Coupon Accepted Successfully!


Miscellaneous topics

  1. Diaphragmatic paralysis
    1. "Most patients with severe diaphragmatic weakness present with hypercapnic respiratory failure Patients present with hypercapnic respiratory failure, frequently complicated by cor-pulmonale, right ventricular failure (because of hypoxemic vasoconstriction in the lungs) pneumonia and atelectasis.
    2. Sniff test is a confirmatory test of unilateral diaphragmatic paralysis. Whether sniff test is also useful for bilateral diaphragmatic paralysis is unconfirmed, although it could show a paradoxical diaphragm movement on both side. (The person is asked to sniff and is observed with fluoroscopy. The paralyzed diaphragm moves paradoxically upwards during inhalation due to negative intrathoracic pressure.)
    3. Diaphragmatic pacing may be a viable alternative if the nerve to the diaphragm is intact.
      Treatment of choice for Bilateral Diaphragmatic Paralysis is assisted ventilation


  1. Unilateral paralysis occurs due to more local cause e.g. nerve invasion from bronchogenic carcinoma. Patients are usually asymptomatic.
  2. Bilateral paralysis occurs due to more central or generalized causes e.g. high spinal cord injury, muscular dystrophy) chest trauma.
  1. Mediastinitis

Most cases of acute mediastinitis are due to esophageal perforation or occur after median sternotomy for cardiac surgery



Acute Mediastinitis Chronic Mediastinitis
1. Esophageal rupture 1. Tuberculosis
2. Median sternotomy for cardiac surgery 2. Histoplasmosis
3. Other fungal diseases 3. Sarcoidosis
  4. Silicosis
  1. Pulmonary Renal syndrome

Differential diagnosis of the “Pulmonary Renal syndrome”

  1. Lung hemorrhage and glomerulonephritis
    1. ANCA-associated vasculitis
      1. Wegener's granulomatosis                
      2. Microscopic polyarteritis
      3. Churg Strauss Syndrome          
      4. Renal Limited vasculitis
    2. Anti-GBM disease - Good posture's syndrome
    3. Cryoglobulinemia vasculitis
    4. Henoch-Schönlein purpura
    5. Beh|et’s syndrome
    6. Systemic lupus erythematosus, RA, systemic sclerosis, Polymyositis and other connective tissue disorders
  2. Pulmonary infections with renal failure
    1. Any severe pneumonia with ATN
    2. Legionella
    3. Hantavirus
    4. Leptospirosis
  3. Severe pulmonary oedema associated with renal failure of any cause
    1. RPGN
    2. Idiopathic immune complex GN
  4. Pulmonary emboli with IVC thrombosis
  5. Paraquat poisoning 
  1. Lung Collapse

Collapse of Right lung may present with homogeneous opacification of right hemithorax and ipsilateral mediastinal Shift·








Ipsilateral Homogenous opacification & No mediastinal shift

Ipsilateral Homogenous opacification & Ipsilateral mediastinal shift

Ipsilateral homogenous opacification & Contralateral shift

Ipsilateral homogenous opacification & Contralateral shift


Characteristic pathological changes in Lungs

1. Thickening of bronchial epithelial basement membrane 2. Thickening of alveolar capillary membrane Characteristic of interstitial lung disease
a. Asthma (diffuse and hyaline) (Associated with decreased DLCO)
b. Other parenchymal chronic inflammatory disease (Associated with normal DLCO)  

Emphysema causes a decrease in DLCO due to reduced surface area of alveolar capillary bed and not due to thickening of alveolar capillary membrane.


Smoking & Lung Disease


Respiratory disease linked to smoking

Significant associations

Less significant associations

1. Chronic obstructive pulmonary disease

2. Emphysema

3. Chronic bronchitis

4. Lung cancer (Bronchial carcinoma)

1. Interstitial lung diseases

2. Respiratory bronchiolitis

3. DIP (Desquamative interstitial pneumonia)



High Risks for Current Smokers of Cigarettes Current Smokers (Ref. Hari. 18th ed., Pg - 3561)
Current Smokers
Disease or Condition
  1. CAD        
  2. CVA            
  3. Aortic aneurysm                
  4. COPD
  5. Cancers:   
    1. Lung
    2. Larynx
    3. Lip, oral cavity, pharynx
    4. Esophagus
    5. Bladder, other urinary organs
    6. Kidney
    7. Pancreas
    8. Stomach
    9. Cervix
    10. Acute myeloid leukemia
  6. Sudden infant death syndrome                    
  7. Infant respiratory distress syndrome                  
  8. Low Birth Weight At Delivery                        
  1. Lung Transplantation 

Indication of lung transplantation (Ref. Hari. 18th ed., Pg - 2189)

  1. The most common indications in the last few years have been COPD.
  2. Idiopathic pulmonary fibrosis (IPF),
  3. Cystic fibrosis (CF),
  4. Alpha 1-antitrypsin deficiency emphysema,
  5. Idiopathic pulmonary arterial hypertension (IPAH),

Test Your Skills Now!
Take a Quiz now
Reviewer Name