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  <head>
    <title>016-01 Foundations</title>
    <ownerName>Integrated Medical Foundations</ownerName>
  </head>
  <body>
    <outline text="Respiratory history, examination and investigation">
      <outline text="What the assessment must deliver">
        <outline text="Urgency, compartment, defect, cause, function"/>
        <outline text="Overlap with cardiac, metabolic and neuromuscular disease"/>
        <outline text="History and examination set pre-test probability"/>
      </outline>
      <outline text="Symptom history">
        <outline text="Dyspnoea">
          <outline text="Sudden: embolism, pneumothorax, obstruction, oedema"/>
          <outline text="Progressive: obstructive, interstitial, vascular, cardiac"/>
        </outline>
        <outline text="Cough: purulent colour reflects leukocytes, not bacteria"/>
        <outline text="Haemoptysis: estimate volume and assess airway risk">
          <outline text="Separate nasopharyngeal and gastrointestinal bleeding"/>
        </outline>
        <outline text="Wheeze: focal obstruction or diffuse airway disease"/>
        <outline text="Stridor is loud upper-airway obstruction and urgent"/>
        <outline text="Pleuritic pain: pleura, embolism, chest wall"/>
        <outline text="Exposure and background">
          <outline text="Smoking, vaping, occupational dust and fumes"/>
          <outline text="Tuberculosis contact, travel, immune suppression"/>
          <outline text="Drugs causing cough, bronchospasm or interstitial disease"/>
        </outline>
      </outline>
      <outline text="Observation and vital signs">
        <outline text="Position, speech, rate, pattern, accessory muscles"/>
        <outline text="Count the respiratory rate rather than estimate it"/>
        <outline text="Record oxygen device and flow with saturation"/>
        <outline text="Tachycardia: hypoxaemia, work, fever, embolism, drugs"/>
        <outline text="Instability demands support before a full examination"/>
      </outline>
      <outline text="Hands, face and neck">
        <outline text="Nicotine staining, cyanosis, tremor, asterixis"/>
        <outline text="Clubbing: cancer, bronchiectasis, fibrosis, abscess"/>
        <outline text="Not expected in uncomplicated asthma or airflow obstruction"/>
        <outline text="Pallor, central cyanosis, dentition, upper airway"/>
        <outline text="Tracheal deviation: volume loss, mass, effusion, tension"/>
      </outline>
      <outline text="Chest examination">
        <outline text="Inspection: shape, scars, symmetry, expansion"/>
        <outline text="Unilateral lag: pain, collapse, pleural disease"/>
        <outline text="Fremitus rises over consolidation, falls with fluid or gas"/>
        <outline text="Percussion: resonant, dull or hyperresonant, compared"/>
        <outline text="Auscultation">
          <outline text="Bronchial breathing peripherally: consolidation or cavity"/>
          <outline text="Fine late crackles: fibrosis or oedema"/>
          <outline text="Coarse crackles: secretions, but overlap is large"/>
          <outline text="Pleural rub is grating and localised"/>
        </outline>
        <outline text="Vocal resonance for consolidation or effusion"/>
        <outline text="Systemic examination: venous pressure, oedema, calves"/>
      </outline>
      <outline text="A reproducible examination map">
        <outline text="Specify side, surface, height, phase and comparison"/>
        <outline text="Not a pathological or segmental diagnosis"/>
        <outline text="Lets another examiner revisit the same region"/>
        <outline text="Compare paired sites before changing height"/>
        <outline text="Poor technique must not become confident localisation"/>
        <outline text="New asymmetry: ventilation, transmission or pain"/>
        <outline text="Record unassessed regions, and never delay support"/>
      </outline>
      <outline text="Arterial and venous blood gases">
        <outline text="Arterial gas: pH, carbon dioxide, oxygen, bicarbonate"/>
        <outline text="Venous gas cannot replace arterial oxygen"/>
        <outline text="Sampling errors: bubbles, delay, contamination"/>
        <outline text="Interpret in order">
          <outline text="pH, then the primary direction of change"/>
          <outline text="Expected compensation"/>
          <outline text="Anion gap in metabolic acidosis"/>
          <outline text="Oxygenation with inspired oxygen and context"/>
        </outline>
        <outline text="Acute retention limits bicarbonate rise, chronic allows more"/>
        <outline text="Alveolar-arterial difference separates hypoventilation"/>
        <outline text="Co-oximetry measures dyshemoglobins directly"/>
      </outline>
      <outline text="Imaging and function testing">
        <outline text="Chest radiograph: volume, opacity, pleura, devices"/>
        <outline text="Technique alters appearance: portable, rotation, supine"/>
        <outline text="A normal film excludes little"/>
        <outline text="Computed tomography, including high-resolution technique"/>
        <outline text="Ultrasound cannot see through aerated lung"/>
        <outline text="Spirometry: a reduced ratio confirms obstruction"/>
        <outline text="Total lung capacity confirms restriction"/>
        <outline text="Diffusing capacity with haemoglobin correction"/>
        <outline text="Challenge testing, walk test, exercise testing"/>
      </outline>
      <outline text="Sampling, severity and procedures">
        <outline text="Sputum quality: saliva contamination reduces value"/>
        <outline text="Bronchoscopy samples and clears, with real risk"/>
        <outline text="Pleural fluid: protein, enzymes, pH, cells, cytology"/>
        <outline text="Very low pH in parapneumonic effusion supports drainage"/>
        <outline text="Severity tools supplement rather than replace judgement"/>
        <outline text="A low score misses trajectory, frailty and barriers"/>
        <outline text="Procedures need indication, consent and clotting review"/>
        <outline text="Complications: pneumothorax, bleeding, re-expansion oedema"/>
        <outline text="Preoperative: optimise rather than test without a question"/>
      </outline>
    </outline>
  </body>
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