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Top100 Diseases

 respiratory diseases

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Chronic obstructive pulmonary disease (COPD)
Chronic obstructive pulmonary disease is a common condition occurring in 17% of men and 8% of women between the ages of 45 and 64 years. It could perhaps more correctly be called ”chronic bronchitis and emphysema” because both conditions coexist in all patients with COPD, to varying degrees. Virtually confined to smokers, mortality from COPD is related to the number of cigarettes smoked per day.

What to learn
  • Diagnostic definitions - clinical history for bronchitis and pathological for emphysema.
  • Symptoms and signs, and the two subtypes of patient: pink puffers and blue bloaters.
  • Management of acute exacerbations and long-term prophylaxis.
  • Interpretation of arterial blood gas results.

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Asthma
Asthma is a common chronic inflammatory condition of the airways that causes reversible obstruction. The airways are characteristically hyperresponsive to a wide range of stimuli. Edema, smooth muscle hypertrophy, and mucous plugging cause obstruction.

What to learn
  • Classification into extrinsic and intrinsic asthma, and the triggering, exacerbating and relieving factors
  • Structural changes that occur in the airway, and their clinical features
  • Emergency management of acute asthma
  • Medical management of chronic asthma and inhaler technique

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Lung cancer
Bronchogenic carcinoma is the most common cause of death from cancer in the UK, affecting 30,000 people per year. Males are affected more often than females, but an increasing incidence is occurring in women. Peak incidence is between 40 and 70 years of age. The UK has the highest incidence of this disease in the world.

What to learn
  • The four main histological types: squamous cell (50%), small cell (20%), adenocarcinoma (20%) and large cell anaplastic (10%).
  • Risk factors, clinical features and prognosis for each type.
  • Symptoms and signs of pulmonary involvement, local spread, metastatic spread, and endocrine and neurological syndromes.
  • Management and palliation.

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Pneumonia
Pneumonia is defined as the consolidation of lung tissue caused by formation of intra-alveolar inflammatory exudates as a result of a lung infection. This must be visible on X-ray to be properly called pneumonia, as opposed to 'chest infection'. Pneumonia is the fifth most common cause of death, according to US data.

What to learn
  • Predisposing factors to chest infection and pneumonia.
  • Common causative organisms and the distinction between community-acquired and hospital-acquired pneumonia.
  • Diagnostic and pathological features of bronchopneumonia, lobar pneumonia and atypical pneumonia.
  • The special features of pneumonia in immunocompromised patients.
  • Appropriate antibiotic use for the various types of pneumonia.

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Pulmonary tuberculosis (TB)
This is a chronic granulomatous infection of the lung caused by Mycobacterium tuberculosis. It is uncommon in the UK, with an incidence of 7 per 100,000 per year, but is extremely common worldwide. Pulmonary TB is a very common exam topic because of the increasing incidence in elderly, immunocompromised, and homeless people, and the emergence of drug-resistant strains.

What to learn
  • Risk factors for infection and routes by which the organism can be spread.
  • Pathogenesis: primary and secondary TB; the histopathological sequence of events that leads to granuloma formation.
  • Symptom, signs and diagnosis of TB.
  • Nonpulmonary TB.
  • Drug treatments for TB, public health measures to prevent spread and the problems of ensuring compliance with treatment.

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Cystic fibrosis
Cystic fibrosis is a hereditary disease characterized by the production of abnormally thick mucus due to the presence of an abnormal transmembrane chloride ion transporter. It primarily affects the lung and pancreas. It is the most common autosomal recessive disorder, affecting 1 in 2000 newborns. Cystic fibrosis is a common exam topic.

What to learn
  • Pathogenesis: learn the genetic and molecular mechanisms and the physiological effects that produce the clinical features of the disease.
  • Symptoms, signs and methods of diagnosis.
  • Prognosis and management of the pulmonary and pancreatic effects of the disease.

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Diffuse interstitial diseases (alveolitis)
These diseases comprise a group of noninfectious, nonmalignant disorders in which there is inflammation of the alveolar walls with a thickening of the interstitium between the alveoli, usually with fibrosis. Learning about the features of the general disease process and one or two of the conditions in more detail is worthwhile.

What to learn
  • Histopathological changes for this general group of diseases, and management, which is similar for all of them.
  • Symptoms, signs and diagnostic features of interstitial diseases.
  • The three main causes of chronic pulmonary fibrosis: (1) idiopathic (sarcoidosis and cryptogenic fibrosing alveolitis); (2) dust inhalation, which might be inorganic (coal workers' pneumoconiosis) or organic (farmers' lung); and (3) iatrogenic (radiation pneumonitis or drug-induced by amiodarone or anticancer drugs).

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Pneumothorax
Pneumothorax is the presence of air in the pleural cavity. It is common and can be spontaneous or caused by trauma. The severity can range from mild to life threatening.

What to learn
  • Causes of pneumothorax: spontaneous (idiopathic or secondary to underlying disease) and traumatic (accidental or iatrogenic).
  • Diagnosis and assessment of severity.
  • Management and risks of recurrence.

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