Index

Page numbers in bold indicate boxes and those in italic indicate tables.

A‐a gradient 320, 320, 332 morbidity and mortality 385, 387 abdominal breathing 12 pathogenesis 385–6 abscess, 309–10 severity 385 accessory inspiratory muscles 12 adenocarcinoma, lung 206, 217 acid–base balance 23 adenovirus 177 acidosis adrenaline 43 metabolic 23, 323 aegophony 97 respiratory 23, 323 aerosol 30 acinus 15 air bronchogram 57 aclidinium bromide 38 air pollution 363 acute altitude sickness 390 airway hyper‐responsiveness 107 acute 175 airway trauma 389 acute chest syndrome 388 alkalosis, respiratory 23 acute crack lung 362 allergens 363, 364 acute eosinophilic 152 allergic bronchopulmonary aspergillosis 110, acute hypersensitivity 126, 151 160–1 allergy 85, 89, 151 acute interstitial pneumonia 149 α‐1 antitrypsin deficiency 125–6 acute lung injury 384 alveolar‐arterial oxygen gradient 320, aetiology 384 320, 332 diagnosis 384–5 alveolar ducts 15 incidence 385 alveolar gas volume 73 investigations 386 alveolar pressure 13–14 management 386–7 alveolar sacs 15 mortality 385 alveolar ventilation 13 pathogenesis 385–6 alveoli 15, 16 transfusion‐related 387–8 aminophylline 42, 124 acute 377 amniotic fluid 8 acute 270, 275–7 amyloidosis 166 acute respiratory distress syndrome 384 anaemia 53 aetiology 384 anatomical dead space 16 Berlin criteria 385 anatomical shunts 23 387 angle of Louis 8 diagnosis 384–5 antibiotics 43–4 differential diagnosis 385 anti‐glomerular basement membrane antibody extra‐corporeal membraneCOPYRIGHTED oxygenation 387 MATERIALsyndrome 284–5 incidence 385 anti‐neutrophil cytoplasmic antibodies 53 inhaled nitric oxide 387 anti‐tuberculous drugs 44, 193–4, 194 intubated patients 385 aortic bodies 20 investigations 386 apnoea 85, 338 management 386–7 apnoea/hypopnoea index 337, 338 mechanical ventilation 387 arterio‐venous malformation 226, 286

Essential Respiratory Medicine, First Edition. Shanthi Paramothayan. © 2019 John Wiley & Sons Ltd. Published 2019 by John Wiley & Sons Ltd. Companion website: www.wiley.com/go/paramothayan/essential_respiratory_medicine

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asbestos exposure self‐management 112–13 356–8 sex differences 107 benign 248, 256 specialist nurses 112–13 benign pleural plaques 254–5 spirometry 110–11 compensation claims 260, 264 symptoms 109 diffuse pleural thickening 255 triggers 113 lung cancer 209 vitamin D 112 occupations associated with 257 weather‐related 114 white/blue asbestos 257, 357 atopy 85, 107, 108, 110 see also mesothelioma atypical mycobacteria 199 aspergillosis auscultation 96–7 allergic bronchopulmonary 110, 126, 151 azithromycin 44 invasive (Aspergillus fumigatus) 179 186, 296 176, 177–9 asterixis 94 161 107–17 bambuterol 37 acute exacerbation 114–16 barrel chest 13 aetiology 107 base excess 23 atopy and 107, 108, 110 BCG vaccination 196 avoidance of triggers 114 beclomethasone 39–40 brittle 114 Berlin criteria 385 bronchial thermoplasty 112 360

cardiac 92 β2‐adrenoceptor agonists 36 chest examination 100 bevacizumab 223–4 chest X‐ray 111 bi‐level positive airway pressure 326–7 chronic 117 biopsies 76, 77, 89 clinical examination 109–10 bird fancier’s lung 160, 161, 163 clinical history 109 Blesovsky syndrome 256 clinical presentation 109 blood tests 52–4 cough‐variant 89, 109 BODE index 122 definition 107 Bohr effect 21 diagnostic algorithm 132 bone scan 64 doctor review 112–13 BORG scale 85 environmental factors 108 Bornholm disease 91 eosinophilia 151 Botzinger complex 18 epidemiology 107–8 bovine cough 89 family history 107 breathing 18, 318–19 fatal 114, 115 breathlessness 85–8 genetics 107 brittle asthma 114 GINA assessment 113 bronchi hospital admission 115 lobar 14, 15 house dust mites 108, 114 main 14 hygiene hypothesis 108 segmental 14, 15 inhaled therapy 112 small 15 investigation 110–11 bronchial arteries 17 lung function tests 68, 111 bronchial breathing 96–7 management 111–12, 133 bronchial hyper‐responsiveness 107 menstruation‐related 114 bronchial thermoplasty 112 nasal polyps 111 294–304 National Review of Asthma Deaths aetiology 296–8 116–17 antibiotic prophylaxis 303 occupational 354–5, 356 CFTR gene 296 pathophysiology 108–9 chest physiotherapy 303 peak expiratory flow homework 67, 110 clinical presentation 299 prognosis 114 cylindrical 299

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cystic 299 central chemoreceptors 19–20 diagnosis 298–9 central pattern generator 18 differential diagnosis 299–300 central sleep apnoea 348 infective exacerbations 302 Cepacia syndrome 305 investigations 300 cerebrospinal fluid 20, 55 management 300–2 CFTR gene 296, 304–5 mucolytic drugs 303 cheese‐washer’s lung 161 nitric oxide 299 chemical pleurodesis 224, 243, 253, 259 non‐ 296 chemical worker’s lung 161 pathogenesis 295–6 chemoreceptors 19–20 prevention of exacerbations 302–4 chest pulmonary rehabilitation 301–2 auscultation 96–7 radiological findings 301 drains 246, 251, 252 shuttle walk test 299 examination 94–9, 100 clearance devices 303 expansion 96 surgical treatment 302 pain 90–2 symptoms and signs 299 percussion 96 bronchioles 15 physiotherapy 303 obliterans organising pneumonia wall deformities 93 (BOOP) 146–7 chest X‐ray 55–61 bronchitis, acute 175 cavitation 58 bronchoalveolar lavage 76 consolidated lung 57, 58 reversibility testing 69 interpretation 57 bronchogenic cyst 375 lobar collapse 58, 59 bronchopulmonary sequestration 310 silhouette sign 57 bronchoscopy 75–6, 89 white out 58 brushings 76 Cheyne–Stokes respiration 85 bucket handle action 12 Chlamydia pneumoniae 179 budesonide 39–40 Chlamydia psittaci 179 bullectomy 123 choriocarcinoma 374 buproprion 45 chronic 152 360 chronic hypersensitivity pneumonitis 162 chronic mediastinitis 377–8 calcium, raised corrected 53 chronic mountain sickness 390 Candida albicans 180 chronic obstructive pulmonary disease cannabis 362–3 (COPD) 117–25 Caplan’s syndrome 359 chest examination 100 carbocisteine 43 chest X‐ray 120–1 carbon dioxide clinical presentation 119–20 central chemoreceptors 20 exacerbation 123–5 retention tremor 94 exercise capacity 121 transport 21–3 inhaled therapy 122 carbon monoxide poisoning 389 investigations 120–1 carboxyhaemoglobin 389 long‐term oxygen therapy 122–3 carcinoid syndrome 227, 229 lung transplant 123 carcinoid tumour 226–7, 229 management 121–3, 134 cardiac asthma 92 mouth breathing 13 cardiac chest pain 91 obstructive sleep apnoea/hypopnoea syndrome cardiopulmonary exercise testing 75 and 343 cardiovascular examination 93 pathophysiology 118–19 carotid body 20 282 caseating granuloma 191 pulmonary rehabilitation 122 catamenial 254 pulse oximetry 120 cataplexy 346 risk factors 117 cavitation 58 severity 120

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chronic obstructive pulmonary disease (COPD) (cont’d ) dermoid 373–4 smoking cessation 121 foregut duplication 375 surgical treatment 123 neuroenteric 375 symptoms and signs 120 oesophageal duplication 375 chronic pulmonary embolism 277 pericardial 375 chronic sleep insufficiency 348 spring water 375 chronic thromboembolic pulmonary thymic 373 hypertension 282 cystic bronchiectasis 299 Churg–Strauss syndrome 110, 151, 285–6 cystic fibrosis 304–8 247–8 CFTR gene 304–5 cilia 15, 294 clinical presentation 305, 306 clarithromycin 44 diagnosis 305 clear water cyst 375 infective exacerbations 305, 307 clubbing 94 management 305, 307–8 club cells 16 mucolytic drugs 305 coal‐worker’s 358–9 pancreatic supplements 307 cocaine 362 prognosis 308 coffee worker’s lung 161 sputum clearance 305 174 cystic teratomas 373–4 common variable immunodeficiency 298 cytomegalovirus 174, 177 community‐acquired pneumonia 176, 181–4 D‐dimers 53, 272 computed tomography (CT) scan 61 deep sea diving 389–90 high‐resolution 62 deep vein thrombosis 268–9 pulmonary angiogram 61–2, 272–3 dermoid cysts 373–4 congenital central hypoventilation syndrome 18 desquamative interstitial pneumonitis 147–8 congenital heart disease 282 detergent worker’s lung 161 connective tissue disorders 281–2, 298 dexamethasone 38, 39 continuous positive airway pressure 344–5 diaphragm contrast‐enhanced pulmonary angiogram 273 anatomy 10–11 COPD Assessment Test 119 development 6 corticosteroids 38–41 hernia 6, 376 inhaled 39–41 paralysis 12 oral 38–9 respiration 12 cortisone 38, 39 differential cell count 53 costochondritis 8, 91 diffuse parenchymal lung diseases 138 cough 88–9 classification 139 cough reflex 18 clinical examination 140 cough‐variant asthma 89, 109 diagnosis 138–9 Coxiella burnetii 179 drug‐related 46, 140 crack cocaine 362 history 140 crackles 96 investigation 139–40 C reactive protein 53 diffusing capacity 73 crizotinib 224 directly observed therapy 194 175 diving 389–90 Cryptococcus neoformans 180 dorsal respiratory group 18 cryptogenic organising pneumonia 146–7 doxapram 44, 328 CT pulmonary angiogram 61–2, 272–3 driving 343–4 CURB‐65 181, 181, 183, 184, 185 drowning 389 cyanide poisoning 388 drug‐related conditions cyanosis 94 diffuse parenchymal lung disease 46, 140 cylindrical bronchiectasis 299 eosinophilia 153 cyst lung damage 45–6 bronchogenic 375 pulmonary arterial hypertension 280–1 clear water 375 recreational drugs 360–3

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dry powder inhalers 32–3 flow volume loop 69–71 dyspnoea 85 fluticasone 39–40 flying 269 echocardiogram 75 folded lung 256 pulmonary embolus 275 foramen of Morgagni diaphragmatic hernia 376

pulmonary hypertension 279 forced expiratory volume in 1 second (FEV1) e‐cigarettes 45 67–9 Eisenmenger’s syndrome 23 forced vital capacity 67–9 electrocardiogram (ECG) 75 foregut duplication cyst 375 pulmonary embolism 271 foreign body aspiration 296, 298 pulmonary hypertension 279 formoterol 37 electroencephalogram (EEG), sleep 75, 334–5 fractional exhaled nitric oxide 74 embryonal cell carcinoma 374 fractures, rib 9 emphysema full blood count 52–3 α‐1 antitrypsin deficiency 125 functional residual capacity 13, 71, 73 functional residual capacity 13 179–80 lung function tests 68 funnel chest 93 empyema 243, 245 antibiotics for 244 gallium scan 157 necessitans 247 ganglioneuroblastoma 376–7 pleural thickening 247 ganglioneuroma 376–7 risk factors 243 gastro‐oesophageal reflux disease (GORD) 89 endobronchial ultrasound‐guided biopsy 76 gefitinib 223 endodermal sinus tumour 374 germ cell tumours 373–4 environmental factors 108, 363, 364 Ghon focus 188 eosinophilic granulomatosis with polyangiitis 110, Global Initiative for Asthma (GINA) 151, 285–6 assessment 113 eosinophilic lung disease 149–50, 151–3 goitre 374 175 Goodpasture’s syndrome 284–5 epinephrine 43 granuloma epoprostenol 283 caseating 191 Epworth Sleepiness Scale 339, 351 non‐tuberculous 226 erdosteine 43 tuberculous 226 erlotinib 223 granulomatosis with polyangiitis 284 erythrocyte sedimentation rate 53 erythromycin 44 haemoglobin 20, 21 Escherichia coli 178 Haemophilus influenzae 177 ethambutol 193, 194 haemoptysis 89–90 excessive daytime sleepiness 336 Haldane effect 21 exercise testing 74–5 hamartoma 226 expiration 11, 14 Hamman–Rich syndrome 149 expiratory muscles 12–13 Hamman’s sign 249 external intercostal muscles 9–10 hand examination 94 extra‐pleural pneumonectomy 260 Heaf Test 192 extrinsic allergic alveolitis 160–3, 360 helium dilution method 71, 73 exudate 242 Henderson–Hasselbalch equation 21, 319 heparin face masks 321 low molecular weight 269, 275 farmer’s lung 160, 161 unfractionated 269, 276 ferruginous bodies 358 hereditary haemorrhagic telangiectasia 286

FEV1/FVC ratio 68 hernia, diaphragmatic 6, 376 fibrosing mediastinitis 377–8 high altitude 20, 390 fine needle aspiration 76 high altitude cerebral oedema (HACE) 390 fistula, ‐oesophageal 6 high altitude pulmonary oedema (HAPE) 390 Fleischner Society Guidelines 226, 227 high‐resolution CT 62

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Histoplasma capsulatum 180 interstitial lung disease history‐taking 84–5 acute pneumonia 149 HIV desquamative pneumonitis 147–8 pulmonary arterial hypertension 282 idiopathic 140–4 pulmonary infections 187, 187, 188 lymphoid pneumonia 148 testing for 54 non‐specific pneumonitis 144–6 tuberculosis 195 respiratory bronchiolitis 148 hoarse voice 92 intrapleural fibrinolytic drugs 246–7 Horner’s syndrome 94, 210 intrapleural pressure 13, 14 hospital‐acquired pneumonia 185 ipratropium bromide 38 hot tub lung 161 irritants 363, 364 house dust mites 108, 114 isoniazid 193, 194 human immunodeficiency virus see HIV humidifier lung 161 jet nebuliser 35 hydrocortisone 38, 39 juxtapulmonary (J) receptors 18–19 hygiene hypothesis 108 hyperbaric oxygen therapy 389 Kartagener’s syndrome 308 hypercapnoea 318 178 hypereosinophilic syndrome 152 Kussmaul breathing 85 hypersensitivity pneumonitis 160–3, 360 kyphosis 93 hypersomnia differential diagnosis 336 laboratory tests 52–5 idiopathic 347–8 lambda sign 157 hypertrophic pulmonary osteopathy 210 Langerhans cell 164 hyperventilation 23 laryngeal tumours 225 hyperventilation syndrome 128 laryngotracheobronchitis 175 hypocapnoea 318 laser‐assisted uvulopalatopharyngoplasty 344 hypogammaglobulinaemia 298 lateral thoracic meningocele 377 hypopnoea 338 left recurrent laryngeal nerve 17 hypoxaemia 318 Legionella pneumophila 178 318 leukotriene antagonists 42 hypoxic drive 20 life‐threatening haemoptysis 89–90 Light’s criteria 241 idiopathic hypersomnia 347–8 lipoid pneumonia 186 idiopathic interstitial pneumonias 140–4 liver function tests 53 idiopathic pleural effusion 248 lobar collapse idiopathic 58, 141–4 chest examination 100 imaging techniques 55–65 chest X‐ray 58, 59 immotile cilia syndrome (primary ciliary Loefgren’s syndrome 154 dyskinesis) 7, 308–9 Loffler’s syndrome 153

immunocompromised 186–8 long‐acting β2‐agonists 37 immunoglobulin deficiencies 298 long‐acting muscarinic agonists 38 immunological tests 54 long‐term oxygen therapy 35–6, 122–3, 322 inferior vena cava filter 276–7 lower 8 A/B 177 low molecular weight heparin 269, 275 inhaled allergens and irritants 363, 364 lung inhaled drugs 36–44 abscess 309–10 inhaler devices 31–5 arterio‐venous malformations 226 insomnia 348 benign masses 225, 225, 226 inspiration 12, 14 blood supply 16–17 inspiratory muscles 11, 12 bronchopulmonary segments 14 intercostal muscles 9–10, 12 cancer see lung cancer interferon gamma release assay 192 carcinoid tumour 226–7, 229 internal intercostal muscles 9–10 cavitating lesions 226

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consolidation 57, 58, 96 multidisciplinary team meeting 224–5 defences 23 neo‐adjuvant chemotherapy 222, 223 development 6–8 non‐small cell 206, 216, 217, 222–3 drug deposition 30–1 nurse specialist 224–5 drug‐related damage 45–6 palliative therapy 222, 223, 224 fibrosis 13 passive smoking 208–9, 361 fissures 14 pathophysiology 209 folded 256 pleural effusion drainage 224 function tests 65–74 radical radiotherapy 221–2 hamartoma 226 radiotherapy‐induced 363 hypoplasia 8 small cell 206, 210–11, 216, 217, 223 imaging 55–65 smoking 208, 361 lobar collapse 58, 59, 100 squamous cell carcinoma 217 lobes 14 staging 217, 219 lymphatics 17–18 staging CT scan 212 nervous supply 17 superior vena cava obstruction 212 non‐tuberculous granuloma 226 surgical resection 217, 219–21 receptors and reflexes 18–19 symptoms 209 resection 217, 218–19 targeted molecular therapy 223–4 rounded 226, 256 TNM classification 217, 218, 219 sequestration 226 two‐week rule referral 212 solitary pulmonary nodule 225–6, 227 lung function tests 65–74 static volumes 71, 73 lymphadenopathy structure 14–16 examination for 93–4 transplant in COPD 123 mediastinal 374–5, 375 tuberculous granuloma 226 lymphangioleiomyomatosis 163–4 volume reduction surgery 123 lymphatics 17–18 lung cancer 205–30 lymphocyte count 53 adenocarcinoma 206, 217 lymphoid interstitial pneumonia 148 adjuvant chemotherapy 223 lymphomas 54, 374 aetiology 208–9 asbestos exposure 209 macrolide antibiotics 44 blood tests 212 magnesium sulfate 42 bone scan 213 magnetic resonance imaging (MRI) 64–5 chemotherapy 222–3 malignant mesothelioma see mesothelioma chest pain 92 malignant pleural effusion 224, 242–3 chest X‐ray 58, 212, 213 malt worker’s lung 161 classification 216–17 mandibular enhancement device 337, 344 clinical assessment 212 Mantoux test 55, 192 clinical presentation 209–10 marijuana 362–3 clinical signs 210, 210 Masaoka system 373, 373 communicating the diagnosis 224 mass median aerodynamic diameter 30 CT brain 214 mechanical ventilation, ARDS 387 CT‐PET 212–13 mediastinitis 377–8 ectopic secretion of hormones 210–11 369–79 endobronchial stents 224 anatomy 370 epidemiology 206–8 anterior mass 371–4 histological diagnosis 214–16 chest X‐ray 371 hypercalcaemia 211–12 diagnosis of mass 370–1 immunocytochemistry 217 lymphadenopathy 374–5, 375 investigations 212–14 mediastinitis 377–8 management 217 middle mass 374–6 molecular mutation testing 217 378 MRI 214 posterior mass 376–7

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medical thoracoscopy 77 multi‐drug resistant tuberculosis 196, 197 melanoptysis 358, 362 multiple endocrine neoplasia (MEN) menstruation syndrome 377 asthma 114 multiple sleep latency test 75, 346 pneumothorax 254 muscles MEN syndrome 377 intercostal 9–10, 12 mesothelin 258 of respiration 11–14, 74 mesothelioma 256–60 musculoskeletal chest pain 92 aetiology 257 myasthenia gravis 371–2 asbestos 257 Mycobacterium bovis 188 chemotherapy 259 Mycobacterium tuberculosis 188–99 chest pain 92 anti‐tuberculous drugs 44, 193–4, 194 chest X‐ray 257 caseating granuloma 191 clinical signs 257 contact tracing 195–6 compensation claims 260, 264 diagnosis 189–92 contrast CT 258 differential diagnosis 192 epidemiology 256–7 directly observed therapy 194 epitheloid 259 epidemiology 188 erionite 257 extra‐pulmonary TB 197–9 immunocytochemistry 258 Find and Treat initiative 196 investigations 257–8 Ghon focus 188 management 259 histology 191 mesothelin 258 HIV and 195 mixed 259 immunology 189, 191–2 MRI 258 infectivity 195 palliative care 259 information to patients 195 pathophysiology 257 latent tuberculosis 196 peritoneal 256 lymphadenitis 197 PET‐CT 258 management 192–5 pleural biopsy 258–9 meningitis 197 radiotherapy 259 microbiology 190–1 sarcomatoid 259 miliary TB 190, 197, 199 surgery 260 multi‐drug resistant TB 196, 197 symptoms 257 myelitis 197 ultrasound guided pleural aspiration 258 notifiable disease 195–6 metabolic acidosis 23, 323 pathogenesis of primary pulmonary TB 188–9 metabolic syndrome 343 pleural effusion 247 methacholine provocation test 74 post‐primary pulmonary TB 189 methylprednisolone 38, 39 prevention 196 microscopic polyangiitis 284 primary complex 188 miliary nodules 58 pulmonary complications 197 miliary tuberculosis 190, 197, 199 radiology 190 minute ventilation 13 reactivation 189 mixed germ‐cell tumour 374 screening immigrants 196 modafanil 44, 347 smear‐positive 191 Monge’s disease 390 symptoms and signs 189 montelukast 42 tuberculoma 197 Moraxella catarrhalis 178 vitamin D 195 Mounier‐Kuhn syndrome 298 pneumoniae 178 mouth breathing 13 mouth pressures 74 N‐acetyl cysteine 43 MRC Dyspnoea Scale 85, 88, 119, 120 nail examination 94 mucociliary escalator 15, 295 narcolepsy 346–7 mucolytic drugs 43 nasal cannulae 321

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nasal mucociliary clearance test 308 polysomnography 341–2 nasal polyps 111 risk factors 339, 340 nasendoscopy 75 sex differences 338 National Review of Asthma Deaths 116–17 surgical treatment 344 near‐drowning 389 symptoms and signs 339 nebuliser 35 weight loss 344 nedocromil sodium 42, 43 occupational history 84–5 neuroblastoma 376–7 occupational lung diseases 354–60 neuroenteric cyst 375 oesophageal duplication cyst 375 neurofibromas 376 oligohydramnios 8 neurofibromatosis 376 omalizumab 43, 112 neurogenic tumours 376 Ondine’s curse 18 neutropenia 53 opportunistic infections 175, 186–7 neutrophil count 53 opportunistic mycobacteria 199 nicotine 361 orthopnoea 85 nicotine replacement therapy 45 Osler–Weber–Rendu syndrome 286 nintedanib 44, 143–4 overlap syndrome 343 nitric oxide overnight pulse oximetry 75, 341 ARDS therapy 387 oxitropium bromide 38 bronchiectasis 299 oxygen–haemoglobin dissociation curve 21 fractional exhaled 74 oxygen therapy secretion 8 alert card 328 nitrogen narcosis 390 devices 321 Nocardia asteroides 180 hyperbaric 389 nocturnal hypoventilation 348 long‐term 35–6, 122–3, 322 non‐invasive ventilation 325–8 type 1 321–2 non‐REM sleep 334–5 type 2 respiratory failure 324 non‐small cell lung cancer 206, 216, 217, 222–3 oxygen transport 20–1 non‐specific interstitial pneumonitis 144–6 non‐tuberculous granuloma 226 pancreatic supplements 307 nose and throat examination 75 panda sign 157 paragangliomas 377 obstructive sleep apnoea/hypopnoea parainfluenza 177 syndrome 337–44 parasomnia 347 apnoea/hypopnoea index 337, 338 parathyroid adenomas 374 children 338–9 parietal pleura 14 clinical features 340 paroxysmal nocturnal dyspnoea 85

consequences 342–3 partial pressure of carbon dioxide (PCO2) 20

continuous positive airway pressure 344–5 partial pressure of oxygen (PO2) 20 COPD and 343 passive smoking 208–9, 361 definitions 338 peak expiratory flow 66–7 diagnosis 342 pectus carinatum 93 driving 343–4 pectus excavatum 93 epidemiology 338–9 Pe max 74 hypertension 342–3 percussion 96 investigations 341–2 pericardial cyst 375 lifestyle 344 periodic limb movement disorder 347 limited sleep study 341 peripheral chemoreceptors 20 management 344 peripheral nerve sheath tumours 376 mandibular advancement devices 344 PET scan 62–4 metabolic syndrome 343 phrenic nerve 11 obesity 338 physiological shunt 23 overnight pulse oximetry 341 pigeon chest 93 pathophysiology 339–41 Pi max 74

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pirfenidone 44, 143 Pneumocystis jiroveci 179 plethysmography 73 pneumocytes, type1 and type 2 7, 16 pleura 236 pneumomediastinum 378 pleural aspiration 76, 237, 239 pneumonia 175 pleural biopsy 77, 239, 241 acute eosinophilic 152 pleural cavities 14 acute interstitial 149 pleural effusion 236–43 aspiration 186, 296 aetiology 236 bacterial 176, 177–9 asbestos‐related 248, 256 bronchiolitis obliterans organising (BOOP) bronchoscopy 241 146–7 chest examination 100 chest examination 100 chest X‐ray 59, 237 chronic eosinophilic 152 clinical assessment 236 community‐acquired 176, 181–4 clinical examination 237 cryptogenic organising 146–7 clinical signs 239 fungal 179–80 CT thorax 237 hospital‐acquired 185 definition 236 idiopathic interstitial 140–4 diagnostic algorithm 237, 238 lipoid 186 exudate 242 lymphoid interstitial 148 idiopathic 248 symptoms and signs 176 investigations 237 ventilator‐associated 185–6 malignant 224, 242–3 viral 175–6, 177 MRI 237 pneumonitis PET‐CT 237 desquamative interstitial 147–8 pleural aspiration 76, 237, 239 hypersensitivity 160–3, 360 pleural biopsy 239, 241 non‐specific interstitial 144–6 pleural fluid analysis 54–5, 240–1, 263–4 pneumothorax 248–54 pulmonary emboli 247 BTS algorithm 254 rheumatoid arthritis 247 catamenial 254 thoracic ultrasound 237 chest drains 251, 252 transudate 241–2 chest examination 100 tuberculous 247 chest X‐ray 250 pleural fluid 236 classification 250 analysis 54–5, 240–1, 263–4 clinical presentation 249 aspiration 76, 237, 239 clinical signs 249 pleural infection 243–8 deep sea diving 390 aetiology 243–4 definition 248 antibiotics for 244 discharge information 251 chest drains 246 history 249 definition 243 iatrogenic 249 epidemiology 243 investigations 250 intrapleural fibrinolytic drugs 246–7 management 250–2 management 244 predisposing lung conditions 249 pathophysiology 244, 245 pregnancy 254 pleural thickening 247 primary spontaneous 248, 250–1 risk factors 243 recurrent 253–4 surgical treatment 246 secondary 248–9, 251 pleural plaques 254–5 surgical intervention 252–3 pleural rub 97 tension 249, 253 pleural thickening traumatic 253 asbestos‐related 255 pollution 363 infection‐related 247 polyarteritis nodosa 284 pleuritic chest pain 91, 91 polycythaemia 53 pleurodesis 224, 243, 253, 259 polysomnography 75, 341–2 pneumoconiosis 355–60 positron emission tomography (PET) scan 62–4

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post‐infection cough 89 proximal vein compressive lower‐extremity post‐nasal drip 89 ultrasound 273 post‐operative respiratory problems 99, 101 recurrent 277 Potter’s syndrome 8 risk factors 269 Pott’s disease 198 symptoms 270, 270 pre‐Botzinger complex 18 transthoracic echocardiogram 275 prednisolone 38, 39 troponins 272 prednisone 38 ventilation perfusion scan 273 pregnancy Wells score 271 pneumothorax 254 Pulmonary Embolism Severity Index (PESI) 277 pulmonary embolism 269, 275 pulmonary fibrosis prematurity 8 chest examination 100 pre‐operative respiratory assessment 99 idiopathic 58, 141–4 pressurised metered dose inhaler 31–2 pulmonary haemorrhagic syndromes 283–4 primary ciliary dyskinesia 7, 308–9 pulmonary hypertension 278–83 primary complex 188 chest X‐ray 279 primary polycythaemia rubra vera 53 chronic thromboembolic 282 pro‐calcitonin 181 classification (WHO) 278, 279–83 progressive massive fibrosis 358 clinical examination 279 proprioreceptors 19 definition 278 prostacyclin 283 ECG 279 Proteus infection 178 epidemiology 278 proximal vein compressive lower‐extremity investigation 279 ultrasound 273 left heart disease 282 pseudochylothorax 248 lung disease 282 Pseudomonas aeruginosa 178 management 283 ptosis 94 multifactorial 282–3 pulmonary alveolar proteinosis 165–6 NYHA functional classification 279 pulmonary amyloidosis 166 presentation 278 pulmonary arterial hypertension 279–82 pulmonary arterial hypertension 279–82 pulmonary arteries 16, 17 surgical treatment 283 pulmonary embolism 268–77 transthoracic echocardiogram 279 acute 270, 275–7 pulmonary Langerhans cell histiocytosis 164–5 anticoagulation 275–6 pulmonary lobule 15 arterial blood gases 271–2 pulmonary mass 58, 225 chest X‐ray 271 pulmonary nodule 58, 225–6 chronic 277 pulmonary oedema clinical signs 270, 270 chest X‐ray 57 contrast‐enhance pulmonary angiogram 273 high altitude 390 CT pulmonary angiogram 272–3 pulmonary rehabilitation 122, 301–2 D‐dimers 272 pulmonary vascular resistance 17 diagnosis 270–5 pulmonary veins 17 ECG 271 pulmonary veno‐occlusive disease 282 epidemiology 269 pulse oximetry flying 269 COPD 120 imaging 272–5 overnight 75, 341 inferior vena cava filter 276–7 pyrazinamide 193, 194 magnetic resonance pulmonary angiogram 273 management of acute embolus 275–7 radioallergosorbent test (RAST) 54 massive life‐threatening 277 radon 363 PESI 277 re‐breathe mask 231 pleural effusion 247 recreational drugs 360–3 pregnancy 269, 275 REM behaviour disorder 347 prognosis 277 REM sleep 335 prophylaxis 269 renal compensation 23

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renal failure 53 150, 154–60 reservoir mask 321 acute 154, 159 residual volume 71, 73 blood tests 158 respiratory acidosis 23, 323 calcium levels 53–4, 55 respiratory alkalosis 23 chronic 154–5 respiratory assessment clinical presentation 154 acutely ill patient 101 epidemiology 150 pre‐operative 99 gallium scan 157 respiratory bronchioles 15 histological diagnosis 158 respiratory bronchiolitis interstitial lung immune reaction 150 disease 148 investigation 155–9 respiratory failure 317–29 lambda sign 157 acid–base balance 23 lung function tests 158 acute type 2 125, 319, 323–4 management 159–60 arterial blood gases 319 multisystem 155, 159–60 chronic type 2 323, 328 panda sign 157 definition 318 prognosis 159–60 mechanisms 319 radiological investigations 155–8 non‐invasive ventilation 325–8 radiological staging 155 oxygen therapy 321–2, 324 self‐limiting disease 159 respiratory stimulants 328 spontaneous remission 159 type 1 318, 318, 319, 319–22 schistosomiasis 282 type 2 125, 318, 318, 319, 319, schwannomas 376 322–8 scoliosis 93 respiratory gas exchange ratio 21, 23 secondary polycythaemia 53 respiratory history 84–5 seminomas 374 respiratory muscles 11–14 septum transversum 6 testing 74 short‐acting anticholinergic drugs 37–8

respiratory quotient 21, 23 short‐acting β2‐agonists 36–7 respiratory syncytial virus 174–5 shunts 23 respiratory system shuttle walk test 74–5 development 6–8 388 examination 92–9 360 respiratory tract 8–11 silhouette sign 57 infections 174–5, 186 359–60 lower 8 simple pulmonary eosinophilia 153 upper 8 175 restless leg syndrome 347 six‐minute walk test 74 rheumatoid arthritis 247, 248, 283 skin prick test 55, 108 ribs 8 sleep cervical 9 chronic insufficiency 348 false (vertebrochondral) 8 physiology 334–5 floating (vertebral) 8 studies 75 fractures 9 small cell lung cancer 206, 210–11, 216, true (vertebrosternal) 8 217, 223 rifampicin 44, 193, 194 smoke inhalation 388–9 right heart catheter 77 smoking 361 right recurrent laryngeal nerve 17 cessation 44–5, 121, 361 roflumilast 42, 122 history 84 rounded atelectasis 226, 256 lung cancer link 208, 361 passive 208–9, 361 saccharin test 308 snoring 92, 336, 344 St George’s Respiratory Questionnaire 119 sodium cromoglycate 42–3 salbutamol 37 solitary pulmonary nodule 225–6, 227 salmeterol 37 spacer device 33–4

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spirometry 67–9 tram lines 299 spring water cyst 375 tranexamic acid 90 sputum transbronchial lymph node aspiration 76 clearance devices 303 transfer coefficient 73, 74 tests 54 transfer coefficient factor for carbon monoxide volume, content and colour 88 73–4 squamous cell lung carcinoma 217 transfusion‐related acute lung injury 387–8 Staphylococcus aureus 178 transthoracic echocardiography 275, 279 static lung volumes 71, 73 transudate 241–2 sternal angle 8 trauma sternum 8 airway 389 177 pneumothorax 253 stridor 101 tropical pulmonary eosinophilia 153 superior vena cava obstruction 212 troponins 272 suppurative lung diseases 294 tuberculin sensitivity (Mantoux) test 55, 192 surfactant 8 tuberculoma 197 sympathetic chain ganglia tumours 376–7 tuberculosis see Mycobacterium tuberculosis syndrome of inappropriate ADH 211 tuberculous effusion 247 systemic lupus erythematosus 283 tuberculous granuloma 226 tube spacers 34 tachypnoea 85 turbohaler 32–3 tactile vocal fremitus 97 talc pleurodesis 224, 243, 253, 259 ultrasonic nebuliser 35 TED stockings 269 ultrasound tension pneumothorax 249, 253 proximal vein compressive lower‐extremity 273 terbutaline 37 thoracic 64, 237 terminal bronchioles 15 unfractionated heparin 269, 276 theophylline 37, 41–2, 54, 122 upper airway resistance syndrome 336–7, 344 thoracic cavity 8 upper respiratory tract 8 thoracic duct 18 urine samples 55 thoracic ultrasound 64, 237 uvulopalatopharyngoplasty 344 thoracocentesis 76, 237, 239 thromboembolic disease 268–9 vagi 17 thromboembolic disease stockings 269 vaping 45 thunderstorms 114, 363 varenicline 45 thymoma 371–3 varicella 177 thymus vascular anomalies 376 carcinoids 373 vasculitis 283–4 cysts 373 ventilation‐perfusion mismatch 23 hyperplasia 373 ventilation perfusion (VQ) scan 64, 273 lipoma 373 ventilator‐associated pneumonia 185–6 thyroid goitre 374 ventral respiratory group 18 tidal volume 13, 71 Venturi mask 324 Tietze’s syndrome 91 video‐assisted thoracoscopy surgery (VATS) 77 tiotropium 38 175–6, 177 TNM classification 217, 218, 219 viral respiratory tract infections 174–5, 175 total lung capacity 71, 73 Virchow’s triad 269 trachea visceral pleura 14 anatomy 14 vital capacity 67, 69, 71 deviation 94 vitamin D 54, 112, 195, 296 oesophageal fistula 6 92, 127–8 tumours 225 vocal resonance 97 tracheobronchomalacia 298 voice hoarseness 92 tracheobronchomegaly 298 volumatic device 33 traffic fumes 363 VQ scan 64, 273

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warfarin 276 World Health Organization (WHO) weather conditions 114, 363 performance status 212 Wells score 271 pulmonary hypertension classification 278, 279–83 92, 96 thymoma staging 373 whispering pectoriloquy 97 white cell count 53 Young syndrome 309 whole‐body plethysmography 73 Williams–Campbell syndrome 298 zafirlukast 42

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