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A pneumothorax is a life-threatening condition in which air collects in the pleural space, causing partial or full collapse of the lung. A pneumothorax can be traumatic or spontaneous. Patients present with a sudden onset of sharp chest pain, dyspnea, and diminished breath sounds on exam. Symptom severity depends on the degree of the collapsed lung. A large or tension pneumothorax can result in cardiopulmonary collapse. A diagnosis is made with imaging, though tension pneumothorax is a clinical diagnosis. Management is based on the size and stability of the patient, and can include needle decompression and chest tube (thoracostomy) placement.

Pneumoconiosis

Pneumoconiosis is an occupational disease that results from the inhalation and deposition of mineral dusts and other inorganic particles in the lung. It can be categorized according to the type of causative particle involved or by the type of response provoked. Coal, silica, asbestos, and talc are the classic fibrogenic types, while beryllium provokes a granulomatous response, and cobalt is associated with giant cell pneumonia. Iron, tin, and barium are considered benign or inert particle types because they do not cause the same type of reactions as the others. After exposure to the fibrogenic types of particles, macrophages and fibroblasts become activated within the pulmonary parenchyma leading to chronic inflammation and fibrosis, which can progress to respiratory failure and death. Occupational history and chest X-rays are the mainstays of diagnosis and staging. Management is mainly symptomatic.

Asthma Medications

Asthma is a chronic inflammatory condition of the small airways of the lungs. The condition is characterized by airway hyperresponsiveness, variable airway obstruction, and airway inflammation. Manifestations include episodic wheezing, coughing, and shortness of breath. Management of asthma aims to reduce symptoms and minimize future risks and adverse outcomes (hospitalizations, loss of lung function, etc.). Medications commonly utilized include inhalers that allow bronchodilation and inflammatory control. Biologic agents are available for severe asthma.

Dyspnea

Dyspnea is the subjective sensation of breathing discomfort. Dyspnea is a normal manifestation of heavy physical or psychologic exertion, but also may be caused by underlying conditions (both pulmonary and extrapulmonary). The medical history and physical exam of a patient presenting with dyspnea should be used to rule out certain conditions or suggest the most likely cause of the respiratory discomfort. Management focuses on treating the underlying condition.

Wheezing

Wheezing is an abnormal breath sound characterized by a whistling noise that can be relatively high-pitched and shrill (more common) or coarse. Wheezing is characterized by a whistling noise produced by the movement of air through narrowed or compressed small (intrathoracic) airways. Wheezes can be inspiratory or (more commonly) expiratory. Since wheezing is experienced by the patient and witnessed by the physician, the condition is a symptom as well as a physical finding. Respiratory diseases that result in obstruction usually lead to wheezing, most commonly asthma; however, other causes also exist, including allergies, pneumonia, and heart failure, among others.

Asthma

Asthma is a chronic inflammatory respiratory condition characterized by bronchial hyperresponsiveness and airflow obstruction. The disease is believed to result from the complex interaction of host and environmental factors that increase disease predisposition, with inflammation causing symptoms and structural changes. Patients typically present with wheezing, cough, and dyspnea. Diagnosis is confirmed with a pulmonary function test showing a reversible obstructive pattern. Treatment, based on symptom severity, includes bronchodilators and inhaled corticosteroids for control of inflammation. Biologic agents targeting inflammatory mediators have been developed for severe persistent asthma.

Obstructive Sleep Apnea

Obstructive sleep apnea (OSA) is a disorder characterized by recurrent obstruction of the upper airway during sleep, causing hypoxia and fragmented sleep. Obstructive sleep apnea is due to a partial or complete collapse of the upper airway and is associated with snoring, restlessness, sleep interruption, and daytime somnolence. The diagnosis relies on medical history, and polysomnography can confirm the diagnosis. Management includes lifestyle changes, methods of positive airway pressure, and surgical intervention.

Cystic Fibrosis

Cystic fibrosis is an autosomal recessive disorder caused by mutations in the gene CFTR. The mutations lead to dysfunction of chloride channels, which results in hyperviscous mucus and the accumulation of secretions. Common presentations include chronic respiratory infections, failure to thrive, and pancreatic insufficiency. The gold standard for diagnosis is the sweat chloride test, which can be complemented by genetic testing. Cystic fibrosis ultimately leads to chronic inflammation and multisystem organ failure. Management includes CFTR modulator therapy and system-specific strategies for supportive care. Prognosis varies depending on treatment and complications. With optimal medical care, patients can live into their mid-40s.

Types of Shock

Shock is a life-threatening condition associated with impaired circulation that results in tissue hypoxia. The different types of shock are based on the underlying cause: distributive (↑ cardiac output (CO), ↓ systemic vascular resistance (SVR)), cardiogenic (↓ CO, ↑ SVR), hypovolemic (↓ CO, ↑ SVR), obstructive (↓ CO), and mixed. The most common symptoms include tachycardia, tachypnea, hypotension, altered mentation, and oliguria. Treatment measures vary depending on the suspected cause of shock and may include mechanical ventilation, IV crystalloids, vasopressors, and blood transfusion.

COVID-19 (Coronavirus disease 2019)

COVID-19, also known as Coronavirus disease, is a respiratory infection caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV 2). Transmission mainly occurs via direct contact or aerosol droplets. The disease may present asymptomatically or with fever and dry cough.

Lung Cancer: Invasion and Metastasis, Paraneoplastic Syndromes and Treatment of Mesothelioma, Small-cell Lung Carcinoma (SCLC) and Non-small Cell Lung Cancer (NSCLC)

Lung cancer is notoriously one of the most common lethal tumors in the medical world. It is essential to be accustomed with the basic details about this disease. In this article, you will gain all exam-relevant information about the epidemiology, pathogenesis and clinical recognition of lung cancer.

Connective Tissue Diseases Associated With Restrictive Lung Disease: Nonspecific Interstitial Pneumonia (NSIP), Scleroderma, Dermatomyositis and Polymyositis

Diseases of the lung are classified as obstructive lung diseases like chronic obstructive pulmonary disease or cystic fibrosis, and restrictive lung diseases.

Thoracic Trauma: Management of Tension Pneumothorax, Rib Fracture, Pulmonary Contusion

Thoracic traumatic injuries can be generally classified according to the mechanism of injury as blunt or penetrating chest injuries. Chest injuries can be also classified according to the site of injury as chest wall, lung, heart, major blood vessel, and esophageal injuries. The extent and specific type of thoracic traumatic injury can be identified by a proper history and physical examination that is supported by adequate imaging studies. The treatment includes fluid therapy and oxygen supplementation in addition to specific treatments depending on the specific type of injury.

Berylliosis — Symptoms and Treatment

Inhalation of Beryllium (Be) dust, or its vapors or compounds, or subcutaneous implantation of Beryllium can lead to either acute or chronic beryllium disease, also known as berylliosis. It can affect genetically susceptible individuals or workers exposed to the fumes or vapors of the metal. It was first described by Hardy and Tabershaw in 1946. Beryllium can cause either an immediate acute form of illness or insidious chronic berylliosis.

Hemoptysis — Etiology and Diagnostic Approach

Hemoptysis can be defined as the expectoration of blood during coughing that originates from the lower respiratory tract. Per this definition, coughing of blood from an upper respiratory tract illness can be excluded. While coughing blood can be alarming to the patient, it is usually a self-limiting symptom. In clinical practice, only 5% of the patients who present with hemoptysis are found to have a serious medical condition that needs further treatment.

Anatomy of the Respiratory System and the Respiratory Muscles

Without oxygen, the human organism is not capable of living. It gains a major part of its energy from oxidative degradation of nutrients. The processes involved in this are called pulmonary respiration or external respiration. The carbon dioxide that is formed in the process of combustion has to be released. The gas exchange between air and blood takes place in the lung. When nutrients are degraded in order to gain energy, oxygen is consumed – a process that takes place in every individual cell of the body and is therefore called cell respiration or internal respiration. The detailed processes of cell respiration are the subject of biochemistry and will not be discussed here.

Sleep Disorders: Narcolepsy (Excessive Uncontrollable Daytime Sleepiness) and Restless Legs Syndrome (RLS)

Permanent sleepless nights are torture: Sleep disorders are accompanied by much suffering for affected individuals. Which of the disorders that mostly occur nocturnally should you know about for your practice routine and the medical exam? The following article will introduce you to the fundamentals of sleep disorders, diagnostics as well as therapeutic remedies in cases of REM sleep behavior disorders and sleep myoclonus. Particular focus is laid on narcolepsy and restless legs syndrome. This article is concisely prepared with focus on the exam and will leave no questions concerning sleep disorders in neurology unanswered.

Modes of Ventilation

Sometimes ventilation is the only way to save a patient's life. Here you'll read about the different forms of mechanical ventilation, how it is different from spontaneous breathing and what modes of ventilation exist.

A-A Gradient & Alveolar Gas Equation – Laboratory Diagnostics

A-A Gradient & Alveolar Gas equation are very evident to determine various causes of hypoxemia. Alveolar gas equation is useful for calculation of the partial pressure of oxygen in lung alveoli and A-A Gradient is the value that shows the difference between alveolar oxygen pressure and arterial oxygen pressure. The etiology of hypoxemia can be hypoventilation, diffusion impairment, and presence of shunt, V/Q mismatch and high altitude. The variation in the values of alveolar gas equation and A-A Gradient establish the laboratory diagnosis of the lung pathologies.

Diagnostic Imaging: X-Ray and CT Scan in the Integrated Pulmonary Pathology

Radiological investigations like x-ray and CT scan are required for the confirmation of clinical findings. The field of radiology in the 21st century has become very advanced and through various radiological investigations, even the smallest calcifications and vascular pathologies can be diagnosed. The chest radiograph (CXR) is the most common radiological investigation.

Lung Cancer (Bronchial Carcinoma) — Classification, Staging and Treatment

The lung is the major organ of the respiratory system and used to inhale oxygen and remove the metabolic waste in the form of CO2 from the body. Malfunctioning of the lungs can lead to serious complications and disturbs the normal living conditions. Lung cancer is one of the severe conditions which have a relatively high mortality risk. Previously, it was the leading cause of death among men in more than 25 developed countries. Now it has become a worldwide cause of death among men. Most common cause of lung cancer is smoking, especially in men. Prognosis of this condition is still poor for malignant tumors. Read everything important about it here.

Lupus (Systemic Lupus Erythematosus; SLE) — Diagnosis and Treatment

The autoimmune disease lupus erythematosus belongs to the collagenoses and can show very different clinical symptoms: The symptoms range from mild conditions to severe organ manifestations which makes the diagnosis not easy sometimes. Read all the important facts about lupus erythematosus here to be prepared for the exam and the subsequent medical daily routine.

Pleural Effusion — Diagnoses, Treatment, Transudate and Exudate

Medical students often encounter patients with pleural effusion during internships and their residency. These patients do not always suffer from dyspnea and an accurate clinical examination is crucial for the diagnosis. In oral and written exams, explaining the difference between transudate and exudate is a frequent task. In this article, you can find all the important information regarding pleural effusion – for clinical practice and your studies!

Sarcoidosis — Symptoms, Diagnosis and Treatment

Sarcoidosis, also referred to as Morbus Boeck or Morbus Besnier-Boeck-Schaumann disease, usually attacks the lungs and is therefore frequently taught within the scope of pulmonary diseases. The bottom line is, however, that this disease can also affect any other organ meaning that medical students may not only encounter its clinical picture in many exams dealing with various specialties but also in their clinical routines in different specialty disciplines. You will learn in this article how to accurately classify the progression and symptoms of sarcoidosis and to take the right steps to diagnose and treat it.

Chronic Obstructive Pulmonary Disease (COPD) — Classification, Symptoms and Diagnosis

Chronic obstructive pulmonary disease (COPD) is the most common chronic disease of the airways that is caused in 90 % of cases by smoking. COPD is a preventable and treatable disease. However, many patients do not know that they suffer from the disease, so the number of unreported cases of patients is very high. In this article, you will find important information on the epidemiology, etiology, pathophysiology and diagnosis, as well as the differential diagnosis and treatment of COPD.

Bronchiectasis — Diagnosis and Treatment

Bronchiectasis can develop from chronic lung diseases or pulmonary infectious diseases. Since it is irreversible, it is most important to diagnose it timely. Only then, it is possible to prevent it from progressing by implementing appropriate measures. This article will introduce you to the pathophysiological and etiological basics of bronchiectasis, and will prepare you for the treatment of affected patients.

Usual Interstitial Pneumonia (UIP) and Idiopathic Pulmonary Fibrosis (IPF) — Symptoms and Treatments

Idiopathic pulmonary fibrosis (IPF) belongs to a group of diseases whose specific cause is not well known, which keeps clinicians and researchers worried: the often rapid progression of IPF is very distressing. Also the underlying causes are mostly unknown, pathophysiologic explanations and findings are still unsatisfying. With only a 5-year survival rate of 20–40 %, only quick decisions such as initiating a lung transplantation, might help prolong a patient’s life.

Acute Respiratory Distress Syndrome (ARDS) — Phases and Treatment

Acute Respiratory Distress Syndrome (ARDS) is a severe inflammatory reaction of the lung that is characterized by presence of pulmonary infiltrates due to alveolar fluid accumulation, without evidence suggestive of a cardiogenic etiology. SIRS and sepsis are the major causes of ARDS. The main finding of ARD is respiratory failure. Chest x-ray usually shows diffuse bilateral lung infiltrates described as " (“butterfly opacity”). Management depends mainly on treating the underlying etiology, and maintaining adequate oxygenation, which may requires intubation and mechanical ventilation.

Emphysema — Causes and Treatment

Emphysema is a condition characterized by the dilation of air spaces, with decreased elasticity and increased compliance, due to alveolar wall destruction; capillaries are also destroyed along with the alveoli. The most common cause for developing emphysema is smoking. Alpha-1-antitrypsin deficiency may also result in the development of emphysema.

Pulmonary Function Tests (PFT)

Pulmonary function tests (PFT) are a battery of tests that measure lung function and aid in the management of patients with respiratory disease. They are performed using standardized equipment and can be used for diagnosis, prognostication, management and follow-up of patients with pulmonary pathology. Although PFT may not identify the exact pathology, it broadly classifies respiratory disorders as either obstructive or restrictive. In this article, the role of PFT in the measurement of lung mechanics and diagnosis of various diseases will be discussed in detail.

Hypersensitivity Pneumonitis & Eosinophilic Pneumonia

Hypersensitivity pneumonitis (HP), also called "extrinsic allergic alveolitis," is an immunologically-induced inflammatory disease affecting the alveoli and terminal airways (bronchioles), caused by repeated inhalation of a variety of inciting agents in a susceptible host. A wide range of organic antigens have been identified from different occupations. The clinical presentations of hypersensitivity pneumonitis vary depending upon the frequency, length, and intensity of exposure to the inciting agent. Surprisingly, cigarette smoking reduces the risk of developing the disease due to decreased antibody reaction to the antigen.

Infant Respiratory Distress Syndrome (IRDS) — Symptoms and Treatment

Respiratory Distress Syndrome (RDS), also known as "Hyaline membrane disease", is caused by the deficiency of lung surfactant in a pre-term infant due to the immaturity of the lungs. The risk of RDS is inversely related to the gestational age, and, most commonly occurs in infants less than 28 weeks of gestational age. Neonatal respiratory distress syndrome is associated with high morbidity and mortality in pre-term infants and considered one of the most common causes of neonatal death. Respiratory distress syndrome should be differentiated from the other causes of respiratory distress after birth, which will be discussed in details in this article.

Chronic Bronchitis — Symptoms and Treatment

Chronic bronchitis is characterized by expectoration for a period of more than three months, in more than two consecutive years. Chronic irritation caused by smoking promotes hyperplasia of mucus glands and increases the production of mucus. Central and peripheral airways are involved in the pathophysiology of the disease and it includes inflammation, oxidative stress, inhibited repair processes, and an imbalance of proteinases/anti- proteinases. This article will prepare you perfectly well for your next exam!

Pulmonary Hypertension (PH) — Categories, Causes and Treatment

Pulmonary hypertension (PH) is a clinical condition that is characterized by elevated pulmonary arterial pressure. It can lead to serious clinical consequences, thus early detection and treatment is important before it becomes advanced and less responsive to therapy. PH is a feature of advanced underlying disease that are usually caused by cardiac, pulmonary, or intrinsic vascular diseases. Therefore, suspected cases will undergo diagnostic testing to confirm the condition and identify the underlying cause. The definition, epidemiology, classification and etiologies, pathophysiology, clinical features, diagnostic evaluation and treatment all will be discussed in this article.

Arterial Blood Gas (ABG) Analysis

ABG analysis is an indispensable test for critically ill patients or patients treated in an ICU. Interpretation of ABG analysis seems complicated; however, an understanding of the basic physiology can ease the interpretation. In this article, the basic physiology behind ABG analysis and a stepwise approach to interpreting ABG analysis will be discussed in detail.

Respiratory Failure: Hypoxemia, Hypercapnia and Hypoxia

The inspiration of oxygen and expiration of carbon dioxide are vital functions of the human body. A decrease in PO2 and increase in PCO2 can alter many normal physiologic processes, and may eventually be fatal. The human body has various reflex mechanisms to manage such changes. Understanding of these reflexes and identification and management of any impairment in them is essential in the management of many respiratory and renal diseases.

Asbestosis and Silicosis — Causes and Treatments

Occupational lung disease covers a specific area of knowledge in respiratory medicine. In these cases, information on the patients's history play an important role in the detection of these disorders, guiding investigations and management. Awareness of this topic is essential.

Pulmonary Embolism (PE) — Symptoms and Treatment

Pulmonary embolism (PE) is a fatal clinical condition that occurs as a result of mechanical obstruction of the pulmonary artery or its branches by any material (such as thrombus, air or fat) from anywhere in the body. Pulmonary embolism can be an acute condition, in which the signs and symptoms develop immediately after the event (i.e., the obstruction of the pulmonary vessels), or it can be chronic, in which the signs and symptoms develop progressively for years. In this article, you will be able to understand the definition, incidence, pathophysiology, risk factors, symptoms and signs and the prognosis of pulmonary embolism.

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Respiratory Pathology

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