Pulmonology

Asthma & Airways · COPD & Respiratory Failure · Pneumonia & Respiratory Infection · Interstitial, Occupational & Sarcoidosis · Lung Cancer, Pleura & Pneumothorax · Pulmonary Vascular & Vasculitis · Physiology, Sleep & Investigations · Drugs & Miscellaneous

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Asthma & Airways

Asthma: Acute Severe — Stratify: moderate PEFR 50–75% best/predicted · severe PEFR 33–50%, can't complete sentences, RR > 25, pulse > 110 · lif
Asthma: Diagnosis — Asthma: diagnosis NICE released guidance on the management of asthma in 2017. These followed on quickly from the 2016 Br
Asthma: Occupational — Asthma: occupational Patients may either present with concerns that chemicals at work are worsening their asthma or you
Asthma: Management in Adults — BTS/NICE/SIGN NG245 (Nov 2024) replaced the previous pathways. The headline change: SABA MONOTHERAPY IS NO LONGER RECOMM
Bronchiectasis: Causes — Bronchiectasis: causes Bronchiectasis describes a permanent dilatation of the airways secondary to chronic infection or
Allergic Bronchopulmonary Aspergillosis — Allergic bronchopulmonary aspergillosis Allergic bronchopulmonary aspergillosis results from an allergy to Aspergillus s
Kartagener's Syndrome — Kartagener's syndrome Kartagener's syndrome (also known as primary ciliary dyskinesia) was first described in 1933 and m
Bronchiectasis: Management — Bronchiectasis: management Bronchiectasis describes a permanent dilatation of the airways secondary to chronic infection
Bronchiolitis Obliterans — Bronchiolitis obliterans is a rare, progressive disease of the small airways causing irreversible airflow obstruction

COPD & Respiratory Failure

COPD — decompensation in other respiratory conditions e.g. life-threatening asthma / pulmonary oedema
COPD: Acute Exacerbation — Acute exacerbation of COPD Acute exacerbations of COPD are one of the most common reasons why people present to hospital
Alpha-1 Antitrypsin Deficiency — Alpha-1 antitrypsin deficiency Alpha-1 antitrypsin (A1AT) deficiency is a common inherited condition caused by a lack of
Smoking Cessation — Smoking cessation NICE released guidance in 2008 on the management of smoking cessation. General points include:
Non-Invasive Ventilation — Non-invasive ventilation The British Thoracic Society (BTS) published guidelines in 2002 on the use of non-invasive vent
Oxygen Therapy — Oxygen therapy The British Thoracic Society updated its guidelines on emergency oxygen therapy in 2017. The following se
Copd: Long-Term Oxygen Therapy — COPD: long-term oxygen therapy The 2018 NICE guidelines on COPD clearly define which patients should be assessed for and
Copd: Investigation and Diagnosis — COPD: investigation and diagnosis NICE recommend considering a diagnosis of COPD in patients over 35 years of age who ar
Copd: Stable Management — General measures for everyone: smoking cessation (offer NRT, varenicline or bupropion) · annual influenza vaccine · one-
Cor Pulmonale — Cor pulmonale

Pneumonia & Respiratory Infection

Klebsiella — Klebsiella Klebsiella pneumoniae is a Gram-negative rod that is part of the normal gut flora. It can cause a number of i
Pneumonia: Assessment and Management — Primary care: assess with CRB65 — Confusion (AMTS ≤ 8/10) · Respiratory rate ≥ 30 · BP systolic ≤ 90 and/or diastolic ≤
Tuberculosis — Tuberculosis Tuberculosis (TB) is an infection caused by Mycobacterium tuberculosis that most commonly affects the lungs
Middle East Respiratory Syndrome — Middle East respiratory syndrome Middle East respiratory syndrome (MERS) is caused by the betacoronavirus MERS-CoV. At t
Cryptogenic Organizing Pneumonia — Cryptogenic organizing pneumonia Cryptogenic organizing pneumonia (COP) is a diffuse interstitial lung disease that affe
Psittacosis — Psittacosis Psittacosis is infection caused by Chlamydia psittaci. The most common presentation is as a cause of atypica
Pleural Infection — Pleural infection All patients with a pleural effusion in association with sepsis or a pneumonic illness require diagnos

Interstitial, Occupational & Sarcoidosis

Lung Fibrosis — Lung fibrosis It is important in the exam to be able to differentiate between conditions causing predominately upper or
Extrinsic Allergic Alveolitis — Extrinsic allergic alveolitis Extrinsic allergic alveolitis (EAA, also known as hypersensitivity pneumonitis) is a condi
Silicosis — Silicosis Silicosis is a fibrosing lung disease caused by the inhalation of fine particles of crystalline silicon dioxid
Bilateral Hilar Lymphadenopathy — Bilateral hilar lymphadenopathy The most common causes of bilateral hilar lymphadenopathy are sarcoidosis and tuberculos
Pulmonary Eosinophilia — Pulmonary eosinophilia Pulmonary eosinophilia describes a situation where there are increased numbers of eosinophils in
Idiopathic Pulmonary Fibrosis — Idiopathic pulmonary fibrosis Idiopathic pulmonary fibrosis (IFF, previously termed cryptogenic fibrosing alveolitis) is
Rheumatoid Arthritis: Respiratory Involvement — Rheumatoid arthritis: respiratory manifestations A variety of respiratory problems may be seen in patients with rheumato
Lofgren’s Syndrome — Loffler’s syndrome is a cause of pulmonary eosinophilia thought to be caused by parasites such as Ascaris lumbricoides
Coal Dust — Isocyanates are more associated with occupational asthma

Lung Cancer, Pleura & Pneumothorax

Pleural Effusion: Investigation — Pleural effusion: investigation and management The British Thoracic Society (BTS) produced guidelines in 2010 covering t
Chest X-Ray: Lung Metastases — Uhest x-ray: lung metastases Lung metastases are seen with a wide variety of cancers including:
Chest X-Ray: Cavitating Lung Lesion — Chest x-ray: cavitating lung lesion Differential
Pneumothorax: Features — Pneumothorax: features Risk factors
Pneumothorax: Management — Primary spontaneous pneumothorax (PSP): no underlying lung disease; secondary (SSP): underlying lung disease. Tension pneumothorax is a clinical emergency — needle decompression immediately, do not wait for imaging.
Lung Cancer: Non-Small Cell Management — Non-small cell lung cancer (NSCLC): management is guided by stage and molecular profile.
Lung Cancer: Risk Factors — Lung cancer: risk factors Smoking
Lung Cancer: Small Cell — Small cell lung cancer: usually CENTRAL, arising from APUD cells (amine precursor uptake and decarboxylation) — hence it
Lung Cancer: Paraneoplastic Features — Lung cancer: paraneoplastic features Small cell
Pleural Effusion: Causes — Pleural effusion: causes Pleural effusions may be classified as being either a transudate or exudate according to the pr
Mesothelioma — Mesothelioma Mesothelioma is a cancer of the mesothelial layer of the pleural cavity that is strongly associated with as
Lung Cancer: Carcinoid — Lung cancer: carcinoid The vast majority of bronchial adenomas are carcinoid tumours, arising from the amine precursor u
Lung Cancer: Referral — Lung cancer: referral The 2015 NICE cancer referral guidelines gave the following advice: Refer people using a suspected
Lung Cancer: Investigation — Lung cancer: investigation Chest x-ray
Chest Drain — Chest drain A chest drain is a tube inserted into the pleural cavity which creates a one-way valve, allowing movement of
Local Anaesthetic Thoracoscopy — Local anaesthetic thoracoscopy Bronchoscopy This patient has presented with a unilateral, exudative, cytology negative p
Secondary Pneumothorax — Secondary pneumothorax Recommendations include:

Pulmonary Vascular & Vasculitis

Eosinophilic Granulomatosis with Polyangiitis — Eosinophilic granulomatosis with polyangiitis (Churg-Strauss syndrome) Eosinophilic granulomatosis with polyangiitis (EG
Pulmonary Hypertension: Causes & Classification — Pulmonary hypertension: causes and classification Pulmonary hypertension may be defined as a sustained elevation in mean
Granulomatosis with Polyangiitis — ^£>.,^11 Granulomatosis with polyangiitis Haemolytic uraemic syndrome Henoch-Schonlein purpura The combination of pulmon

Physiology, Sleep & Investigations

Transfer Factor — Transfer factor The transfer factor describes the rate at which a gas will diffuse from alveoli into blood. Carbon monox
Altitude Related Disorders — Altitude related disorders There are three main types of altitude related disorders: acute mountain sickness (AMS), whic
Obstructive Sleep Apnoea/Hypopnoea — Obstructive sleep apnoea/hypopnoea syndrome Predisposing factors
Respiratory Acidosis — Respiratory acidosis Respiratory acidosis may be caused by a number of conditions:
Oxygen Dissociation Curve — Oxygen dissociation curve The oxygen dissociation curve describes the relationship between the percentage of saturated h
Respiratory Physiology: Lung Volumes — Respiratory physiology: lung volumes The diagram below demonstrates the lung volumes which may be measured: E •• nuj Tid
Atelectasis — Atelectasis Atelectasis is a common postoperative complication in which basal alveolar collapse can lead to respiratory
Respiratory Alkalosis — Respiratory alkalosis Common causes
Acute Respiratory Distress Syndrome — Acute respiratory distress syndrome Acute respiratory distress syndrome (ARDS) is caused by the increased permeability o
Pulmonary Function Tests — Pulmonary function tests Pulmonary function tests can be used to determine whether a respiratory disease is obstructive
Short Synacthen Test — Short synacthen test Urgent referral to the chest clinic Stop bendroflumethiazide Urgent gastroscopy Despite a normal ch
Assessment of Sleepiness — Assessment of sleepiness

Drugs & Miscellaneous

Asbestos and the Lung — Asbestos and the lung Asbestos can cause a variety of lung disease from benign pleural plaques to mesothelioma. Pleural
Sarcoidosis — Sarcoidosis Sarcoidosis is a multisystem disorder of unknown aetiology characterised by non-caseating granulomas. It is
Sarcoidosis: Management — Sarcoidosis: management Sarcoidosis is a multisystem disorder of unknown aetiology characterised by non-caseating granul
Sarcoidosis: Investigation — Sarcoidosis: investigation There is no one diagnostic test for sarcoidosis and hence diagnosis is still largely clinical
Sarcoidosis: Prognostic Features — Sarcoidosis: prognostic features Sarcoidosis is a multisystem disorder of unknown aetiology characterised by non-caseati
Leukotriene Receptor Antagonists — Leukotriene receptor antagonists Basics
p-ANCA — Churg-Strauss syndrome is associated with a positive pANCA
Asbestosis — Asbestosis The severity of asbestosis is related to the length of exposure. This is in contrast to mesothelioma where ev
Amiodarone — Amiodarone is a cause of lower zone pulmonary fibrosis, seen with long-term use
Long-Acting Beta2-Agonist — Long-acting beta2-agonist Long-acting beta2-agonist + inhaled corticosteroid (ICS) Inhaled corticosteroid Use the SAMA r
Montelukast — Montelukast can unmask an underlying Churg-Strauss syndrome
Syndromes Associated with Sarcoidosis — Syndromes associated with sarcoidosis Lofgren's syndrome is an acute form of the disease characterised by bilateral hila