch
I - Impaired diffusion
SH - SHunt e.g. pulmonary AV shunt, pneumonia, oedema

Influenza infection Clinical manifestations : "FLU"
F - Fever
L - Lethargy
U - Upset appetite (nausea and vomiting)

Interstitial lung disease causes: "DISCO ARI"
D - Drugs
I - Idiopathic
S - Sarcoidosis
C - Connective tissue disease
O - Occupational exposure
A - Allergic reaction
R - Radiation
I - Infection

Life-threatening breathing injuries: Important to rule out the following during primary survey "ATOM FC"
A - Airway obstruction
T - Tension pneumothorax
O - Open pneumothorax
M - Massive haemorrhage (>1500ml)
F - Flail chest abnormal breathing within lung tissue
C - Cardiac tamponade

Pneumonia complications : "SLAP HER"

S - Septicaemia , spread from lung parenchyma, can lead to metastatic infection e.g. endocarditis.

L - Lung abcess , look for swinging fever, foul-smelling sputum, weight loss, haemoptysis, pleuritic chest pain.

A - Atrial fibrilation esp. in elderly, may require beta-blocker.

P - Pericarditis/myocarditis may complicate pneumonia.

H - Hypotension , may be due to dehydration and sepsis-induced vasodilatation.

E - Empyema , if recurrent fever, yellowish pleural effusion aspirated.

R - Respiratory failure , type 1 is common, act if PaCO2 >6kPa.

Pneumothorax presentation: "P-THORAX"
P : Pleuretic pain
T : Trachea deviation
H : Hyperresonance
O : Onset sudden
R : Reduced breath sounds (& dypsnea)
A : Absent fremitus
X : X-ray shows collapse

Pulmonary embolism risk factors : "7 Hs"
• Hereditary (eg factor V Leyden, protein C or S deficiency)
• History (previous DVT or PE)
• Hypomobility (fracture, CVA, severe illness, obesity, long trip)
• Hypovolaemia (nephrotic syndrome, dehydration)
• Hypercoagulability (smoking, malignancy)
• Hormones (oestrogens [esp. in OCP], puerperium)
• Hyperhomocysteinaemia

Pulmonary embolism risk factors: "REFERS TO CMPH"
R - Rest (bed-ridden)
E - Elderly
F - Fracture
E - Estrogen (pregnancy, post-partum)
R - Road trip
S - Surgery
T - Trauma
O - Obesity
C - Cardiac disease
M - Malignancy
P - Past history
H - Hospitalization

Pulmonary fibrosis: differential of both upper and lower lobes: "BREAST SCAR"
Upper lobe:
Beryliosis
Radiation
Extrinsic allergic alveolitis
Ankylosing spondylitis
Sarcoidosis
TB
Lower lobe:
S - Systemic sclerosis
C - Cryptogenic fibrosing alveolitis
A - Asbestosis
R - Radiation

Respiratory distress syndrome in infants major risk factors: "PCD" (Primary Ciliary Dyskinesia, a cause of Respiratory distress syndrome)
P - Prematurity
C - Cesarean section
D - Diabetic mother

Respiratory history : "CAPTION"
C - Cough +/- sputum, purulent, blood
A - Atopy or allergy
P - Pain : site and if pleuritic
T - Timing of breathlessness e.g. nocturnal/acute
I - Infective prodrome or not including gastrointestinal symptoms
O - Other similar episodes
N - Normal state and treatment –usual morbidity/co-morbidity

Restrictive lung disease causes: "SPICE"
S - Space-occupying lesion e.g. tumour, cyst
P - Pleural disease e.g. effusion, pneumothorax
I - Interstitial lung disease e.g. fibrosis, oedema
C - Chest wall disease e.g. kyphosis, neuromuscular disease
E - Extrathoracic conditions e.g. obesity, ascites, pregnancy

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

Stridor causes : "Check English Variety SHAWL"
C - Croup (acute)
E - External compression e.g. vascular ring (chronic)
V - Vocal cord paralysis (chronic stridor)
S - Subglottic stenosis (chronic)
H - Hypocalcaemia (chronic)
A - Acute epiglotitis (acute stridor)
W - Web, laryngeal (chronic)
L - Laryngomalacia (chronic)

TB features , TB is characterised by : "4 Cs"
Caseation
Calcification
Cavitation
Cicatrization

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