Disease Aetiology Pathology Signs Symptoms Investigations Treatment Notes
Asthma - Atopy (Familial, IgE, - Bronchial muscle - Tachypnoea. Intermittent - PEF on walk + before/after - Step 1- Inhaled β2 agonist. If Hay Fever, Shellfish,
Wealing). contraction caused by - Audible wheeze. dyspnoea dilators. used > once daily/nocturnal Cats, Wheat, Smoke,
- Airway stimuli. - Hyperinflated chest. - Wheeze. - Spirometry (15% improve on symptoms → Step 2. Dust Mites, Latex,
hyperresponsiveness. - Mucosal inflammation - Hyper resonant - Cough (often dilators). - Step 2- Add standard dose Pollen, Milk, Peanuts,
- Th2→↑IgE→↑IL- caused by mast cell and percussion note. nocturnal). - Exercise tolerance test. inhaled corticosteroid. Eggs, Cold Weather,
5→Inflammation. basophil degranulation - ↓Air entry. - Sputum production. - Histamine provocation. - Step 3- Add LABA. If beneficial, Exercise, Grass.
causing release of - Widespread - Corticosteroid trial. but inadequate control, continue
inflammatory mediators. polyphonic wheeze. - Full blood count (U&E, CRP). LABA and ↑ corticosteroid. If no If asthma, then airway
- ↑ Mucus production. - Chest x-ray. effect, then stop LABA and obstruction is reversible.
- Skin prick test to identify ↑corticosteroid. Leukotriene
allergen. receptor antagonist or oral
theophylline may be tried.
- Step 4- Consider trials of
increasing corticosteroid or
adding a fourth drug e.g. oral
leukotriene receptor antagonist,
modified release (both) β2
agonist and theophylline tablets.
- Step 5- Use daily steroid tablet
in lowest dose to provide
adequate control and maintain
high dose inhaled corticosteroid.
Bronchitis (COPD) - Smoking. Large airways- mucous gland - Tachypnoea. - Cough. - Full blood count. - Smoking cessation. Infection,
- Pollution. hyperplasia, goblet cell - Use of accessory - Sputum. - Chest X-ray. - Pulmonary rehabilitation. Pneumothorax, Cor
- Occupational dust. hyperplasia, inflammation and muscles on - Dyspnoea. - CT scan. - Nutritional assessment/ pulmonale, Oedema,
Cough plus sputum - Viral/bacterial infection. fibrosis are a minor expiration. - Wheeze. - ECG (cor pulmonale). improve diet. Respiratory failure.
production for 3 months of - Advanced age. component. - Hyperinflation. - Arterial blood gas. - SABA/SAMA (first treatment).
2 successive years. -Hypertrophy/hyperplasia - ↓ chest expansion. - Spirometry. - Add long acting bronchodilator Different from
of mucous-secreting glands. Small airways- goblet cells - Resonant/hyper (LAMA/LABA) if symptoms Emphysema as
(Non-reverisble airway appear, inflammation and resonant percussion exacerbate. Bronchitis causes
obstruction) fibrosis in long standing note. - Add another LAMA/LABA if patients lungs to
disease. - Wheeze. symptoms further worsen. become very inflamed.
- Cyanosis. - Triple therapy (inhaled
- Cor pulmonale. corticosteroid, LAMA and LABA).
Emphysema - Smoke exposure/smoking, - Increase beyond the normal Same as Bronchitis. Same as Bronchitis. Same as Bronchitis. Same as Bronchitis. Same as Bronchitis.
- Air pullition. in the size of airspaces distal
(COPD) - Chemical fumes and dust. to the terminal bronchiole. Different from
- Ageing, Bronchitis as
(Non-reversible airway - Alpha-1-antitrypsin - Caused by bronchiolar Emphysema is the
obstruction) deficiency. dilatation or from destruction gradual destruction of
of alveoli walls and without the alveoli in the lung.
obvious fibrosis.
Pharyngitis, URTI - Bacterial (haemophilus - Bacteria or viruses may - Lymphadenopathy. - Fever. - Throat swab (Microscop, No treatment or 10 days of Quinsy (Tonsil abscess),
influenzae, moraxella directly invade the - Dysphagia. - Sore Throat. Gram Stain, Cults). penicillin. Ear pain, Scarlet fever –
cattarrhalis, streptococcus pharyngeal mucosa, causing a - Fauces - ↓ apetite. - Nasal swab. Streptococcus Pyogenes,
pyogenes). local inflammatory response. - Inflammation. - FBC (↑WCC, ↑CRP, ↑ESR). Don’t give amoxycillin. Erythema Nodosum.
- Pus (tonsil exudate).
- Viral (Adenovirus, EBV, - Other viruses (Rhinovirus) Antibiotics do not
RSV, Influenza A and B, can cause irritation of usually help with URTI
Parainfluenza I and III pharyngeal mucosa and often add to
Rhinovirus). secondary to nasal morbidity.
secretions.
, Infectious - EBV. - EBV innfect B cells in the - Lymphadenopathy. - Fever. - Blood Film (Atypical - Steroids (Severe).
- Kissing oropharyngeal epithelium. - Pharyngitis. - Prolonged malaise. mononuclear cells).
Mononeucleosis - Sneezing. - Circulating B cells spread - Splenomegaly, - Fatigue. - FBC (ESR). No penicillin G’s.
(Glandular fever) - Coughing. the infection throughout the - Palatal Petechiea. - Nausea (without - Throat swab.
entire reticular endothelial - Hepatomegaly. vomitting). - Heterophile antibody test.
system (liver spleen and
peripheral lymphy nodes).
Pneumonia - Strep pneumoniae (+ve) - Loss of protective upper - Pyrexia. - Malaise. - Serum biochemistry, CRP - CURB65 (Confusion, blood Levofloxacin given if
- Staph aureus (+ve). airway reflexes. - Tachypnoea. - Myalgia. and FBC. Urea>7, RR>30, diastolic BP<60, penicillin allergic.
- Enterococcus (+ve). - Allows bacteria form upper - Central cyanosis. - Fever. - Chest X-Ray. age>65).
- H Influenzae (-ve). airways into the lung. - Dullness on - Chest pain - Blood cultures. Treeatment 1: Complications-
- E. Coli (-ve). - Results in pneumonia. percussion of affected (pleuritic). - Throat swab (for atypical - CURB (0-1)- amoxycillin or septicaemia, acute
- M catarrhalis (-ve). lobe(s). - Cough. pathogens). clarithromycin/doxycycline. kidney injury,
- Mycoplasma species. - Bronchial breath - Rusty Sputum. - Urinary legionella antigen. - CURB (2)- amoxycillin and empyema, lung abscess,
- Chlamydophila species. sounds. - Dyspnoea. - Sputum microscopy and clarithromycin/levofloxacin. metastatic infection,
- Legionella species. - Inspiratory culture. - CURB (3-5 (severe))- co- ARDS.
- Coxiella burnetti. crepitations. - HIV test (pneumonia occurs amoxiclav and
- ↑ vocal resonance. frequently in HIV patients). clarithromycin/levofloxacin. Different types-
Bronchopneumonia,
Treatment 2- Oxygen, IV fluids, Lobar pneumonia,
CPAP, intubation and Organising pneumonia
ventilation. (cryptogenic or
bronchioloitis
obliterans).
Disease Aetiology Pathology Signs Symptoms Investigations Treatment Notes
Bronchiectasis - Idiopathic. Chronic iniflammation of - Finger clubbing. - Chronic cough. - High resolution CT Thorax. - Chest physiotherapy. Complications-
- Immotile Cilia Syndrome. bronchi and brochioles - Coarse inspiratory - Daily sputum - Sputum culture. - Antibiotics (to treat Pneumonia,
(COPD) - Cystic fibrosis. leading to permanent crepitations. production (a lot). - Serum immunoglobulins. infections). Haemorrhage,
- Childhood infections such as dilatation and thinning of - Total IgE and aspergillus - Possibly inhaled therapy Empyema,
measles. these airways. Sometimes: precipitins. including β2 agonist or Pneumothorax.
-Hypogammaglobulinaemia. - Wheeze. - Cystic fibrosis genotyping. corticosteroid.
- Allergic - Dyspnoea. - Spirometry. - Surgery.
Bronchopulmonary - Tiredness. - Chest X-ray.
Aspergillosis (ABPA). - Flitting chest pains.
- Haemoptysis.
Lung Cancer - Tobacco smoke. - Squamous cell carcinoma - Chest signs. - Cough. - Chest X-ray. - Surgery (lobectomy, TNM (Tumour, Nodes,
- Asbestos. (40%). - Finger clubbing. - Haemoptysis. - FBC. pneumonectomy). Metastases) staging
- Environmental radon. - Adenocarcinoma (41%). - Lymphadeopathy. - Dyspnoea. - Renal and liver functions. - Radiotherapy. used to determine the
- Occupation. - Small Cell carcinoma - Horner’s syndrome. - Chest pain. - Calcium. - Chemotherapy (can be development and
- Air pollution. (15%). - Pancoast tumour. - Recurrent/slow - Clot screening. combined with radiotherapy severiy of cancer.
- Pulmonary fibrosis. - Large Cell carcinoma (4%). - SVC obstruction. resolving pneumonia. - Spirometry. or used after surgery).
- Hepatomegaly. - Lethargy, anorexia. - CT thorax and abdomen. - Immunotherapy.
- Skin nodules - Unexplained weight - Bronchoscopy.
(metastases). loss. - EBUS.
- Mediastinoscopy.
- Image guided biopsy.
Pleural Effusion - Transudate (due to ↑ venous - Transudate (inbalance of - Decreased chest - Asymptomatic. - Chest X-ray. - Drainage. Mediastinal or Parietal
pressure or hypoproteinaemia). hydrostatic forces <25g/L). expansion. - Dyspnoea. - Ultrasound. - Pleurodesis with talc Nodules >20cm =
- Exudate (↑Permiability of - Stony dull - Pleuritic chest pain. - Diagnostic aspiration. (recurrent effusions). malignant.
- Exudate (due to leaky pleura and capillaries percussion note. - Pleural biopsy (thorascopic - Thorascopc mechanical If transudate 25-20g use
capillaries secondary to >25g/L). - Diminished breath or CT guided). pleurodesis (malignant light criteria.
infection, inflammation or sounds. effusions).
malignancy). - ↓ vocal resonance. - Intra-pleural alteplase and
Asthma - Atopy (Familial, IgE, - Bronchial muscle - Tachypnoea. Intermittent - PEF on walk + before/after - Step 1- Inhaled β2 agonist. If Hay Fever, Shellfish,
Wealing). contraction caused by - Audible wheeze. dyspnoea dilators. used > once daily/nocturnal Cats, Wheat, Smoke,
- Airway stimuli. - Hyperinflated chest. - Wheeze. - Spirometry (15% improve on symptoms → Step 2. Dust Mites, Latex,
hyperresponsiveness. - Mucosal inflammation - Hyper resonant - Cough (often dilators). - Step 2- Add standard dose Pollen, Milk, Peanuts,
- Th2→↑IgE→↑IL- caused by mast cell and percussion note. nocturnal). - Exercise tolerance test. inhaled corticosteroid. Eggs, Cold Weather,
5→Inflammation. basophil degranulation - ↓Air entry. - Sputum production. - Histamine provocation. - Step 3- Add LABA. If beneficial, Exercise, Grass.
causing release of - Widespread - Corticosteroid trial. but inadequate control, continue
inflammatory mediators. polyphonic wheeze. - Full blood count (U&E, CRP). LABA and ↑ corticosteroid. If no If asthma, then airway
- ↑ Mucus production. - Chest x-ray. effect, then stop LABA and obstruction is reversible.
- Skin prick test to identify ↑corticosteroid. Leukotriene
allergen. receptor antagonist or oral
theophylline may be tried.
- Step 4- Consider trials of
increasing corticosteroid or
adding a fourth drug e.g. oral
leukotriene receptor antagonist,
modified release (both) β2
agonist and theophylline tablets.
- Step 5- Use daily steroid tablet
in lowest dose to provide
adequate control and maintain
high dose inhaled corticosteroid.
Bronchitis (COPD) - Smoking. Large airways- mucous gland - Tachypnoea. - Cough. - Full blood count. - Smoking cessation. Infection,
- Pollution. hyperplasia, goblet cell - Use of accessory - Sputum. - Chest X-ray. - Pulmonary rehabilitation. Pneumothorax, Cor
- Occupational dust. hyperplasia, inflammation and muscles on - Dyspnoea. - CT scan. - Nutritional assessment/ pulmonale, Oedema,
Cough plus sputum - Viral/bacterial infection. fibrosis are a minor expiration. - Wheeze. - ECG (cor pulmonale). improve diet. Respiratory failure.
production for 3 months of - Advanced age. component. - Hyperinflation. - Arterial blood gas. - SABA/SAMA (first treatment).
2 successive years. -Hypertrophy/hyperplasia - ↓ chest expansion. - Spirometry. - Add long acting bronchodilator Different from
of mucous-secreting glands. Small airways- goblet cells - Resonant/hyper (LAMA/LABA) if symptoms Emphysema as
(Non-reverisble airway appear, inflammation and resonant percussion exacerbate. Bronchitis causes
obstruction) fibrosis in long standing note. - Add another LAMA/LABA if patients lungs to
disease. - Wheeze. symptoms further worsen. become very inflamed.
- Cyanosis. - Triple therapy (inhaled
- Cor pulmonale. corticosteroid, LAMA and LABA).
Emphysema - Smoke exposure/smoking, - Increase beyond the normal Same as Bronchitis. Same as Bronchitis. Same as Bronchitis. Same as Bronchitis. Same as Bronchitis.
- Air pullition. in the size of airspaces distal
(COPD) - Chemical fumes and dust. to the terminal bronchiole. Different from
- Ageing, Bronchitis as
(Non-reversible airway - Alpha-1-antitrypsin - Caused by bronchiolar Emphysema is the
obstruction) deficiency. dilatation or from destruction gradual destruction of
of alveoli walls and without the alveoli in the lung.
obvious fibrosis.
Pharyngitis, URTI - Bacterial (haemophilus - Bacteria or viruses may - Lymphadenopathy. - Fever. - Throat swab (Microscop, No treatment or 10 days of Quinsy (Tonsil abscess),
influenzae, moraxella directly invade the - Dysphagia. - Sore Throat. Gram Stain, Cults). penicillin. Ear pain, Scarlet fever –
cattarrhalis, streptococcus pharyngeal mucosa, causing a - Fauces - ↓ apetite. - Nasal swab. Streptococcus Pyogenes,
pyogenes). local inflammatory response. - Inflammation. - FBC (↑WCC, ↑CRP, ↑ESR). Don’t give amoxycillin. Erythema Nodosum.
- Pus (tonsil exudate).
- Viral (Adenovirus, EBV, - Other viruses (Rhinovirus) Antibiotics do not
RSV, Influenza A and B, can cause irritation of usually help with URTI
Parainfluenza I and III pharyngeal mucosa and often add to
Rhinovirus). secondary to nasal morbidity.
secretions.
, Infectious - EBV. - EBV innfect B cells in the - Lymphadenopathy. - Fever. - Blood Film (Atypical - Steroids (Severe).
- Kissing oropharyngeal epithelium. - Pharyngitis. - Prolonged malaise. mononuclear cells).
Mononeucleosis - Sneezing. - Circulating B cells spread - Splenomegaly, - Fatigue. - FBC (ESR). No penicillin G’s.
(Glandular fever) - Coughing. the infection throughout the - Palatal Petechiea. - Nausea (without - Throat swab.
entire reticular endothelial - Hepatomegaly. vomitting). - Heterophile antibody test.
system (liver spleen and
peripheral lymphy nodes).
Pneumonia - Strep pneumoniae (+ve) - Loss of protective upper - Pyrexia. - Malaise. - Serum biochemistry, CRP - CURB65 (Confusion, blood Levofloxacin given if
- Staph aureus (+ve). airway reflexes. - Tachypnoea. - Myalgia. and FBC. Urea>7, RR>30, diastolic BP<60, penicillin allergic.
- Enterococcus (+ve). - Allows bacteria form upper - Central cyanosis. - Fever. - Chest X-Ray. age>65).
- H Influenzae (-ve). airways into the lung. - Dullness on - Chest pain - Blood cultures. Treeatment 1: Complications-
- E. Coli (-ve). - Results in pneumonia. percussion of affected (pleuritic). - Throat swab (for atypical - CURB (0-1)- amoxycillin or septicaemia, acute
- M catarrhalis (-ve). lobe(s). - Cough. pathogens). clarithromycin/doxycycline. kidney injury,
- Mycoplasma species. - Bronchial breath - Rusty Sputum. - Urinary legionella antigen. - CURB (2)- amoxycillin and empyema, lung abscess,
- Chlamydophila species. sounds. - Dyspnoea. - Sputum microscopy and clarithromycin/levofloxacin. metastatic infection,
- Legionella species. - Inspiratory culture. - CURB (3-5 (severe))- co- ARDS.
- Coxiella burnetti. crepitations. - HIV test (pneumonia occurs amoxiclav and
- ↑ vocal resonance. frequently in HIV patients). clarithromycin/levofloxacin. Different types-
Bronchopneumonia,
Treatment 2- Oxygen, IV fluids, Lobar pneumonia,
CPAP, intubation and Organising pneumonia
ventilation. (cryptogenic or
bronchioloitis
obliterans).
Disease Aetiology Pathology Signs Symptoms Investigations Treatment Notes
Bronchiectasis - Idiopathic. Chronic iniflammation of - Finger clubbing. - Chronic cough. - High resolution CT Thorax. - Chest physiotherapy. Complications-
- Immotile Cilia Syndrome. bronchi and brochioles - Coarse inspiratory - Daily sputum - Sputum culture. - Antibiotics (to treat Pneumonia,
(COPD) - Cystic fibrosis. leading to permanent crepitations. production (a lot). - Serum immunoglobulins. infections). Haemorrhage,
- Childhood infections such as dilatation and thinning of - Total IgE and aspergillus - Possibly inhaled therapy Empyema,
measles. these airways. Sometimes: precipitins. including β2 agonist or Pneumothorax.
-Hypogammaglobulinaemia. - Wheeze. - Cystic fibrosis genotyping. corticosteroid.
- Allergic - Dyspnoea. - Spirometry. - Surgery.
Bronchopulmonary - Tiredness. - Chest X-ray.
Aspergillosis (ABPA). - Flitting chest pains.
- Haemoptysis.
Lung Cancer - Tobacco smoke. - Squamous cell carcinoma - Chest signs. - Cough. - Chest X-ray. - Surgery (lobectomy, TNM (Tumour, Nodes,
- Asbestos. (40%). - Finger clubbing. - Haemoptysis. - FBC. pneumonectomy). Metastases) staging
- Environmental radon. - Adenocarcinoma (41%). - Lymphadeopathy. - Dyspnoea. - Renal and liver functions. - Radiotherapy. used to determine the
- Occupation. - Small Cell carcinoma - Horner’s syndrome. - Chest pain. - Calcium. - Chemotherapy (can be development and
- Air pollution. (15%). - Pancoast tumour. - Recurrent/slow - Clot screening. combined with radiotherapy severiy of cancer.
- Pulmonary fibrosis. - Large Cell carcinoma (4%). - SVC obstruction. resolving pneumonia. - Spirometry. or used after surgery).
- Hepatomegaly. - Lethargy, anorexia. - CT thorax and abdomen. - Immunotherapy.
- Skin nodules - Unexplained weight - Bronchoscopy.
(metastases). loss. - EBUS.
- Mediastinoscopy.
- Image guided biopsy.
Pleural Effusion - Transudate (due to ↑ venous - Transudate (inbalance of - Decreased chest - Asymptomatic. - Chest X-ray. - Drainage. Mediastinal or Parietal
pressure or hypoproteinaemia). hydrostatic forces <25g/L). expansion. - Dyspnoea. - Ultrasound. - Pleurodesis with talc Nodules >20cm =
- Exudate (↑Permiability of - Stony dull - Pleuritic chest pain. - Diagnostic aspiration. (recurrent effusions). malignant.
- Exudate (due to leaky pleura and capillaries percussion note. - Pleural biopsy (thorascopic - Thorascopc mechanical If transudate 25-20g use
capillaries secondary to >25g/L). - Diminished breath or CT guided). pleurodesis (malignant light criteria.
infection, inflammation or sounds. effusions).
malignancy). - ↓ vocal resonance. - Intra-pleural alteplase and
