Principles of

PULMONARY MEDICINE *

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Principles of Pulmonary Medicine

EIGHTH EDITION

Steven E. Weinberger, MD, MACP, FRCP

Executive Vice President and Chief Executive Officer Emeritus, American College of Physicians, Adjunct Professor of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania

Barbara A. Cockrill, MD

Associate Dean for Faculty Development—MD Program, Thibault Associate Professor of Medicine, Harvard Medical School, Pulmonary Vascular Disease and Lung Center, Brigham and Women’s Hospital, Boston, Massachusetts

Jess Mandel, MD, MACP, FRCP

Kenneth M. Moser Professor of Medicine, Chief, Division of Pulmonary, Critical Care, and Sleep Medicine, University of California San Diego School of Medicine, La Jolla, California

Table of Contents

Cover image

Title page

Copyright

Dedication

Introduction to the eighth edition

Online contents

1.Pulmonary anatomy and physiology: The basics Anatomy

Physiology

Abnormalities in gas exchange Suggested readings

2.Presentation of the patient with pulmonary disease Dyspnea

Cough Hemoptysis Chest pain

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3.Evaluation of the patient with pulmonary disease Evaluation on a macroscopic level Evaluation on a microscopic level Assessment on a functional level

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4.Anatomic and physiologic aspects of airways Structure

Function Suggested readings

5.Asthma

Etiology and pathogenesis

Pathology

Pathophysiology

Clinical features

Diagnostic approach

Treatment

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6.Chronic obstructive pulmonary disease Etiology and pathogenesis Pathology

Pathophysiology Clinical features

Diagnostic approach and assessment Treatment

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7.Miscellaneous airway diseases Bronchiectasis

Cystic fibrosis Upper airway disease

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8.Anatomic and physiologic aspects of the pulmonary parenchyma Anatomy

Physiology Suggested readings

9.Overview of diffuse parenchymal lung diseases

Pathology

Pathogenesis

Pathophysiology

Clinical features

Diagnostic approach

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10.Diffuse parenchymal lung diseases associated with known etiologic agents Diseases caused by inhaled inorganic dusts

Hypersensitivity pneumonitis Drug-induced parenchymal lung disease Radiation-induced lung disease Suggested readings

11.Diffuse parenchymal lung diseases of unknown etiology

Idiopathic pulmonary fibrosis

Other idiopathic interstitial pneumonias

Pulmonary parenchymal involvement complicating systemic rheumatic disease Sarcoidosis

Miscellaneous disorders involving the pulmonary parenchyma

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12.Anatomic and physiologic aspects of the pulmonary vasculature Anatomy

Physiology Suggested readings

13.Pulmonary embolism

Etiology and pathogenesis

Pathology

Pathophysiology

Clinical features

Diagnostic evaluation

Treatment

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14.Pulmonary hypertension Pathogenesis Pathology Pathophysiology Clinical features Diagnostic features

Specific disorders associated with pulmonary hypertension Suggested readings

15.Pleural disease

Anatomy

Physiology

Pleural effusion

Pneumothorax

Malignant mesothelioma

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16.Mediastinal disease Anatomic features Mediastinal masses Pneumomediastinum Suggested readings

17.Anatomic and physiologic aspects of neural, muscular, and chest wall interactions with the lungs Respiratory control

Respiratory muscles Suggested readings

18.Disorders of ventilatory control

Primary neurologic disease

Cheyne-stokes breathing

Control abnormalities secondary to lung disease

Sleep apnea syndrome

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19. Disorders of the respiratory pump

Neuromuscular disease affecting the muscles of respiration

Diaphragmatic disease

Disorders affecting the chest wall

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20.Lung cancer: Etiologic and pathologic aspects Etiology and pathogenesis

Pathology

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21.Lung cancer: Clinical aspects Clinical features

Diagnostic approach Principles of therapy Bronchial carcinoid tumors Solitary pulmonary nodule Suggested readings

22.Lung defense mechanisms Physical or anatomic factors Antimicrobial peptides Phagocytic and inflammatory cells Adaptive immune responses

Failure of respiratory defense mechanisms Augmentation of respiratory defense mechanisms Suggested readings

23.Pneumonia

Etiology and pathogenesis

Pathology

Pathophysiology

Clinical features and initial diagnosis

Therapeutic approach: General principles and antibiotic susceptibility Initial management strategies based on clinical setting of pneumonia Suggested readings

24. Bacterial and viral organisms causing pneumonia

Bacteria

Viruses

Intrathoracic complications of pneumonia

Respiratory infections associated with bioterrorism

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25.Tuberculosis and nontuberculous mycobacteria Etiology and pathogenesis

Definitions Pathology Pathophysiology

Clinical manifestations Diagnostic approach Principles of therapy Nontuberculous mycobacteria Suggested readings

26.Miscellaneous infections caused by fungi, including Pneumocystis Fungal infections

Pneumocystis infection Suggested readings

27.Pulmonary complications in the immunocompromised host Acquired immunodeficiency syndrome

Pulmonary complications in non–HIV immunocompromised patients Suggested readings

28.Classification and pathophysiologic aspects of respiratory failure Definition of respiratory failure

Classification of acute respiratory failure

Presentation of gas exchange failure

Pathogenesis of gas exchange abnormalities

Clinical and therapeutic aspects of hypercapnic/hypoxemic respiratory failure Suggested readings

29. Acute respiratory distress syndrome

Physiology of fluid movement in alveolar interstitium

Etiology

Pathogenesis

Pathology

Pathophysiology

Clinical features

Diagnostic approach

Treatment

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30. Management of respiratory failure

Goals and principles underlying supportive therapy

Mechanical ventilation

Selected aspects of therapy for chronic respiratory failure

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Appendix A. Sample problems using respiratory equations

Appendix B. Pulmonary function tests: Guidelines for interpretation and sample problems Appendix C. Arterial blood gases: Guidelines for interpretation and sample problems Index