key concepts

• Subacute productive cough, foul-smelling sputum, night sweats → ?lung abscess
• Small cell lung carcinoma secreting ACTH can cause Cushing's syndrome
• Parathyroid hormone-related protein secretion (PTHrP) is a paraneoplastic syndrome associated with squamous cell lung cancer
• Azithromycin prophylaxis is recommended in COPD patients who meet certain criteria and who continue to have exacerbations
• Consider granulomatosis with polyangiitis when a patient presents with ENT (e.g. saddle shaped nasal deformity), respiratory and kidney involvement
• Hypercalcaemia + bilateral hilar lymphadenopathy → ? sarcoidosis
• Following weight loss, CPAP is the first-line treatment for moderate/severe obstructive sleep apnoea
• 30-40 year old with basal emphysema and abnormal LFTs → ? alpha-1 antitrypsin
• In primary pneumothorax that has either shortness of breath or >2cm rim of air, aspiration should be attempted
• Adult with asthma not controlled by a SABA - add a low-dose ICS
• Adults with suspected asthma should have both a FeNO test and spirometry with reversibility
• Small cell lung carcinoma secreting ACTH can cause Cushing's syndrome
• Mining occupation, upper zone fibrosis, egg-shell calcification of hilar nodes → ? silicosis
• COPD - still breathless despite using SABA/SAMA and no asthma/steroid responsive features → add a LABA + LAMA
• Polycythaemia (increased haematocrit) is a complication of COPD
• Moderate asthma PEFR 50-75% best or predicted
• A negative result on spirometry does not exclude asthma as a diagnosis, and should be further investigated
• Localised disease is an indication for surgery in bronchiectasis
• Tuberculosis typically causes upper zone pulmonary fibrosis
• When using an inhaler, for a second dose you should wait for approximately 30 seconds before repeating
• Mining occupation, upper zone fibrosis, egg-shell calcification of hilar nodes → ? silicosis
• Pneumoconiosis is a restrictive lung condition. Therefore spirometry results will commonly show a normal or slightly reduced FEV1 and a reduced FVC
• COPD - still breathless despite using SABA/SAMA and asthma/steroid responsive features → add a LABA + ICS
• Gynaecomastia - associated with adenocarcinoma of the lung
• Patients diagnosed with pneumonia who have COPD should be given corticosteroids even if no evidence of the COPD being exacerbated
• The Epworth Sleepiness Scale is used in the identification of obstructive sleep apnoea
• Pleural plaques are benign and do not undergo malignant change. They, therefore don't require any follow-up.
• Klebsiella most commonly causes a cavitating pneumonia in the upper lobes, mainly in diabetics and alcoholics 
• Pneumothorax can occur following high pressure non-invasive ventilation
• Severe asthma RR > 25/min
• Coal workers' pneumoconiosis typically causes upper zone fibrosis
• COPD: Discontinue SAMA (switch to SABA) if commencing LAMA
• Children aged 5-16 years should have both spirometry and a bronchodilator reversibility (BDR) test to diagnosis asthma
• COPD - still breathless despite using SABA/SAMA and no asthma/steroid responsive features → add a LABA + LAMA
• NIV should be considered in all patients with an acute exacerbation of COPD in whom a respiratory acidosis (PaCO2>6kPa, pH <7.35 ≥7.26) persists despite immediate maximum standard medical treatment
• Pulmonary fibrosis causes restrictive spirometry picture (FEV1:FVC >70%, decreased FVC) and impaired gas exchange (reduced TLCO)
• Statins must be temporarily held when prescribing a macrolide antibiotic due to the increased risk of rhabdomyolysis when combing the two drugs
• Lower zones lung fibrosis: amiodarone
• Azithromycin prophylaxis is recommended in COPD patients who meet certain criteria and who continue to have exacerbations
• A SABA or SAMA is the first-line pharmacological treatment of COPD