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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_2935_Библиотеки_им_академика_М_И_Перельмана
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Abbreviationsx
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CRP: C-reactive protein
•
CSS: Churg-Strauss syndrome
•
CT: Computerised tomography
•
CTEPH: Chronic thromboembolic pulmonary hypertension
•
CTPA: Computerised tomography pulmonary angiogram
•
CURB-65: Confusion, urea, respiratory rate, blood pressure, 65
•
CXR: Chest X-ray
•
DIP: Desquamative interstitial pneumonia
•
DOTS: Directly observed treatment, short course
•
DVT: Deep vein thrombosis
•
EBUS: Endobronchial ultrasound
•
ECG: Electrocardiogram
•
ED: Emergency Department
•
EEG: Electroencephalogram
•
EGFR-TK: Epidermal growth factor receptor tyrosine kinase
•
EGPA: Eosinophilic granulomatosis with polyangiitis
•
EIA: Enzyme immunoassay
•
EPTB: Extra-pulmonary tuberculosis
•
ESRD: End-stage renal disease
•
ESS: Epworth Sleepiness Scale
•
FBC: Full blood count
•
FeNO: Fractional exhaled nitric oxide
•
FEV1: Forced expiratory volume in 1 second
•
FEV1/FVC: Forced expiratory volume in 1 second/forced vital capacity ratio
•
FVC: Forced vital capacity
•
GBM: Glomerular basement membrane
•
GCT: Germ cell tumour
•
GORD: Gastro-oesophageal reflux disease
•
GPA: Granulomatosis with polyangiitis (Wegener’s granulomatosis)
•
GPS: Goodpasture’s syndrome
•
H: Haemagglutinin
•
HAART: Highly active antiretroviral therapy
•
HAP: Hospital-acquired pneumonia
•
HGV: Heavy goods vehicle
•
HIV: Human immunodeficiency virus
•
HRCT: High-resolution computerised tomography
•
IA: Inflammatory arthritis
•
ICSI: Intracytoplasmic sperm injection
•
ICU: Intensive care unit
•
IgE: Immunoglobulin E
•
IgG: Immunoglobulin G
•
IGRA: Interferon gamma release assays
•
ILD: Interstitial lung disease
•
INR: International normalised ratio
•
IPAH: Idiopathic pulmonary arterial hypertension
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•
IPF: Idiopathic pulmonary fibrosis
•
IRIS: Immune reconstitution inflammatory syndrome
•
IV: Intravenous
•
IVC: Inferior vena cava
•
JVP: Jugular venous pressure
•
KUB: Kidney, ureter, bladder
•
LABA: Long-acting beta agonist
•
LDH: Lactate dehydrogenase
•
LFTs: Liver function tests
•
LIP: Lymphoid interstitial pneumonia
•
LMWH: Low-molecular-weight heparin
•
LRTI: Lower respiratory tract infection
•
LTOT: Long-term oxygen therapy
•
LV: Left ventricle
•
MAC: Mycobacterium avium complex
•
MAD: Mandibular advancement device
•
MALT: Mucosa-associated lymphoid tissue
•
MC&S: Microscopy, culture and sensitivity
•
MDR-TB: Multidrug-resistant tuberculosis
•
MGIT: Mycobacteria growth indicator tube
•
MPA: Microscopic polyangiitis
•
MRSA: Methicillin-resistant Staphylococcus aureus
•
N: Neuraminidase
•
NICE: National Institute for Health and Care Excellence
•
NIV: Non-invasive ventilation
•
NPPV: Non-invasive positive pressure ventilation
•
NRT: Nicotine replacement therapy
•
NSAID: Non-steroidal anti-inflammatory drug
•
NSCLC: Non–small cell lung cancer
•
NSIP: Non-specific interstitial pneumonia
•
NTM: Non-tuberculous mycobacteria
•
ODI: Oxygen desaturation index
•
OSAHS: Obstructive sleep apnoea/hypopnea syndrome
•
PA: Posteroanterior
•
PaCO2: Partial pressure of carbon dioxide in arterial blood
•
PAH: Pulmonary arterial hypertension
•
pANCA: Perinuclear anti-neutrophil cytoplasmic antibody
•
PaO2: Partial pressure of oxygen in arterial blood
•
PCD: Primary ciliary dyskinesia
•
PCP: Pneumocystis jirovecii pneumonia
•
PCR: Polymerase chain reaction
•
PE: Pulmonary embolism
•
PEF: Peak expiratory flow
•
Abbreviations xi
Abbreviationsxii
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PEFR: Peak expiratory flow rate
•
PEP: Positive expiratory pressure
•
PFT: Pulmonary function test
•
PO: Per os (orally)
•
PPE: Personal protective equipment
•
PPI: Proton pump inhibitor
•
PR3: Proteinase 3
•
PSG: Polysomnography
•
PSP: Primary spontaneous pneumothorax
•
PVR: Peripheral vascular resistance
•
QDS: Four times daily
•
QoL: Quality of life
•
RB-ILD: Respiratory bronchiolitis–associated interstitial lung disease
•
RCP: Royal College of Physicians
•
RV: Right ventricle
•
SABA: Short-acting beta agonist
•
SBOT: Short burst oxygen therapy
•
SBP: Systolic blood pressure
•
SCLC: Small cell lung cancer
•
SIADH: Syndrome of inappropriate antidiuretic hormone secretion
•
SLE: Systemic lupus erythematosus
•
SSP: Secondary spontaneous pneumothorax
•
SVC: Superior vena cava
•
SVCO: Superior vena cava obstruction
•
TB: Tuberculosis
•
TDS: ree times daily
•
TFTs: yroid function tests
•
Tlco: Transfer factor for carbon monoxide
•
TNF: Tumour necrosis factor
•
TST: Tuberculin skin test
•
TTE: Transthoracic echocardiogram
•
U&E: Urea and electrolytes
•
UFH: Unfractionated heparin
•
UIP: Usual interstitial pneumonia
•
URTI: Upper respiratory tract infection
•
USS: Ultrasound scan
•
V/Q scan: Ventilation/perfusion scan
•
VATS: Video-assisted thoracoscopic surgery
•
VC: Vital capacity
•
WCC: White cell count
•
WHO: World Health Organisation
•
XDR-TB: Extensively drug-resistant tuberculosis
•
An Explanation of the Text
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e book is divided into two parts covering the clinical aspects of respiratory
medicine, including investigations and prescribing, and a self-assessment section. We have used bullet points to keep the text concise and supplemented this
with a range of diagrams, pictures and MICRO boxes (explained below).
Where possible we have endeavoured to include treatment options for the
conditions covered. Nevertheless, drug sensitivities and clinical practices are
constantly under review, so always check your local guidelines for up-to-date
information.
You will find the following resources useful to find out more about any of the
drugs mentioned in this book:
BNF (at www.bnf.org/bnf/index.htm)
eMC (at www.medicines.org.uk/emc/)
MICRO-facts
These boxes expand on the text and contain clinically relevant facts
and memorable summaries of the essential information.
MICRO-print
These boxes contain additional information to the text that may interest certain readers but is not essential for everybody to learn.
MICRO-case
These boxes contain clinical cases relevant to the text and include
a number of summary bullet points to highlight the key learning
objectives.
MICRO-references
These boxes contain references to important clinical research and
national guidance.
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Part
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Respiratory Medicine
I
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1
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Clinical
Assessment
1.1 HISTORY
1. HISTORY OF PRESENTING COMPLAINT
Breathlessness:
•
• Onset: sudden or gradual?
• Timing: on exercise or at rest?
– If shortness of breath on exertion, clarify the patient’s exercise toler-
ance. “How far can you walk before you have to stop because of your
breathing?”
– Compare this to their “normal” exercise tolerance or tolerance before
this episode of breathlessness.
• Timing: nocturnal/early morning symptoms?
• Duration.
• Exacerbating factors: cold air, exercise, dust, pets, drugs.
• Relieving factors: medications, rest.
• Severity – the MRC Dyspnoea Scale can be used (see Table 1.1)
• Orthopnoea or paroxysmal nocturnal dyspnoea?
– ese are suggestive of cardiac failure.
• Other features.
Table 1.1 MRC Dyspnoea Scale.
DESCRIPTION GRADE
I only get breathless with strenuous exercise 0
I get short of breath when hurrying on level ground or walking up a 1
slight hill
On level ground, I walk slower than people of my age because of breathless- 2
ness, or I have to stop for breath when walking at my own pace on the level
I stop for breath after walking about 100 yards or after a few 3
minutes on level ground
I am too breathless to leave the house or I am breathless when 4
dressing/undressing
DOI: 10.1201/9781315113937-2
Clinical Assessment4
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Cough:
•
• Onset: acute or chronic?
• Diurnal variability: overnight/early morning suggests asthma.
• Exacerbating factors.
• Productive or unproductive?
– If productive, ask about sputum:
◯
Colour: see Table 1.2.
◯
Consistency: see Table 1.2.
◯
Quantity: large quantities are associated with bronchiectasis.
◯
Odour: foul-smelling or foul-tasting sputum suggests anaerobic
infection.
◯
Presence or absence of blood.
Table 1.2 Characteristic sputum appearances in respiratory disease.
SPUTUM
TYPE COLOUR CONSISTENCY CAUSE
Serous Clear/Pink in Acute – pulmonary oedema
Watery/Frothy Chronic – alveolar cancer
Mucoid Clear/White/ Viscid COPD
Grey Asthma
Purulent Yellow ick Acute infection
Asthma
Green ick Chronic infection:
Pneumonia
Bronchiectasis
Cystic fibrosis
Lung abscess
Rusty Rusty Red ick Pneumococcal pneumonia
Haemoptysis:
•
• Clarify if fresh blood e.g. bright red or dark altered blood.
• If mixed with sputum, this may reflect an infective aetiology, but this is
not exclusive.
• Volume >200 mL in 24 hours is considered “massive haemoptysis” (see
Chapter 18: Respiratory Emergencies).
• Pure red blood may reflect a bleed from a bronchial artery (as in bron-
Respiratory Medicine
chiectasis, pulmonary emboli and malignancy).
• Any features of vasculitis? (Patient may have alveolar haemorrhage; see
Chapter 13: Vasculitis and the lung.)
Pain:
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•
• Pleuritic pain: sharp, stabbing, worse on inspiration.
– Causes include pulmonary embolism (PE), pneumonia, pneumotho-
rax, rib fracture, musculoskeletal pain.
• Chest wall pain:
– Localised, following trauma: rib fracture or muscular strain.
– Dermatomal: herpes zoster.
– Progressive dull, aching, gnawing pain: consider malignancy.
• Central chest pain may be due to non-respiratory causes:
– Cardiac: central, crushing pain.
– Upper gastrointestinal: associated with gastrointestinal symptoms,
burning, retrosternal pain e.g. gastro-oesophageal reflux. Can be
confused with aortic dissection.
– Aortic: tearing pain in aortic dissection, radiates to the back.
– Mediastinal: central, retrosternal and unrelated to coughing/respi-
ration. Causes include lymphadenopathy and thymoma.
MICRO-facts
“SOCRATES”: Questions to ask when enquiring about pain:
Site
Onset
Character
Radiation
Associated symptoms
Timing
Exacerbating/relieving factors
Severity.
1.1 Histor y
5
2. PAST MEDICAL HISTORY
Previous atopic disease: eczema and hay fever are associated with asthma.
•
Recent trauma/surgery: especially useful if a PE is suspected.
•
Immunosuppression: increases risk of TB and atypical infection.
•
Perinatal illness: potential chronic lung disease of the newborn if history of
•
prematurity, assisted delivery or admission to the neonatal unit.
3. DRUG HISTORY
Current inhaler use: type, dosage, frequency.
•
Home oxygen therapy: long-term oxygen therapy (LTOT), ambulatory or
•
short burst oxygen therapy (SBOT).
Home nebulisers.
•
Respiratory Medicine
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