Rüzgar Miroğlu

Pulmonology 1









Pulmonology lectures

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Unit I. Electrocardiography - Recognition of Dysrhythmias

 

 

 

 

Unit II. Cardiac Rehabilitation - Cardiac Medications - Exercise Prescription For Special Populations

 

Unit Activities Assignment # 1 : Patient Case : Writing A Comprehensive Fitness Program

 

 

 

 

Unit III. Pulmonary Rehabilitation - Pulmonary medications - Pulmonary Function

 

 

 

Primary Right Heart Failure ( Cor Pulmonale)

Filed under: PULMONOLOGY by medippt — Leave a comment
October 27, 2010
Cor pulmonale or pulmonary heart disease is enlargement of the right ventricle of the heart as a response to increased resistance or high blood pressure in the lungs.Chronic cor pulmonale usually results in right ventricular hypertrophy (RVH).
There are several mechanisms leading to pulmonary hypertension and cor pulmonale:
* Pulmonary vasoconstriction
* Anatomic changes in vascularization
* Increased blood viscosity
* Idiopathic or primary pulmonary hypertension
Causes
* Acute: – Massive pulmonary embolization,Exacerbation of chronic cor pulmonale
*Chronic: – COPD,Increased pulmonary bloodpressure due to left ventricle insufficiency (Backward failure),Loss of lung tissue following trauma or surgery,Pierre Robin sequence,End stage Pneumoconiosis,Sarcoidosis,Obstructive sleep apnea and Bronchopulmonary dysplasia (in infants)
Cor pulmonale may lead to congestive heart failure (CHF), with worsening of respiration due to pulmonary edema, swelling of the legs due to peripheral edema and painful congestive hepatomegaly.

 

 
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Tube Thoracostomy: Complications and the Role of Prophylactic Antibiotics

Filed under: EMERGENCY MEDICINE, PULMONOLOGY by medippt — 1 Comment
October 12, 2010

A chest tube (tube thoracostomy) is a flexible plastic tube that is inserted through the side of the chest into the pleural space. It is used to remove air (pneumothorax) or fluid (pleural effusion, blood, chyle), or pus (empyema) from the intrathoracic space. 

 Indications
*Pneumothorax:
*Pleural effusion: Chylothorax, Empyema, Hemothorax, Hydrothorax
Contraindications to chest tube placement include refractory coagulopathy, lack of cooperation by the patient, and diaphragmatic hernia.
Chest tubes are usually inserted under local anesthesia. The skin over the area of insertion is first cleansed with antiseptic solution, such as iodine, before sterile drapes are placed around the area.If necessary, patients may be given additional analgesics for the procedure. Once the tube is in place it is sutured to the skin to prevent it falling out and a dressing applied to the area. Once the drain is in place, a chest radiograph will be taken to check the location of the drain.
Major complications are hemorrhage, infection, and reexpansion pulmonary edema. Chest tube clogging can also be a major complication if it occurs in the setting of bleeding or the production of significant air or fluid.

 

 
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Understanding Dyspnoea

Filed under: MEDICINE, PULMONOLOGY by medippt — 1 Comment
October 2, 2010

 

Dyspnoea also called shortness of breath (SOB) is a debilitating symptom that is the experience of unpleasant or uncomfortable respiratory sensations.It is a common symptom of numerous medical disorders, particularly those involving the cardiovascular and respiratory systems;Dyspnoea on exertion (or exertional dyspnea) is the most common presenting complaint for people with respiratory impairment.

Pulmonary disorders
* Obstructive lung disease-Asthma,Bronchitis,Chronic obstructive pulmonary disease,Cystic fibrosis,Emphysema
* Diseases of lung parenchyma and pleura
Pneumonia,Fibrosing alveolitis,Atelectasis,Hypersensitivity pneumonitis,Interstitial lung disease,Lung cancer,Pleural effusion,Pneumothorax,Non-cardiogenic pulmonary edema or acute respiratory distress syndrome
* Pulmonary vascular diseases
Pulmonary emboli,Pulmonary hypertension,Pulmonary veno-occlusive disease,Superior vena cava syndrome

Disorders of the cardiovascular system
* Aortic dissection
* Cardiomyopathy
* Congenital heart disease
* Heart failure
* Ischaemic heart disease
* Pericardium disorders, including:Cardiac tamponade,Constrictive pericarditis,Pericardial effusion
* Valvular heart disease

 

 
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Small Cell Lung Cancer and SIADH

Filed under: ENDOCRINOLOGY, PULMONOLOGY by medippt — Leave a comment
September 21, 2010
 The main types of lung cancer are small cell lung carcinoma and non-small cell lung carcinoma. This distinction is important, because the treatment varies; non-small cell lung carcinoma (NSCLC) is sometimes treated with surgery, while small cell lung carcinoma (SCLC) usually responds better to chemotherapy and radiation.The most common cause of lung cancer is long-term exposure to tobacco smoke.The most common symptoms are shortness of breath, cough and hemoptysis and weight loss.
Small cell lung carcinoma is less common. It was formerly referred to as “oat cell” carcinoma. Most cases arise in the larger airways (primary and secondary bronchi) and grow rapidly.The small cells contain dense neurosecretory granules,which give this tumor an endocrine/paraneoplastic syndrome association.
Depending on the type of tumor, so-called paraneoplastic phenomena may initially attract attention to the disease.In lung cancer, these phenomena may include Lambert-Eaton myasthenic syndrome , hypercalcemia, or syndrome of inappropriate antidiuretic hormone (SIADH).Lung cancer may be seen on chest radiograph and computed tomography (CT scan). The diagnosis is confirmed with a biopsy. This is usually performed by bronchoscopy or CT-guided biopsy. Treatment and prognosis depend upon the histological type of cancer, the stage (degree of spread), and the patient’s performance status.
Small cell lung carcinoma is treated primarily with chemotherapy and radiation, as surgery has no demonstrable influence on survival.
SIADH

 

 
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Pulmonary Embolism

Filed under: MEDICINE, PULMONOLOGY by medippt — 1 Comment
August 16, 2010
Pulmonary embolism is a blockage of the main artery of the lung or one of its branches by embolism. Usually this is due to embolism of a thrombus from the deep veins in the legs. A small proportion is due to the embolization of air, fat or amniotic fluid. The obstruction of the blood flow through the lungs and the resultant pressure on the right ventricle of the heart leads to the symptoms and signs of PE. The risk of PE is increased in various situations, such as cancer and prolonged bed rest.Symptoms of pulmonary embolism include Dyspnea,Pleuritic chest pain,Anxiety,Cough,Hemoptysis,Sweating,Syncope.Clinical signs include low blood oxygen saturation and cyanosis, rapid breathing, and a rapid heart rate. Severe cases of PE can lead to collapse, abnormally low blood pressure, and sudden death.
Diagnosis is based on these clinical findings in combination with laboratory tests (such as the D-dimer test) and imaging studies, usually CT pulmonary angiography.
 
XRAY findings in PE include
  • Westermark’s sign- A dilation of the pulmonary vessels proximal to the embolism along with collapse of distal vessels, sometimes with a sharp cutoff
  • Hampton’s Hump- A triangular or rounded pleural-based infiltrate with the apex toward the hilum, usually located adjacent to the hilum.

 

 
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Tuberculosis

Filed under: INFECTIOUS DISEASES, MEDICINE, PULMONOLOGY by medippt — Leave a comment
August 2, 2010
Tuberculosis is a common infectious disease caused by various strains of mycobacteria, usually Mycobacterium tuberculosis.Tuberculosis usually attacks the lungs but can also affect other parts of the body.
When the disease becomes active, 75% of the cases are pulmonary TB, that is, TB in the lungs. Symptoms include chest pain, coughing up blood, and a productive, prolonged cough for more than three weeks. Systemic symptoms include fever, chills, night sweats, appetite loss, weight loss, pallor, and often a tendency to fatigue very easily.
In the other 25% of active cases, the infection moves from the lungs, causing other kinds of TB, collectively denoted extrapulmonary tuberculosis.This occurs more commonly in immunosuppressed persons and young children. Extrapulmonary infection sites include the pleura in tuberculosis pleurisy, the central nervous system in meningitis, the lymphatic system , the genitourinary system in urogenital tuberculosis, and bones and joints in Pott’s disease of the spine. An especially serious form is disseminated TB, more commonly known as miliary tuberculosis. Extrapulmonary TB may co-exist with pulmonary TB as well.
 
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Acute Respiratory Failure

Filed under: EMERGENCY MEDICINE, MEDICINE, PULMONOLOGY by medippt — Leave a comment
July 27, 2010
Acute respiratory failure is defined as inadequate gas exchange by the respiratory system, with the result that arterial oxygen and/or carbon dioxide levels cannot be maintained within their normal ranges. A drop in blood oxygenation is known as hypoxemia[oxygen PaO2 less than 60 mmHg (8.0 kPa)]; a rise in arterial carbon dioxide levels is called hypercapnia[ carbon dioxide PaCO2 greater than 45 mmHg (6.0 kPa)].Classification into type I or type II relates to the absence or presence of hypercapnia respectively.
Type 1 respiratory failure is defined as hypoxaemia without hypercapnia, and indeed the PaCO2 may be normal or low. It is typically caused by a ventilation/perfusion (V/Q) mismatch
Type 1 respiratory failure seen in
* Parenchymal disease (V/Q mismatch)
* Diseases of vasculature and shunts: right-to-left shunt, pulmonary embolism
* interstitial lung diseases: ARDS, pneumonia, emphysema.
Type 2 respiratory failure is caused by increased airway resistance; both oxygen and carbon dioxide are affected.
Emergency treatment follows the principles of cardiopulmonary resuscitation. Treatment of the underlying cause is required. Endotracheal intubation and mechanical ventilation may be required. Respiratory stimulants such as doxapram may be used, and if the respiratory failure resulted from an overdose of sedative drugs such as opioids or benzodiazepines, then the appropriate antidote such as naloxone or flumazenil will be given.
 
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Venous Thromboembolism: Deep Venous Thrombosis and Pulmonary Embolism

Filed under: EMERGENCY MEDICINE, PULMONOLOGY, SURGERY by medippt — Leave a comment
July 23, 2010
Deep vein thrombosis commonly affects the femoral vein or the popliteal vein or the deep veins of the pelvis. Occasionally the veins of the arm are affected.In many cases the affected area will be painful, swollen, red, warm and the superficial veins may be engorged. The most serious complication of a DVT is that the clot could dislodge and travel to the lungs, which is called a pulmonary embolism (PE). DVT is a medical emergency, present in the lower extremity there is 3% chance of a PE killing the patient. A late complication of DVT is the post-phlebitic syndrome, which can manifest itself as edema, pain or discomfort and skin problems.
Venous thrombosis occurs via three mechanisms: decreased flow rate of the blood, damage to the blood vessel wall and hypercoagulability.The most commonly used tests for the diagnosis of DVT are a blood test called D-dimers and doppler ultrasound of the affected veins.
Pulmonary embolism (PE) is a blockage of the main artery of the lung or one of its branches by a embolised blood clot from elsewhere in the body.Usually this is due to embolism of a thrombus from the deep veins in the legs, a process termed venous thromboembolism.
Symptoms of pulmonary embolism include difficulty breathing, chest pain on inspiration, and palpitations. Clinical signs include low blood oxygen saturation and cyanosis, rapid breathing, and a rapid heart rate. Severe cases of PE can lead to collapse, abnormally low blood pressure, and sudden death.
Diagnosis is based on these clinical findings in combination with laboratory tests and imaging studies, usually CT pulmonary angiography. Treatment is typically with anticoagulant medication, including heparin and warfarin. Severe cases may require thrombolysis or may require surgical intervention via pulmonary thrombectomy.
 
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Wheezing in children

Filed under: PAEDIATRICS, PULMONOLOGY by medippt — Leave a comment
July 21, 2010
 

Wheeze is a continuous, coarse, whistling sound produced in the respiratory airways during breathing. It is caused by narrowed or obstructed respiratory tree or airflow velocity within the respiratory tree must be heightened. Wheezing is commonly experienced by persons with a lung disease; the most common cause of recurrent wheezing is asthma attacks.The differential diagnosis of wheezing is wide, and the cause of wheezing in a given patient is determined by considering the characteristics of the wheezes and the historical and clinical findings made by the examining physician.

Asthma is a common chronic inflammatory disease of the airways characterized by variable and recurring symptoms, airflow obstruction, and bronchospasm.Symptoms include wheezing, coughing, chest tightness, and shortness of breath.Asthma is clinically classified according to the frequency of symptoms, forced expiratory volume in 1 second (FEV1), and peak expiratory flow rate.Asthma may also be classified as atopic (extrinsic) or non-atopic (intrinsic), based on whether symptoms are precipitated by allergens (atopic) or not (non-atopic).
Medicines such as inhaled short-acting beta-2 agonists may be used to treat acute attacks.Attacks can also be prevented by avoiding triggering factors such as allergens or rapid temperature changes and through drug treatment such as inhaled corticosteroids. Leukotriene antagonists are less effective than corticosteroids, but have fewer side effects.The monoclonal antibody omalizumab is sometimes effective.
 
 
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Acute respiratory distress syndrome in Trauma

Filed under: EMERGENCY MEDICINE, PULMONOLOGY by medippt — 2 Comments
July 13, 2010

 

Acute respiratory distress syndrome (ARDS) is associated with diffuse alveolar damage and lung capillary endothelial injury.
Early ARDS is characterized by an increase in the permeability of the alveolar-capillary barrier leading to an influx of fluid into the alveoli.The insults resulting in damage either to the vascular endothelium (eg, sepsis) or to the alveolar epithelium(eg, aspiration of gastric contents). could result in ARDS.
Injury to the endothelium results in increased capillary permeability and the influx of protein-rich fluid into the alveolar space. Injury to the alveolar lining cells also promotes pulmonary edema formation. Two types of alveolar epithelial cells exist. Type I cells, comprising 90% of the alveolar epithelium, are injured easily. Damage to type I cells allows both increased entry of fluid into the alveoli and decreased clearance of fluid from the alveolar space.Damage to type II cells results in decreased production of surfactant with resultant decreased compliance and alveolar collapse. Interference with the normal repair processes in the lung may lead to the development of fibrosis.
Neutrophils are thought to play an important role in the pathogenesis of ARDS.
Cytokines, such as tumor necrosis factor (TNF), leukotrienes, macrophage inhibitory factor,along with platelet sequestration and activation, also are important in the development of ARDS.
ARDS is uniformly associated with pulmonary hypertension. Pulmonary artery vasoconstriction likely contributes to ventilation-perfusion mismatch and is one of the mechanisms of hypoxemia in ARDS. Normalization of pulmonary artery pressures occurs as the syndrome resolves. The development of progressive pulmonary hypertension is associated with a poor prognosis.
ARDS in Children

Lecture Slides

Physical Exam Study Guides

  Contact: Richard Rathe, MD / rrathe@dean.med.ufl.edu
Copyright: 1996-99 by the University of Florida
 Location: http://medinfo.ufl.edu/year1/bcs/clist/index.html
  Created: August 1, 1996   Modified: December 19, 2000

Respiratory Examination

   Author: Richard Rathe, MD / rrathe@dean.med.ufl.edu
Copyright: 1996 by the University of Florida
 Location: http://medinfo.ufl.edu/year1/bcs/clist/resp.html
  Created: January 15, 1996   Modified: July 20, 1999

Equipment Needed

  • A Stethoscope
  • A Peak Flow Meter

General Considerations

  • The patient must be properly undressed and gowned for this examination.
  • Ideally the patient should be sitting on the end of an exam table.
  • The examination room must be quiet to perform adequate percussion and auscultation.
  • Try to visualize the underlying lobes of the lungs as you examine the patient.
  • Observe the patient for general signs of respiratory disease (finger clubbing, cyanosis, air hunger, etc.).

Inspection

  1. Observe the rate, rhythm, depth, and effort of breathing. Note whether the expiratory phase is prolonged. [p237] [1] [2]
  2. Listen for obvious abnormal sounds with breathing such as wheezes.
  3. Observe for retractions and use of accessory muscles (sternomastoids, abdominals).
  4. Observe the chest for asymmetry, deformity, or increased anterior-posterior (AP) diameter. [3]
  5. Confirm that the trachea is near the midline? [4]

Palpation

  1. Indentify any areas of tenderness or deformity by palpating the ribs and sternum. [p238, p248]
  2. Assess expansion and symmetry of the chest by placing your hands on the patient's back, thumbs together at the midline, and ask them to breath deeply.
  3. Check for tactile fremitus. ++ [5]

Percussion

Use the proper technique to elicit percussion "notes." [p241]

Posterior Chest

  1. Percuss from side to side and top to bottom using the pattern shown in the illustration. Omit the areas covered by the scapulae. [p238]
  2. Compare one side to the other looking for asymmetry.
  3. Note the location and quality of the percussion sounds you hear.
  4. Find the level of the diaphragmatic dullness on both sides.

    Diaphragmatic Excursion

  5. Find the level of the diaphragmatic dullness on both sides.
  6. Ask the patient to inspire deeply.
  7. The level of dullness (diaphragmatic excursion) should go down 3-5cm symmetrically. [6] ++

Anterior Chest

  1. Percuss from side to side and top to bottom using the pattern shown in the illustration. [p249]
  2. Compare one side to the other looking for asymmetry.
  3. Note the location and quality of the percussion sounds you hear.

Interpretation

Percussion Notes and Their Meaning
Flat or Dull Pleural Effusion or Lobar Pneumonia
Normal Healthy Lung or Bronchitis
Hyperresonant Emphysema or Pneumothorax

Auscultation

Use the diaphragm of the stethoscope to auscultate breath sounds.

Posterior Chest

  1. Auscultate from side to side and top to bottom using the pattern shown in the illustration. Omit the areas covered by the scapulae. [p244]
  2. Compare one side to the other looking for asymmetry.
  3. Note the location and quality of the sounds you hear.

Anterior Chest

  1. Auscultate from side to side and top to bottom using the pattern shown in the illustration. [p250]
  2. Compare one side to the other looking for asymmetry.
  3. Note the location and quality of the sounds you hear.

Interpretation

Breath sounds are produced by turbulent air flow. They are categorized by the size of the airways that transmit them to the chest wall (and your stethoscope). The general rule is, the larger the airway, the louder and higher pitched the sound. Vesicular breath sounds are low pitched and normally heard over most lung fields. Tracheal breath sounds are heard over the trachea. Bronchovesicular and bronchial sounds are heard in between. Inspiration is normally longer than expiration (I > E). [2]

Breath sounds are decreased when normal lung is displaced by air (emphysema or pneumothorax) or fluid (pleural effusion). Breath sounds shift from vesicular to bronchial when there is is fluid in the lung itself (pneumonia).

Adventitious (Extra) Lung Sounds
Crackles These are high pitched, discontinuous sounds similar to the sound produced by rubbing your hair between your fingers. (Also known as Rales)
Wheezes These are generally high pitched and "musical" in quality. Stridor is an inspiratory wheeze associated with upper airway obstruction (croup).
Rhonchi These often have a "snoring" or "gurgling" quality. Any extra sound that is not a crackle or a wheeze is probably a rhonchi.

Special Tests

Peak Flow Monitoring

Peak flow meters are inexpensive, hand-held devices used to monitor pulmonary function in patients with asthma. The peak flow roughly correlates with the FEV1. [7] ++

  1. Ask the patient to take a deep breath.
  2. Then ask them to exhale as fast as they can through the peak flow meter.
  3. Repeat the measurement 3 times and report the average.

Voice Transmission Tests

These tests are only used in special situations. This part of the physical exam has largely been replaced by the chest x-ray. All these tests become abnormal when the lungs become filled with fluid (referred to as consolidation).

Tactile Fremitus

  1. Ask the patient to say "ninety-nine" several times in a normal voice. [p239] ++
  2. Palpate using the ball of your hand.
  3. You should feel the vibrations transmitted through the airways to the lung.
  4. Increased tactile fremitus suggests consolidation of the underlying lung tissues. [8]

Bronchophony

  1. Ask the patient to say "ninety-nine" several times in a normal voice. [p247] ++
  2. Auscultate several symmetrical areas over each lung.
  3. The sounds you hear should be muffled and indistinct. Louder, clearer sounds are called bronchophony.

Whispered Pectoriloquy

  1. Ask the patient to whisper "ninety-nine" several times. [p247] ++
  2. Auscultate several symmetrical areas over each lung.
  3. You should hear only faint sounds or nothing at all. If you hear the sounds clearly this is referred to as whispered pectoriloquy. [9]

Egophony

  1. Ask the patient to say "ee" continuously. [p247] ++
  2. Auscultate several symmetrical areas over each lung.
  3. You should hear a muffled "ee" sound. If you hear an "ay" sound this is referred to as "E -> A" or egophony.

 

 

Notes

  1. Page numbers refer to A Guide to Physical Examination and History Taking, Sixth Edition by Barbara Bates, published by Lippincott in 1995.
  2. A prolonged expiratory phase (E > I) indicates airway narrowing, as in asthma.
  3. AP diameter increases somewhat with age, however, a round or "barrel" chest is often a sign of advanced emphysema.
  4. The trachea will deviate to one side in cases of tension pneumothorax.
  5. Additional Testing - Tests marked with (++) may be skipped unless an abnormality is suspected.
  6. Decreased or asymmetric diaphragmatic excursion may indicate paralysis or emphysema.
  7. It has been said that "a peak flow meter is to asthma as a thermometer is to fever." Peak flow measurements are used to gauge severity of asthma attacks and track the disease over time. Ideally new readings are compared to the patient's current "personal best." Readings less than 80% of "best" may indicate a need for additional therapy. Readings less than 50% may indicate an emergency situation.
  8. Increased fremitus indicates fluid in the lung. Decreased fremitus indicates sound transmission obstructed by chronic obstructive pulmonary disease (COPD), fluid outside the lung (pleural effusion), air outside the lung (pneumothorax), etc.
  9. Whispered pectoriloquy is right up there with borborygmi on Dr. Rathe's list of favorite medical terms.






Topic
  
Dyspnoea Download (501 KB)
Revised National Tuberculosis Control Programme Download (212 KB)
Massive Hemoptysis Download (237 KB)
Tubercular Pleural effusions Download (51 KB)
Aerosol therapy Download (206 KB)
Management of severe sepsis Download (198 KB)
Management of stable COPD Download (184 KB)
Non resolving pneumonia Download (90 KB)
Approach to DPLD Download (278 KB)
Diffuse alveolar haemorrhage Download (112 KB)
Pulmonary manifestations of heart disease Download (365 KB)
Acute exacerbation of asthma and COPD: similarities and differences Download (54KB)
Management of IPF Download (104 KB)
Pulmonary Manifestations of connective tissue disease Download (297 KB)

Interventional Bronchoscopy Download (2048 KB)
Lung Volumes & Airway Resistance Download (767 KB)
Respiratory Mechanics in
Mechanical Ventilation		 Download (650 KB)
Lung in extreme environments Download (565 KB)
Mechanical Ventilation: New Modes Download (961 KB)
Congenital and Developmental Anomalies of the Lung Download (191 KB)
Oxygen and CO2 Cascade Download (666 KB)
Ventilation-perfusion in Health & Disease Download (642 KB)
Pulmonary Host Defences Download (462 KB)
July - December 2008
Renal Replacemnt Therapy in ICU Download (196 KB)
Functional Assessment Download (604 KB)
Filteration in ICU Download (976 KB)
Humidification in ICU Download (169 KB)
Fever in ICU Download (331 KB)
Ultrasound in ICU Download (367 KB)
Extrapulmonary manifestations of COPD Download (358 KB)
IPF: recent advances in Management Download (271 KB)
Genetic and targeted therapies for lung cancer Click here to view
Recruitment maneuvers- Rationale , Protocols and utility Click here to view
Chemotherapy Related Complications Click here to view
Targetted therapies in asthma Click here to view
January-June 2008
Steroid dependant asthma Download (512 KB)
Hemodynamic monitoring in ICU Download (213KB)
Rheumatological emergencies in ICU Download (230KB)
Inhaled drug (non-bronchodilator) therapy Download (257KB)
Approach to the critically ill poisoned patient Download (405KB)
Anti fungal therapies Download (567 KB)
Scoring Systems in ICU Download (315 KB)
Diffusion Download (176 KB)
July - December 2007
Occupational asthma Download (167 KB)
Advances in diagnosis of TB Download (246 KB)
Silicosis and silico-tuberculosis Download (115 KB)
Pulmonary hypertension in CTD Download (276 KB)
Pre-operative Evaluation for Lung Resection Download (128 KB)
Preventing Ventilator Induced Lung Injury in ARDS Download (1.64 MB)
Airway Remodelling Download (131 KB)
Management of Sarcoidosis Download (652 KB)
Pre-operative Evaluation for non-thoracic surgery Download (422 KB)
Recent Advances in Bronchoscopic procedures Download (821 KB)
January-June 2007
Pulmonary and Extra Pulmonary ARDS: Fizz or Fuss ? Download (309 KB)
Weaning from Mechanical Ventilator Download (531 KB)
Exhaled Biomarkers Download (165 KB)
Pulmonary Rehablitation Download (406 KB)
Brochiolar Disorders Download (601 KB)
Air Travel and Lungs Download (251 KB)
2004- 2006
Oxygen-Carbon dioxide transport Download (113 KB)
Diffusion Download (306 KB)
Control of Breathing Download (129 KB)
Bronchiolitis Download (763 KB)
ABG: Clinical interpretation Download (154 KB)
Pulmonary Hypertension Download (454 KB)
Advances in treatment of ARDS Download (578KB)
Obstructive Sleep Apnea Download (463 KB)
Ventilation Download (340 KB)
Sarcoidosis Download (261 KB)
Inoperable Non Small Cell Lung Cancer Download (160 KB)
Small cell Lung Cancer Download (544 KB)
Acute Exacerbation of COPD Download (740 KB)
HIV-TB Coinfection Download (1.1 MB)
Uncommonl ILDs Download (186 KB)
Idiopathic Interstial Pneumonias Download (2.1 MB)
Lungs Ageing, Pregnancy & Excercise Download (180 KB)
BAL and TBLB Download (249 KB)
Major Airway Obstruction Download (380 KB)
LVRS & Bullectomy Download (700 KB)
Thoracoscopy Download (470 KB)
Cardio-pulmonary exercise testing Download (487 KB)
Immunotherapy in asthma Download (209 KB)
Swan-Ganz catheterisation Download (180 KB)
Staging of lung cancer Download (336 KB)
Molecular tools in diagnosis of TB Download (330 KB)
Pulmonary infections associated with hematological malignancies and bone marrow transplant Download (256 KB)
MDR TB in extra-pulmonary sites Download (406 KB)
Current concepts in Rx of TB Download (165 KB)
Antibiotic therapy Download (307 KB)
Nutrition in ICU Download (452 KB)
NSLC current concepts in Rx Download (85 KB)
Non Invasive Ventilation Download (166 KB)
Newer Modes of Ventilation Download (290 KB)
Respiratory Failure Download (187 KB)
Emerging Therapies in COPD Download (83 KB)
Pulmonary Vasculitides Download (300 KB)
Neuromuscular Weakness in ICU Download (530 KB)
Chest wall Diseases Download (189 KB)
Emerging Pulmonary Infections Download (188 KB)
Malignant Mesothelioma Download (192 KB)
Nuclear Medicine Techniques in Pulmonology Download (611KB)
Current and emerging therapies in pulmonary hypertension Download (102 KB)
Oragnophosphate poisoning Download (622 KB)
Anaemia in ICU Download (825 KB)
Surfactant in health and disease Download (209 KB)
Oxidative stree and anti-oxidants in respiratory diseases Download (359 KB)
Immunological agents in respiratory medicine Download (429 KB)
Lung transplantation Download (164 KB)
Sedation in ICU Download (799 KB)
Early detection of lung cancer Download (178 KB)
Cystic Fibrosis in Asians Download (182 KB)
Tropical Pulmonary Diseases Download (538 KB)
 
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