Pulmonary Medicine

Overview

Pulmonary medicine is the diagnosis and management of disorders of the lungs, upper airways,

thoracic cavity, and chest wall. The pulmonary specialist has expertise in neoplastic,

inflammatory, and infectious disorders of the lung parenchyma, pleura, and airways; pulmonary

vascular disease and its effect on the cardiovascular system; and detection and prevention of

occupational and environmental causes of lung disease. Other specialized areas include

respiratory failure and sleep-disordered breathing.

The general internist should be able to evaluate and manage cough, dyspnea, fever with

infiltrates, mass or nodule on the chest radiograph, pleurisy, and pleural effusion. He or she

should also be able to diagnose and manage patients with common respiratory infections; initiate

the diagnostic evaluation of respiratory neoplasm; and manage the initial approach to patients

with respiratory failure, including those in intensive care units.

The internist will usually be assisted by the pulmonary specialist for diagnostic procedures and

complicated conditions such as advanced respiratory failure. If such expertise is not available,

the internist, with additional training, may have to assume these roles.

Common Clinical Presentations

· Chest pain

· Cough

· Dyspnea

· Excessive daytime sleepiness

· Febrile patient with infiltrate

· Hemoptysis

· Nodule or mass on chest radiograph

· Pleural effusion, pleurisy

· Stridor, hoarseness

· Wheezing

Procedure Skills (see also Critical Care Medicine)

· Arterial blood gas sampling

· Endotracheal intubation

· Monitoring of oxygen saturation

· Skin test for anergy, tuberculosis

· Spirometry and peak flow assessment

· Pulmonary artery catheterization

· Thoracentesis

· Pleural biopsy (optional)

Primary Interpretation of Tests

· Complete pulmonary function tests (spirometry; measurement of lung volumes, diffusing

capacity, flow volume loop)

· Pulmonary artery catheter readings

Ordering and Understanding Tests

· Bronchoscopy, including lavage and biopsy

· Cardiopulmonary exercise test

· Computed tomography of thorax

· Cytology, pathology of lung and pleural biopsy specimens

· Diagnostic studies for venous thrombosis

· Mediastinoscopy, mediastinotomy

· Pleural fluid analysis

· Pulmonary angiography

· Sleep study

· Ventilation/perfusion lung scans