The document outlines key points about internal medicine and evaluating patients with respiratory diseases: - Internal medicine links basic courses and provides a platform to understand disease etiology and treatment principles. - Evaluating respiratory diseases requires collecting a thorough history, performing a physical exam, and understanding lab results to make an initial diagnosis. - Chest radiography and CT can provide further evidence of respiratory conditions beyond physical exam findings alone.

1. 1
OutlinesOutlines
for Internal Medicinefor Internal Medicine

2. 2
BackgroundBackground
 Internal Medicine is, on one hand, an integralInternal Medicine is, on one hand, an integral
clinical course which links all the basic coursesclinical course which links all the basic courses
together. On the other hand, it provides atogether. On the other hand, it provides a
platform to learn and grasp knowledge for otherplatform to learn and grasp knowledge for other
clinical courses. So it is important to master theclinical courses. So it is important to master the
essentials, know well about the etiology, and toessentials, know well about the etiology, and to
understand treatment principles, not only for thisunderstand treatment principles, not only for this
course itself, but for all clinical courses.course itself, but for all clinical courses.

3. 3
Big challengeBig challenge
 With the amazing development of biochemistry,With the amazing development of biochemistry,
biophysics, biostatistics, molecular biology,biophysics, biostatistics, molecular biology,
genetic engineering, and other bioscientificgenetic engineering, and other bioscientific
courses, the conception and extension ofcourses, the conception and extension of
Internal Medicine is becoming more and moreInternal Medicine is becoming more and more
complicated. As a result, the methods andcomplicated. As a result, the methods and
lectured contents are required to adapt to all thelectured contents are required to adapt to all the
challenges.challenges.

4. 4
AimAim
 Primary task is to masterPrimary task is to master basic theoriesbasic theories forfor
diseases and emergencies that commonlydiseases and emergencies that commonly
occuroccur
 Be capable to collect history, perform systemicBe capable to collect history, perform systemic
physical examination skillfully, & to understandphysical examination skillfully, & to understand
significance of lab results as wellsignificance of lab results as well
 AbleAble to make ato make a primary diagnosisprimary diagnosis byby integralintegral
analysis ofanalysis of all clinical informationall clinical information.. Referred toReferred to
treatment,treatment, they are required tothey are required to master principlesmaster principles
for management of common emergency &for management of common emergency &
DiseasesDiseases

5. 5
 Ethical educationEthical education
1.1. Ethical viewpoints, despite divergences amongEthical viewpoints, despite divergences among
different cultures, are something educateddifferent cultures, are something educated
through the whole lecturing processthrough the whole lecturing process
2.2. Anyhow, treating patients with kindness and fullAnyhow, treating patients with kindness and full
respect is the same in different culturalrespect is the same in different cultural
background. Other personalities such asbackground. Other personalities such as
patience, prudence and diligence are importantpatience, prudence and diligence are important
for a qualified doctor.for a qualified doctor.

6. 6
 Therefore, quality education should beTherefore, quality education should be
embodied in class lecturing and clinicalembodied in class lecturing and clinical
practicepractice
 Qualified doctorsQualified doctors is The end aim foris The end aim for
clinical medical educationclinical medical education
 What’s a qualified doctor?What’s a qualified doctor?

7. 7
1.1. HumanityHumanity
2.2. plentiful knowledgeplentiful knowledge
3.3. Skillful techniqueSkillful technique
4.4. Diligence & IntelligenceDiligence & Intelligence
5.5. Prudence & PatiencePrudence & Patience
 All above is my answerAll above is my answer

8. 8
MethodMethod
 Theoretic lecture is important in class, forTheoretic lecture is important in class, for
basic knowledgebasic knowledge
 Complemental form, practice for historyComplemental form, practice for history
collecting—scene simulation-- is helpful tocollecting—scene simulation-- is helpful to
strengthen theoretic knowledge lectured instrengthen theoretic knowledge lectured in
classclass
 Clinical practice in hospital is a step forClinical practice in hospital is a step for
every student.every student.

9. 9
EvaluationEvaluation
 Education is evaluated byEducation is evaluated by
1.1. Topic discussion in classTopic discussion in class
2.2. HomeworkHomework
3.3. Sectional, midterm and final exams.Sectional, midterm and final exams.

10. 1010
Approach to patients withApproach to patients with
diseases of respiratorydiseases of respiratory
systemsystem

11. 11
General principlesGeneral principles
 Almost commonest diseases in the worldAlmost commonest diseases in the world
 In China, occurrence is 1st in rural areas,In China, occurrence is 1st in rural areas,
4th in urban areas.4th in urban areas.
 Death rate is overall the 1stDeath rate is overall the 1st

12. 12
 Currently, occurrence of lung cancer andCurrently, occurrence of lung cancer and
bronchi asthma increased quickly.bronchi asthma increased quickly.
 COPD is still a very commonCOPD is still a very common
diseasedisease ，， tuberculosis has the ascendingtuberculosis has the ascending
trend.trend.
 AIDS related opportunistic infection andAIDS related opportunistic infection and
malignancymalignancy
 New epidemic diseases, such as SARSNew epidemic diseases, such as SARS
and bird flu, is inflamed all over the worldand bird flu, is inflamed all over the world

13. 13
How to make a diagnosisHow to make a diagnosis
 Patients with RD have both common andPatients with RD have both common and
specific presentationsspecific presentations
 A diagnosis, even more refined differentialA diagnosis, even more refined differential
diagnosis, relied on symptoms, signs,diagnosis, relied on symptoms, signs,
radiographsradiographs, and other examinations, and other examinations

14. 14
What can we get fromWhat can we get from history inquiryhistory inquiry
Common symptomsCommon symptoms
 DyspneaDyspnea (shortness of breath) &(shortness of breath) &
cough, according to time course, dividedcough, according to time course, divided
into acute, subacute, and chronicinto acute, subacute, and chronic
1.1. AcuteAcute (a period of hours to days):(a period of hours to days): indicateindicate
asthma, pulmonary parenchyma infection,asthma, pulmonary parenchyma infection,
pneumothorax, or pulmonary emboluspneumothorax, or pulmonary embolus

15. 15

22 SubacuteSubacute (over days to weeks):(over days to weeks):
exacerbation of airway diseases (asthmaexacerbation of airway diseases (asthma
and bronchitis), a parenchymal infectionand bronchitis), a parenchymal infection
or noninfectious inflammation with aor noninfectious inflammation with a
relatively slow pace, AIDS relatedrelatively slow pace, AIDS related
pneumocistis carinii pneumonia,pneumocistis carinii pneumonia,
mycobacterial or fungal pneumonia,mycobacterial or fungal pneumonia,
Wegner’s granulomatosis, eosinophilicWegner’s granulomatosis, eosinophilic
pneumoniapneumonia

16. 16
• 3. Chronic3. Chronic (months to years): COPD,(months to years): COPD,
chronic interstitial lung diseases, chronicchronic interstitial lung diseases, chronic
cardiac diseases, which is characterizedcardiac diseases, which is characterized
as exacerbation & remission.as exacerbation & remission.

17. 17
Other common symptomsOther common symptoms
 CoughCough may indicate RD, but not usefulmay indicate RD, but not useful
for differential diagnosis. However,for differential diagnosis. However,
accompanied symptoms indeed helpfulaccompanied symptoms indeed helpful
1.1. SputumSputum:: always give a hint to diagnosisalways give a hint to diagnosis
2.2. HemoptysisHemoptysis: may originate from disease of: may originate from disease of
parenchyma, airway vasculature. Subacuteparenchyma, airway vasculature. Subacute
(over days to weeks(over days to weeks):):
3.3. Chest painChest pain

18. 18
HemoptysisHemoptysis: may originate from disease of: may originate from disease of
parenchyma, airway, vasculature.parenchyma, airway, vasculature.
 Parenchymal diseasesParenchymal diseases : localized diseases including: localized diseases including
pneumonia, lung abscess, tuberculosis, or infection withpneumonia, lung abscess, tuberculosis, or infection with
aspergillus (aspergillus ( 曲霉属曲霉属 ); diffuse diseases such as); diffuse diseases such as
Goodpasture’s syndrome, idiopathic pulmonaryGoodpasture’s syndrome, idiopathic pulmonary
hemosiderosis (hemosiderosis ( 含铁血黄素沉着症含铁血黄素沉着症 ))
 Airway diseasesAirway diseases :: acute or chronic bronchitis,acute or chronic bronchitis,
bronchiectasis, cystic fibrosis, or neoplasmbronchiectasis, cystic fibrosis, or neoplasm
 Vasculature diseasesVasculature diseases : pulmonary: pulmonary
thromboembolic disease or arteriovenousthromboembolic disease or arteriovenous
malformationsmalformations

19. 19
Other common symptomsOther common symptoms
 Chest painChest pain
1.1. Always indicates the parietal pleura is involvedAlways indicates the parietal pleura is involved
2.2. Accentuated by respiratory motion, referred asAccentuated by respiratory motion, referred as
pleuriticpleuritic
3.3. Caused by primary pleural diseases such asCaused by primary pleural diseases such as
neoplasm, inflammatory disorders; secondaryneoplasm, inflammatory disorders; secondary
to pulmonary parenchymal disorders such asto pulmonary parenchymal disorders such as
pneumonia or pulmonary infarctionpneumonia or pulmonary infarction

20. 20
Additional historic informationAdditional historic information
Cigarette smokingCigarette smoking
 Current or pastCurrent or past
 The intensity: number of packs per dayThe intensity: number of packs per day
 COPD & lung neoplasm is most important complications resultedCOPD & lung neoplasm is most important complications resulted
from smokingfrom smoking
 Interval since cessation: which is related to the risk of lung cancerInterval since cessation: which is related to the risk of lung cancer
 Others: spontaneous pneumothorax, respiratory bronchitis-Others: spontaneous pneumothorax, respiratory bronchitis-
interstitial pneumonia, eosinophilic granuloma of the lung orinterstitial pneumonia, eosinophilic granuloma of the lung or
pulmonary hemorrhage (Goodpasture’s syndrome), etcpulmonary hemorrhage (Goodpasture’s syndrome), etc

21. 21
Additional historic informationAdditional historic information
Exposure of other inhaled agentsExposure of other inhaled agents
 This may act via direct toxicity or through immune mechanismThis may act via direct toxicity or through immune mechanism
 Occupational or avocationalOccupational or avocational
 Inorganic dusts associated with pneumoconiosis (asbestos orInorganic dusts associated with pneumoconiosis (asbestos or
silica dusts); organic antigens (antigen from mold or animalsilica dusts); organic antigens (antigen from mold or animal
protein) associated with hypersensitivity pneumoniaprotein) associated with hypersensitivity pneumonia
 Asthma always exacerbated by such exposureAsthma always exacerbated by such exposure

22. 22
Additional historic informationAdditional historic information
 ContactContact with special population infected withwith special population infected with
specific respiratory pathogens, such as TB, SARSspecific respiratory pathogens, such as TB, SARS
or bird flu, etcor bird flu, etc

23. 23
Additional historic informationAdditional historic information
 Coexisting systemic diseases, Examples: rheumatic diseases, neoplasm,Coexisting systemic diseases, Examples: rheumatic diseases, neoplasm,
AIDSAIDS
 Previous treatment of other diseasesPrevious treatment of other diseases
1.1. ChemotherapyChemotherapy →immunosuppressive→immunosuppressive
2.2. AdrenergicAdrenergic ββ-receptor blockers-receptor blockers → airway obstruction→ airway obstruction
3.3. ACEI (Angiotensin-converting enzyme inhibitors)ACEI (Angiotensin-converting enzyme inhibitors) → cough→ cough

24. 24
Physical ExaminationPhysical Examination
PrinciplesPrinciples
1.1. Sequence:Sequence: inspection palpation percussioninspection palpation percussion
and auscultationand auscultation
2.2. NNoott only foronly for apparent ascertainingapparent ascertaining
abnormalitiesabnormalities,, but also forbut also for underlyingunderlying lunglung
diseases, that is from phenomena to reality,diseases, that is from phenomena to reality,
which is refined bywhich is refined by analysis and synthesesanalysis and syntheses
of all signsof all signs

25. 25
On inspectionOn inspection
 Rate and pattern of respirationRate and pattern of respiration
 Depth and symmetry of thoracicDepth and symmetry of thoracic
expansionexpansion
 Rapid, labored or associated withRapid, labored or associated with
accessory muscles:accessory muscles: augmented demands oraugmented demands or
increased work of breathing (airway orincreased work of breathing (airway or
parenchymal problems)parenchymal problems)
 Asymmetry expansion:Asymmetry expansion: unilateralunilateral obstruction ofobstruction of
airway, parenchymal or pleural diseases, or phrenicairway, parenchymal or pleural diseases, or phrenic
nervenerve paralysisparalysis
 Abnormal thoracic cage:Abnormal thoracic cage: kyphoscoliosis,kyphoscoliosis,
ankylosing spondylitisankylosing spondylitis → labored breathing,→ labored breathing,
dyspneadyspnea

26. 26
On palpationOn palpation
 Symmetry of lung expansion, confirmingSymmetry of lung expansion, confirming
findings by inspectionfindings by inspection
 Tactile fremitus:Tactile fremitus: ↓or none↓or none →→pleural fluidpleural fluid
interposed between lung & chest wall, orinterposed between lung & chest wall, or
obstruction of airway altering sound transmission;obstruction of airway altering sound transmission;
increase → localized consolidationincrease → localized consolidation

27. 27
On percussion and auscultationOn percussion and auscultation
 We can have valuable findings for differentWe can have valuable findings for different
conditions (table 1)conditions (table 1)

28. 28
ConditionCondition PercussionPercussion FremitusFremitus Breath sndBreath snd Voice transVoice trans Advent sndAdvent snd
NormalNormal ResonanceResonance NormalNormal VesicularVesicular NormalNormal AbsentAbsent
* Consolid* Consolid DullDull IncreaseIncrease BronchialBronchial @Broncho@Broncho
phonyphony
CracklesCrackles
# Consolid# Consolid
atelectasisatelectasis
DullDull DecreaseDecrease DecreaseDecrease DecreaseDecrease AbsentAbsent
AsthmaAsthma ResonanceResonance NormalNormal VesicularVesicular NormalNormal WheezingWheezing
InterstitialInterstitial ResonanceResonance NormalNormal VesicularVesicular NormalNormal CracklesCrackles
EmphysemEmphysem HyperHyper DecreasedDecreased DecreaseDecrease DecreaseDecrease Absent orAbsent or
wheezingwheezing
PneumothxPneumothx HyperHyper DecreaseDecrease DecreaseDecrease DecreaseDecrease AbsentAbsent
PleuralPleural
effusioneffusion
DullDull DecreasesDecreases DecreaseDecrease DecreaseDecrease Absent orAbsent or
friction rubfriction rub
Table 1 Typical chest PE findings in selected
conditions

29. 29
 @: bronchophony, or whispered@: bronchophony, or whispered
pectoliquuy, egophonypectoliquuy, egophony
 *: with patent airway*: with patent airway
 #: with blocked airway#: with blocked airway

30. 30
Chest RadiographyChest Radiography
 Most commonly and always initial appliedMost commonly and always initial applied
 Evaluation for patients with R. symptomsEvaluation for patients with R. symptoms
 Provide evidenceProvide evidence in casesin cases free of symptomfree of symptom
 FurtherFurther informationinformation is required with CTis required with CT

31. 31
Solitary circumscribed densitySolitary circumscribed density
 Nodule (Nodule (<6cm<6cm) or mass () or mass (≥6cm≥6cm))
 Primary or metastatic neoplasmPrimary or metastatic neoplasm
 Localized infection, such as abscess, TB orLocalized infection, such as abscess, TB or
fungal infectionfungal infection
 Wegner’s granuloma (1 or several)Wegner’s granuloma (1 or several)
 Rheumatoid (1 or several)Rheumatoid (1 or several)
 Vascular malformationVascular malformation
 Bronchogenic cystBronchogenic cyst

32. 32
图图 33-33- 肺 癌鳞肺 癌鳞
右肺下叶中高分化 癌鳞
（ SQ.CA ） - 病 毛灶边缘 糙
，内 偏心空洞，内壁不见
， 向腔内突起规则 见结节

33. 33
图图 37-37- 肺小腺癌肺小腺癌
病 端可 胸膜灶远 见
凹陷征

34. 34
Localized opacification (infiltrate)Localized opacification (infiltrate)
 Pneumonia: bacterial, atypical, TB, or fungalPneumonia: bacterial, atypical, TB, or fungal
 NeoplasmNeoplasm
 Radiation pneumoniaRadiation pneumonia
 Bronchiolitis obliterans with organizingBronchiolitis obliterans with organizing
pneumoniapneumonia
 Bronchocentric granulomatosisBronchocentric granulomatosis
 Pulmonary infarctionPulmonary infarction

35. 35
Diffuse interstitial diseaseDiffuse interstitial disease
 Idiopathic pulmonary fibrosisIdiopathic pulmonary fibrosis
 Pulmonary fibrosis with systemic RheumatoidPulmonary fibrosis with systemic Rheumatoid
diseasesdiseases
 Sarcoidosis (nodular disease)Sarcoidosis (nodular disease)
 Drug induced lung diseaseDrug induced lung disease
 Pneumoconiosis (dusty lung)Pneumoconiosis (dusty lung)
 Hypersensitivity pneumoniaHypersensitivity pneumonia
 Infection (pneumocystis (Infection (pneumocystis ( 囊虫属囊虫属 ), viral pneumonia)), viral pneumonia)
 Eosinophilic granulomaEosinophilic granuloma

36. 36
图图 32-32- 肺 病间质 变肺 病间质 变
薄 （层 1mm ）高分辨法
CT 描、重建扫

37. 37
Diffuse alveolar diseasesDiffuse alveolar diseases
 Cardiogenic pulmonary edemaCardiogenic pulmonary edema
 ARDS (acute respiratory distress syndrome)ARDS (acute respiratory distress syndrome)
 Diffuse alveolar hemorrhageDiffuse alveolar hemorrhage
 Infection (pneumocystis, viral or bacterialInfection (pneumocystis, viral or bacterial
pneumonia)pneumonia)
 SarcoidosisSarcoidosis

38. 38
图图 40-40- 肺泡 胞癌细肺泡 胞癌细
肺泡 胞癌（细 alveolar
Cell Ca. ） - 肺弥漫分两
布， 广泛型为

39. 39
Diffuse nodular diseasesDiffuse nodular diseases
 Metastatic neoplasmMetastatic neoplasm
 Hematogenous spread of infection (Bacterial,Hematogenous spread of infection (Bacterial,
TB, fungal)TB, fungal)
 PneumoconiosisPneumoconiosis
 Eosinophilic granulomaEosinophilic granuloma

40. 40
图图 71-71- 肺矽肺矽
肺 期（矽 晚 Silicosis ）

41. 41
图图 69-69- 肺矽肺矽
肺 区及 隔内两侧 门 纵
多 淋巴 大、组 结增 钙
化（ 4R 、 4L 、 5 ）组

42. 42
Disturbance of respiratoryDisturbance of respiratory
functionfunction
 Discussed in another timeDiscussed in another time

43. 43
Other procedures in RDOther procedures in RD
 Imaging studiesImaging studies
 Histology or cytologyHistology or cytology
 Endoscope-related techniquesEndoscope-related techniques

44. 44
BronchoscopyBronchoscopy
 Diagnosis for bronchial tumor, TB,Diagnosis for bronchial tumor, TB,
foreign body, Location forforeign body, Location for
hemoptysis, etchemoptysis, etc 。。

45. 45
Imaging studiesImaging studies
 Routine RadiographyRoutine Radiography
 BronchographyBronchography
 Computed TomographyComputed Tomography
 Magnetic Resonance ImagingMagnetic Resonance Imaging
 Scintigraphic ImagingScintigraphic Imaging
 Pulmonary AngiographyPulmonary Angiography
 UltrasoundUltrasound

46. 46
Routine RadiographyRoutine Radiography
 Posterioanterior and lateral viewsPosterioanterior and lateral views
 In some cases, need apical lordotic view forIn some cases, need apical lordotic view for
apical diseaseapical disease
 Portable equipment for patients in emergency orPortable equipment for patients in emergency or
not in erect positionnot in erect position

47. 47
环状透亮影 蜂窝状影

48. 48
BronchographyBronchography
 More helpful for bronchial diseases, suchMore helpful for bronchial diseases, such
as bronchiectasis, tumor, atelectasis, etcas bronchiectasis, tumor, atelectasis, etc

49. 49
正常支气管 支气管扩张

50. 50
Computed TomographyComputed Tomography
Advantages over routine radiographyAdvantages over routine radiography
1.1. Cross-sectioned imagesCross-sectioned images→ distinguish between→ distinguish between
densities superimposed in AP filmdensities superimposed in AP film
2.2. Far better at characterizing tissue density,Far better at characterizing tissue density,
distinguish subtle differences betweendistinguish subtle differences between
adjacent tissuesadjacent tissues
3.3. Provide more accurate size assessmentProvide more accurate size assessment
4.4. Particular valuable in assessing hilar (Particular valuable in assessing hilar ( 肺门的肺门的 ))
or mediastinal diseases, in identifying diseasesor mediastinal diseases, in identifying diseases
adjacent to chest wall or spineadjacent to chest wall or spine

51. 51
混合状支扩

52. 52
Advantages over routine radiographyAdvantages over routine radiography
1.1. Cross-sectioned imagesCross-sectioned images
2.2. Far better at characterizing tissue densityFar better at characterizing tissue density
3.3. Provide more accurate size assessmentProvide more accurate size assessment
4.4. Particular valuable in assessing hilar diseasesParticular valuable in assessing hilar diseases
5.5. Valuable in the staging of lung cancerValuable in the staging of lung cancer
6.6. In identifying fatty or calcification area in nodulesIn identifying fatty or calcification area in nodules
7.7. With help of contrast medium, distinguish vascular fromWith help of contrast medium, distinguish vascular from
nonvascular structuresnonvascular structures

53. 53
Other special applicationOther special application
 Helical CT: allows the collection ofHelical CT: allows the collection of
continuous data over a large volume of lungcontinuous data over a large volume of lung
during a single breath-holding maneuver,during a single breath-holding maneuver,
which is not accomplished by conventionalwhich is not accomplished by conventional
CTCT
 CT Angiography: pulmonary emboli beCT Angiography: pulmonary emboli be
foundfound

54. 54
Other special applicationOther special application
 High-Resolution CT: cross-section is even thinner, 1-High-Resolution CT: cross-section is even thinner, 1-
2mm vs 10mm in conventional CT, also, image2mm vs 10mm in conventional CT, also, image
reconstruction is possible. Better recognition ofreconstruction is possible. Better recognition of
subtle parenchymal & airway or interstitial D, such assubtle parenchymal & airway or interstitial D, such as
bronchiectasis, emphysema, & diffuse parenchymal D,bronchiectasis, emphysema, & diffuse parenchymal D,
interstitial D including Idiopathic pulmonary fibrosis,interstitial D including Idiopathic pulmonary fibrosis,
Sarcoidosis, Eosinophilic granuloma, or lymphatic carcinomaSarcoidosis, Eosinophilic granuloma, or lymphatic carcinoma

55. 55
Magnetic Resonance ImagingMagnetic Resonance Imaging
 Less well defined than that of CTLess well defined than that of CT
 Advantages over CTAdvantages over CT
1.1. Restructed in saggital, coronary andRestructed in saggital, coronary and
transverse planes, so better for imagingtransverse planes, so better for imaging
abnormalities near lung apex, spine, andabnormalities near lung apex, spine, and
thoracoabdominal junctionthoracoabdominal junction
2.2. Better for imaging vascular structures withoutBetter for imaging vascular structures without
administration of contrast (vessels as hollowadministration of contrast (vessels as hollow
tubular structures)tubular structures)

56. 56
Scintigraphic ImagingScintigraphic Imaging
 Radioactive isotypes administered intravenouslyRadioactive isotypes administered intravenously
or by inhalation, image obtained with a gammaor by inhalation, image obtained with a gamma
cameracamera
 Most common use isMost common use is ventilation-perfusion lungventilation-perfusion lung
scanningscanning → pulmonary thromboembolism→ pulmonary thromboembolism
 Another use is the evaluation of lung functionAnother use is the evaluation of lung function
before and after surgerybefore and after surgery

57. 57
Pulmonary AngiographyPulmonary Angiography
 Catheter threaded into pulmonary artery,Catheter threaded into pulmonary artery,
contrast media administrated to makecontrast media administrated to make
angiographyangiography
 Very helpful for Pulmonary embolism, whichVery helpful for Pulmonary embolism, which
demonstrated either a defect in the lumen or andemonstrated either a defect in the lumen or an
abrupt termination (cutoff sign)abrupt termination (cutoff sign)
 Less common indications for pulmonaryLess common indications for pulmonary
arteriovenous malformation or arterial invasionarteriovenous malformation or arterial invasion
by a neoplasmby a neoplasm

58. 58
UltrasoundUltrasound
 Not useful for evaluation of pulmonary parenchymalNot useful for evaluation of pulmonary parenchymal
diseases, because ultrasound energy dissipateddiseases, because ultrasound energy dissipated
rapidly in airrapidly in air
 But for pleural diseases orBut for pleural diseases or used as a guide toused as a guide to
placement of a needle for sampling or drainageplacement of a needle for sampling or drainage

59. 59
Collection of sputumCollection of sputum
 MethodsMethods
1.1. Spontaneous expectorationSpontaneous expectoration
2.2. Induced after inhalation of irritating aerosolInduced after inhalation of irritating aerosol
(hypertonic saline), better for diagnostic(hypertonic saline), better for diagnostic
studiesstudies
 Appearance & qualityAppearance & quality
 Gram staining and cultureGram staining and culture
 Cytological stainingCytological staining

60. 60
Histology and CytologyHistology and Cytology
 Methods for samplingMethods for sampling
1.1. Collection of sputumCollection of sputum
2.2. Percutaneous needle aspirationPercutaneous needle aspiration
3.3. Thoracentesis: 1) palliation of dyspneaThoracentesis: 1) palliation of dyspnea
when large quantity of pleural fluidwhen large quantity of pleural fluid
exists, 2) diagnostic sampling: routineexists, 2) diagnostic sampling: routine
biochemical analysis, cytologybiochemical analysis, cytology
4.4. Bronchoscopy and mediastinoscopyBronchoscopy and mediastinoscopy

61. 61
Endoscope related techniquesEndoscope related techniques
 Including: bronchoscope,Including: bronchoscope,
mediastinoscope, and thoracoscopemediastinoscope, and thoracoscope
 ApplicationApplication
1.1. DiagnosisDiagnosis
2.2. TherapiesTherapies

62. 62
 DiagnosisDiagnosis
 Visual information, bronchoalveolar lavage, washing or brushingVisual information, bronchoalveolar lavage, washing or brushing
for cytology, endobronchial or peribronchial biopsy for histology,for cytology, endobronchial or peribronchial biopsy for histology,
endoscopic aspiration for lymph nodeendoscopic aspiration for lymph node

63. 63
 TherapiesTherapies
1.1. Endoscopic laser therapyEndoscopic laser therapy
2.2. CryotherapyCryotherapy
3.3. ElectrocauteryElectrocautery
4.4. Stent placement for obstructed airwayStent placement for obstructed airway
5.5. Video-assisted thoracic surgery, thoracotomyVideo-assisted thoracic surgery, thoracotomy
6.6. And mediastinotomy as wellAnd mediastinotomy as well

64. 64
CurriculumCurriculum
 Respiratory diseases Total 27Respiratory diseases Total 27
1.1. 2-28 Preface2-28 Preface
2.2. 3-04 Asthma3-04 Asthma
3.3. 3-07 COPD3-07 COPD
4.4. 3-11 Lung cancer3-11 Lung cancer
5.5. 3-14 Pneumonia, Lung abscess3-14 Pneumonia, Lung abscess
6.6. 3-18 Pulmonary TB3-18 Pulmonary TB
7.7. 3-21 Bronchiectasis, ARDS3-21 Bronchiectasis, ARDS
8.8. 3-25 Pleural diseases3-25 Pleural diseases
9.9. 3-28 Respiratory failure3-28 Respiratory failure