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Stephen J. Bourke. Respiratory Medicine
Table of Contents
List of Tables
List of Illustrations
Guide
Pages
Respiratory Medicine. Lecture Notes
Preface
About the Companion Website
1 Anatomy and physiology of the lungs
A brief revision of clinically relevant anatomy. Bronchial tree and alveoli
Lung perfusion
Physiology
Ventilation
The muscles that drive the pump
The inherent elastic property of the lungs
Airway resistance
Site of maximal resistance
The flow‐limiting mechanism
The effects of disease on maximum flow rate
Airway resistance and lung volume
Lung volume and site of maximal airway resistance
Gas exchange
Where does the air go?
Where does the blood go?
Relationship between the partial pressures of O2 and CO2
Carbon dioxide
Oxygen
The carriage of CO2 and O2 by blood
Effect of local differences in V/Q
Effect on arterial CO2 content
Effect on arterial O2 content
The alveolar gas equation
The control of breathing
KEY POINTS
FURTHER READING
Multiple choice questions
Multiple choice answers
2 History taking and examination. History taking
Symptoms
Dyspnoea
Wheeze
Cough and sputum
Haemoptysis
Chest pain
Associated symptoms
History. Past medical history
General medical history
Family history
Social history
Occupational history
Examination
General examination
Cough
Hands
Clubbing
Jugular veins
Cyanosis
Chest
Inspection
Palpation
Percussion
Auscultation
Breath sounds
Added sounds
Signs
KEY POINTS
FURTHER READING
Multiple choice questions
Multiple choice answers
3 Pulmonary function tests
Normal values
Simple tests of ventilatory function
Lung volumes
Spirometry
Vital capacity
Forced expiratory volume in 1 second and FEV1:FVC ratio
Maximal midexpiratory flow
Peak expiratory flow
Flow/volume loop
Total lung capacity
Respiratory muscle function tests
Gas transfer (transfer factor for carbon monoxide)
Single‐breath method
Transfer coefficient
Interpretation
Arterial blood gases
Review of acid/base balance
Bicarbonate concentration
Acid/base disturbances
Respiratory acidosis (acute): pH reduced, PCO2 raised, bicarbonate normal
Respiratory acidosis (chronic): pH normal (lower half of normal range), PCO2 raised, bicarbonate high
Respiratory alkalosis (cases are usually acute, as the causes are rarely sustained): pH raised, PCO2 reduced, bicarbonate normal
Metabolic acidosis: pH reduced, PCO2 reduced, bicarbonate reduced
Metabolic alkalosis: pH raised, PCO2 high normal or slightly raised, bicarbonate raised
Mixed disturbances
Arterial oxygenation
Respiratory failure
A simple algorithm for reviewing blood gas results
KEY POINTS
FURTHER READING
Multiple choice questions
Multiple choice answers
4 Radiology of the chest. Chest X‐ray
Abnormal features. Collapse
Consolidation
Pulmonary masses
Cavitation
Fibrosis
Mediastinal masses
Ultrasonography of the chest
Computed tomography
Positron emission tomography
KEY POINTS
FURTHER READING
Multiple choice questions
Multiple choice answers
5 Upper respiratory tract infections and influenza
Common cold
Pharyngitis
Sinusitis
Acute laryngitis
Croup
Pertussis
Acute epiglottitis
Influenza. Seasonal influenza
Influenza vaccination
Pandemic influenza
KEY POINTS
FURTHER READING
Multiple choice questions
Multiple choice answers
6 Pneumonia. Lower respiratory tract infections
Pneumonia
Classification in relation to clinical context
Site of infection
Age of the patient
Community‐ or hospital‐acquired infection
Concurrent disease
Environmental and geographical factors
Severity of the illness
Clinical features
Investigation
General investigations
Specific investigations
Treatment. General
Antibiotics
Specific pathogens. Pneumococcal pneumonia
Haemophilus influenzae pneumonia
Staphylococcal pneumonia
Klebsiella pneumonia
Pseudomonas aeruginosa pneumonia
Pneumonia caused by ‘atypical pathogens’
Mycoplasma pneumonia
Chlamydial respiratory infections
Legionella pneumonia
Severe acute respiratory syndrome (SARS‐CoV‐1)
Coronavirus disease 2019 (COVID‐19)
Clinical features
Treatment
Vaccines
Long‐term effects
Immunocompromised patients
Pulmonary complications of HIV infection
Bacterial respiratory infections
Pneumocystis pneumonia
Mycobacterial infection. Mycobacterium tuberculosis
Mycobacterium avium complex
Viral infections
Fungal pulmonary infections
HIV‐related neoplasms. Kaposi sarcoma
Lymphoma
Interstitial pneumonitis
Primary pulmonary hypertension
Immune reconstitution syndromes
Respiratory emergencies: pneumonia
KEY POINTS
FURTHER READING
Multiple choice questions
Multiple choice answers
7 Tuberculosis
Epidemiology
Clinical course
Primary tuberculosis
Postprimary tuberculosis
Diagnosis. Clinical features
Laboratory diagnosis
Treatment
Latent tuberculosis
Tuberculin testing
Interferon‐γ release assays
Control. Treating active disease
Contact tracing
Screening of new entrants
BCG vaccination
Non‐tuberculous mycobacterial pulmonary disease
KEY POINTS
FURTHER READING
Multiple choice questions
Multiple choice answers
8 Bronchiectasis and lung abscess. Bronchiectasis
Pathogenesis
Aetiology
Infections
Bronchial obstruction
Immunodeficiency states
Allergic bronchopulmonary aspergillosis
Ciliary dyskinesia
Cystic fibrosis
Associated diseases
Clinical features
Investigations
Treatment
Lung abscess
Necrobacillosis
Bronchopulmonary sequestration
Respiratory emergencies: severe exacerbation of bronchiectasis in hospital
KEY POINTS
FURTHER READING
Multiple choice questions
Multiple choice answers
9 Cystic fibrosis. Introduction
The basic defect
Lungs
Gastrointestinal tract
Clinical features
Infants and young children
Older children and adults. Respiratory disease
Gastrointestinal disease
Other complications
Diagnosis
Sweat testing
DNA analysis
Non‐classic cystic fibrosis
Newborn screening
Treatment
CFTR modulator therapy
Chest physiotherapy
Antibiotics
Bronchodilator medication
Mucoactive medication
Antiinflammatory medication
Nutrition
Advanced disease
Prospective treatments
KEY POINTS
FURTHER READING
Multiple choice questions
Multiple choice answers
10 Asthma. Definition
Prevalence
Aetiology
Genetic susceptibility
Environmental factors
Indoor environment
Outdoor environment
Occupational environment
Pathogenesis and pathology
Allergic eosinophilic asthma
Non‐allergic eosinophilic asthma
Non‐eosinophilic asthma
Clinical features
Diagnosis
Investigations
Pulmonary function tests (see Chapter 3)
Tests for hypersensitivity
Exhaled nitric oxide
General investigations
Conditions associated with asthma
Management. Patient education
Avoidance of precipitating factors
Drug treatment
Bronchodilators. Short‐acting β 2 ‐agonists
Long‐acting β 2 ‐agonists
Antimuscarinic bronchodilators
Theophyllines
Magnesium
Antiinflammatory drugs. Inhaled corticosteroids
Maintenance and Reliever Therapy (MART) regime
Oral steroid treatment
Leukotriene receptor antoagonists
Biologic therapy (see Fig. 10.2)
Bronchial thermoplasty
Stepwise approach to treatment of asthma (Fig. 10.3)
Inhaler devices
Metered‐dose inhalers (MDIs)
Spacer devices
Breath‐actuated aerosol inhalers
Dry‐powder devices
Nebulisers
Acute severe asthma
Signs of acute severe asthma
Life‐threatening asthma
Near‐fatal asthma
Immediate management
Investigations
Monitoring treatment
Management during recovery in hospital and following discharge
Respiratory emergencies: asthma
KEY POINTS
FURTHER READING
Multiple choice questions
Multiple choice answers
11 Chronic obstructive pulmonary disease. Introduction
Definitions. Chronic obstructive pulmonary disease
Chronic bronchitis
Emphysema
Airway obstruction (see Chapter 3)
Aetiology
Clinical features and progression
Investigations
Lung function tests (see Chapter 3)
Radiology
A multisystem disease
Management
Smoking cessation
Pharmacotherapy for smoking cessation
Pharmacological treatments in the management of stable COPD. Short‐acting bronchodilators
Long‐acting bronchodilators
Corticosteroids
Treatment strategy
Inhaler technique
Oral medications
Psychological treatment
Pulmonary rehabilitation
Oxygen therapy in stable disease
Long‐term oxygen therapy
Prescribing criteria
Oxygen concentrator
Ambulatory oxygen
Short‐burst oxygen
Hypoxia during air travel
The danger of excess oxygen
Home ventilation
Surgery
Emergency treatment
Antibiotics
Emergency oxygen
Ventilatory support
Practical application
Admission avoidance and early supported discharge for COPD
Respiratory emergencies: COPD
KEY POINTS
FURTHER READING
Multiple choice questions
Multiple choice answers
12 Carcinoma of the lung. Introduction
Aetiology
Pathology
Diagnosis
Bronchoscopy
Communicating the diagnosis
Lung cancer screening
Treatment
Small cell carcinoma (15%)
Non‐small cell carcinoma (85%)
Palliative care
Carcinoid tumour
Respiratory emergencies: superior vena caval obstruction (SVCO)
KEY POINTS
FURTHER READING
Multiple choice questions
Multiple choice answers
13 Interstitial lung disease. Introduction. Clinical features
Differential diagnosis
Investigations
Idiopathic pulmonary fibrosis
Idiopathic interstitial pneumonias
Connective tissue diseases
Rheumatoid disease
Systemic sclerosis (scleroderma)
Systemic lupus erythematosus
Drug‐induced interstitial lung disease
Hypersensitivity pneumonitis
Sarcoidosis
Acute sarcoidosis
Erythema nodosum
Bilateral hilar lymphadenopathy
Chronic sarcoidosis
Chronic pulmonary sarcoidosis
Chronic extrapulmonary sarcoidosis
Diagnosis
Treatment
Respiratory emergencies: acute exacerbation of fibrotic lung disease
KEY POINTS
FURTHER READING
Multiple choice questions
Multiple choice answers
14 Occupational lung disease. Introduction
Work‐related asthma
Diagnosis
Management
Berylliosis
Flavouring‐related obliterative bronchiolitis: “popcorn worker’s lung”
Pneumoconiosis
Coal worker’s pneumoconiosis
Caplan syndrome (rheumatoid pneumoconiosis)
Chronic obstructive pulmonary disease
Silicosis
Siderosis
Asbestos‐related lung disease
Asbestosis
Pleural plaques
Asbestos pleuritis and pleural effusions
Pleural thickening
Asbestos‐related lung cancer
Mesothelioma
Compensation
KEY POINTS
FURTHER READING
Multiple choice questions
Multiple choice answers
15 Pulmonary vascular disease. Pulmonary embolism
Deep vein thrombosis
Clinical features
Investigations. General investigations
Specific investigations
Diagnosing pulmonary embolism
Pregnancy
Treatment. Anticoagulant therapy
Reperfusion treatment
DVT prophylaxis
Pulmonary hypertension
Cor pulmonale
Pulmonary arterial hypertension (PAH)
Pulmonary vasculitis
Granulomatosis with polyangiitis
Eosinophilic granulomatosis with polyangiitis
Polyarteritis nodosa
Anti‐GBM disease
Respiratory emergencies: pulmonary embolism
KEY POINTS
FURTHER READING
Multiple choice questions
Multiple choice answers
16 Pneumothorax and pleural effusion. Pneumothorax
Pathogenesis
Clinical features
Treatment
Pleural effusion
Pleural fluid dynamics
Clinical features
Investigations
Causes
Transudates
Exudates
Oesophageal rupture
Respiratory emergencies: pneumothorax
KEY POINTS
FURTHER READING
Multiple choice questions
Multiple choice answers
17 Acute respiratory distress syndrome. Introduction
Pathogenesis
Pressure pulmonary oedema
Permeability pulmonary oedema
Clinical features
Recognition of critically ill patients
Treatment
Treatment of initiating illness
Respiratory support
Optimising haemodynamic function
General management
Antiinflammatory therapies
Prognosis
KEY POINTS
FURTHER READING
Multiple choice questions
Multiple choice answers
18 Ventilatory failure and sleep‐related breathing disorders. Introduction
Sleep physiology
Ventilatory failure
Ventilatory failure and sleep
Treatment
Obstructive sleep apnoea syndrome (Fig. 18.3)
Pathogenesis
Clinical features
Diagnosis (sleep studies)
Treatment. General measures
Nasal CPAP
Other therapies
Central sleep apnoea
KEY POINTS
FURTHER READING
Multiple choice questions
Multiple choice answers
19 Lung transplantation. Introduction
Types of operation
Heart–lung transplant
Single‐lung transplant
Bilateral lung transplant
Living lobar transplantation
Indications for transplantation
Post‐transplantation complications and treatment
Prognosis
Future prospects
KEY POINTS
FURTHER READING
Multiple choice questions
Multiple choice answers
Index. A
B
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D
E
F
G
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W
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