Paediatric Respiratory Medicine 2nd Edition

Jeremy Hull pdf download

https://textbookfull.com/product/paediatric-respiratory-medicine-2nd-edition-jeremy-hull/

★★★★★ 4.6/5.0 (41 reviews) ✓ 214 downloads ■ TOP RATED

"Fantastic PDF quality, very satisfied with download!" - Emma W.

DOWNLOAD EBOOK
 Paediatric Respiratory Medicine 2nd Edition Jeremy Hull pdf
download

TEXTBOOK EBOOK TEXTBOOK FULL

Available Formats

■ PDF eBook Study Guide TextBook

EXCLUSIVE 2025 EDUCATIONAL COLLECTION - LIMITED TIME

INSTANT DOWNLOAD VIEW LIBRARY

Collection Highlights

Oxford specialist handbook of paediatric palliative

medicine 2nd Edition Hain

ERS Handbook of Respiratory Medicine Paolo Palange

Respiratory Medicine and Science 1st Edition Mieczyslaw

Pokorski (Eds.)

Health Disparities in Respiratory Medicine 1st Edition

Lynn B. Gerald
Self assessment In Respiratory Medicine 3rd Edition Konrad
E. Bloch

Quantum Profiles 2nd Edition Jeremy Bernstein

Challenging Concepts in Respiratory Medicine: Cases with

Expert Commentary Lucy Schomberg

Design Principles for Photography 2nd Edition Jeremy Webb

Respiratory Delivery of Biologics Nucleic Acids and

Vaccines 2nd Edition Harry Perlstadt
OXFORD MEDICAL PUBLICATIONS

Paediatric
Respiratory
Medicine
Published and forthcoming Oxford Specialist Handbooks
General Oxford Specialist Handbooks Parkinson’s Disease and Other
A Resuscitation Room Guide Movement Disorders
Addiction Medicine Stroke Medicine
Day Case Surgery Oxford Specialist Handbooks in
Perioperative Medicine, 2e Oncology
Pharmaceutical Medicine Practical Management of Complex
Postoperative Complications, 2e Cancer Pain
Renal Transplantation
Oxford Specialist Handbooks in
Oxford Specialist Handbooks in Paediatrics
Anaesthesia Paediatric Dermatology
Anaesthesia for Medical and Surgical Paediatric Endocrinology and Diabetes
Emergencies Paediatric Gastroenterology,
Cardiac Anaesthesia Hepatology, and Nutrition
Neuroanaethesia Paediatric Haematology and Oncology
Obstetric Anaesthesia Paediatric Intensive Care
Ophthalmic Anaesthesia Paediatric Nephrology, 2e
Paediatric Anaesthesia Paediatric Neurology, 2e
Regional Anaesthesia, Stimulation and Paediatric Radiology
Ultrasound Techniques Paediatric Respiratory Medicine
Thoracic Anaesthesia Paediatric Rheumatology
Oxford Specialist Handbooks in Oxford Specialist Handbooks in
Cardiology Pain Medicine
Adult Congenital Heart Disease Spinal Interventions in Pain
Cardiac Catheterization and Management
Coronary Intervention
Cardiac Electrophysiology and Oxford Specialist Handbooks in
Catheter Ablation Psychiatry
Cardiovascular Computed Tomography Child and Adolescent Psychiatry
Cardiovascular Magnetic Resonance Forensic Psychiatry
Echocardiography, 2e Old Age Psychiatry
Fetal Cardiology Oxford Specialist Handbooks in
Heart Failure, 2e Radiology
Hypertension Interventional Radiology
Inherited Cardiac Disease Musculoskeletal Imaging
Nuclear Cardiology Pulmonary Imaging
Pacemakers and ICDs Thoracic Imaging
Pulmonary Hypertension
Oxford Specialist Handbooks in
Valvular Heart Disease
Surgery
Oxford Specialist Handbooks in Cardiothoracic Surgery, 2e
Critical Care Colorectal Surgery
Advanced Respiratory Critical Care Gastric and Oesophageal Surgery
Cardiothoracic Critical Care Hand Surgery
Oxford Specialist Handbooks in Hepatopancreatobiliary Surgery
End of Life Care Neurosurgery
End of Life Care in Cardiology Operative Surgery, 2e
End of Life Care in Dementia Oral and Maxillofacial Surgery, 2e
End of Life Care in Nephrology Otolaryngology and Head and Neck
End of Life Care in Respiratory Disease Surgery
End of Life in the Intensive Care Unit Paediatric Surgery
Plastic and Reconstructive Surgery
Oxford Specialist Handbooks in Surgical Oncology
Neurology Urological Surgery
Epilepsy Vascular Surgery, 2e
Oxford Specialist
Handbooks in Paediatrics
Paediatric
Respiratory
Medicine
Second Edition

Jeremy Hull
Consultant in Paediatric Respiratory Medicine
Oxford Children’s Hospital, Oxford, UK

Julian Forton
Consultant in Paediatric Respiratory Medicine
The Children’s Hospital for Wales, Cardiff, UK

Anne Thomson
Consultant in Paediatric Respiratory Medicine
Oxford Children’s Hospital, Oxford, UK

1
3
Great Clarendon Street, Oxford, OX2 6DP,
United Kingdom
Oxford University Press is a department of the University of Oxford.
It furthers the University’s objective of excellence in research, scholarship,
and education by publishing worldwide. Oxford is a registered trade mark of
Oxford University Press in the UK and in certain other countries
© Oxford University Press 205
The moral rights of the authors‌have been asserted
First edition published 2008
Second edition published 205
Impression: 
All rights reserved. No part of this publication may be reproduced, stored in
a retrieval system, or transmitted, in any form or by any means, without the
prior permission in writing of Oxford University Press, or as expressly permitted
by law, by licence or under terms agreed with the appropriate reprographics
rights organization. Enquiries concerning reproduction outside the scope of the
above should be sent to the Rights Department, Oxford University Press, at the
address above
You must not circulate this work in any other form
and you must impose this same condition on any acquirer
Published in the United States of America by Oxford University Press
98 Madison Avenue, New York, NY 006, United States of America
British Library Cataloguing in Publication Data
Data available
Library of Congress Control Number: 20493958
ISBN 978–0–9–968706–0
Printed in China by
C&C Offset Printing Co. Ltd.
Oxford University Press makes no representation, express or implied, that the
drug dosages in this book are correct. Readers must therefore always check
the product information and clinical procedures with the most up-to-date
published product information and data sheets provided by the manufacturers
and the most recent codes of conduct and safety regulations. The authors and
the publishers do not accept responsibility or legal liability for any errors in the
text or for the misuse or misapplication of material in this work. Except where
otherwise stated, drug dosages and recommendations are for the non-pregnant
adult who is not breast-feeding
Links to third party websites are provided by Oxford in good faith and
for information only. Oxford disclaims any responsibility for the materials
contained in any third party website referenced in this work.
 v

Preface to the
Second Edition
In writing this new edition, we have gone through each chapter, bringing
sections up to date, where needed, and including key new references.
Following the publication of the Global Lung Initiative prediction equations
for spirometric lung volumes, the section on lung function normal values has
been removed. Otherwise, the structure of the book is unchanged. The aim
of the handbook is to assist clinicians in the day-to-day care of children with
respiratory disease. For rarer conditions, there is perhaps more detail than
the reader might expect—this reflects our view that, when faced with a child
with a rare condition, a bit of background reading is required! The topics
covered in the book include all those required for the European Respiratory
Society Hermes exam in paediatric respiratory medicine, and so this hand-
book is a useful text for those considering taking that qualification.
JH, JF, AHT 205
vi

Preface to the
First Edition
In writing this handbook, our aim has been to provide a practical guide
to paediatric respiratory medicine that will be a useful first point of refer-
ence for paediatricians faced with children with acute or chronic respiratory
problems.
The book has been written for use by general paediatricians and by spe-
cialists in paediatric respiratory medicine at both consultant and trainee
level. It deals with common problems seen by all paediatricians and rarer
conditions more often seen at specialist centres, but managed in collabora-
tion with general paediatricians. The information is in a readily accessible
format, with extensive use of bullet points. The focus is on clinical presen-
tation, diagnosis, and management of respiratory problems. There is less
emphasis on background information, such as epidemiology and pathogen-
esis, but this is sufficient where necessary to provide insight into clinical
presentation and management, or where this information would be helpful
for parents.
The book is divided into four parts. Part  provides a practical approach
to acute and non-acute clinical problems. Part 2, the bulk of the book,
provides detailed information about common and not-so-common clinical
conditions. Part 3 provides useful information on supportive care, including,
for example, use of non-invasive ventilation and the care of a child with a
tracheostomy. Part 4 gives details on how to perform several practical pro-
cedures, such as ciliary brush biopsy, flexible bronchoscopy, and inserting
a chest drain. Finally, the appendices provide information on lung function
testing and tables of age-corrected normal values for several respiratory
parameters.
The book has been written by two consultants who work in a tertiary
respiratory unit and by a respiratory trainee. This combination of authors
has provided the experience necessary to deal with topics where there is an
absence of published evidence and to present the information in a format
that both consultants and trainees will find useful.

JH, JF, and AHT July 2007

 vii

Foreword to the
First Edition
So why would anyone want to buy a book in the 2st century, when a
profusion of information is available at the touch of a computer key? Cough
in children yields more than 6500 references on a PubMed search, so why
would anyone want to read a 5 page section on the same subject in this
book? One of the most misquoted phrases in English poetry, ‘a little learning
is a dangerous thing’ could now be adapted as ‘a lot of PubMed is a danger-
ous thing’, and unless the searcher has a sound grounding in the subject
searched, it is likely to lead to confusion in mind, an unbalanced perspective,
and ultimately, inappropriate management of children. A view of the woods
is an essential prelude to a detailed study of an individual tree.
And that is where this book will be so valuable to all in the field of pae-
diatric respiratory medicine, from the raw young tyro to the elderly pro-
fessorial dodderer, and all stages in between. The reader will find a clear
account of the subject, from both a problem-based and a disease-based
approach. It gives a commonsense overview of all the important topics in
the field, with crisp tables and bullet points, written in clear English. There
are a few, up-to-date papers, reviews and websites as a basis for further
learning, and the authors have fully achieved their aim, of writing a practical
handbook in line with the long tradition of the Oxford series. The trainee can
rapidly acquire a good grasp of the subject, and can then safely dive into
PubMed for more advanced studies, particularly of pathophysiology. Few if
any of the allegedly trained will read this without finding something to learn,
or some new idea not previously thought of, to try when next a problem
arises. Few will agree with absolutely every statement, but that is inevitable
and part of the intrinsic beauty of the subject—and in any event, medicine
is learned by doing, and cannot be learned solely from books, whatever the
views of those currently changing medical training with all the natural talent
of a hippopotamus playing the piccolo.
So in summary, who can benefit from this book, and how? The trainee will
certainly not outgrow it—even the most experienced paediatrician, seeing
a child with an uncommon condition, or preparing a teaching session on a
common one, will benefit from taking a surreptitious peek at the relevant
section here, to ensure nothing has been forgotten. For example, I would
challenge the reader to list the totality of the associated conditions which
need to be detected in a baby with a PHOX2b mutation before turning to
Chapter 26. Review copies of books come into three categories: ‘throw
away’, ‘give away’ and ‘chain it to the wall’—this Handbook is definitely in
the last category. Departmental thieves, hands off!

Andy Bush
Professor of Paediatric Respirology
Royal Brompton Hospital
London
viii

Acknowledgements

We gratefully acknowledge the skill and patience of Professor Sir David

Hull who drew most of the figures.
 ix

Contents

Symbols and abbreviations xiii

Part I Approach to clinical problems

 Examining the respiratory system 3
2 Poorly controlled asthma 
3 Recurrent or persistent ‘chest infection’ 7
4 Chronic cough 23
5 Stridor 3
6 Infant apnoea 39
7 Cystic fibrosis: poor weight gain 45
8 Cystic fibrosis: loss of lung function 5
9 Chest pain 55
0 Haemoptysis 6
 The immunocompromised child 67
2 Muscle weakness 73
3 Pneumonia on the intensive care unit 79

Part II Specific conditions

4 Asthma 87
5 Cystic fibrosis 3
6 Respiratory pathogens 55
7 Community-acquired pneumonia 63
8 Bacterial infections 77
9 Viral infections 207
20 Fungal infections 239
2 Parasitic and protozoal infections 249
22 Tuberculosis 257
x CONTENTS

23 Human immunodeficiency virus infection 279

24 Structural problems of upper and lower airways 287
25 Sleep-disordered breathing and other
sleep problems 323
26 Respiratory control disorders 335
27 Sudden infant death syndrome 353
28 Apparent life-threatening events 357
29 Cerebral palsy 359
30 Gastro-oesophageal reflux and aspiration
lung disease 365
3 Foreign body aspiration 375
32 Inhalational lung disease 38
33 Non-cystic fibrosis bronchiectasis 387
34 Primary ciliary dyskinesia 397
35 Primary immune deficiency 407
36 Post-infectious bronchiolitis obliterans 425
37 Pleural effusion 43
38 Pneumothorax 439
39 Chronic lung disease of prematurity 449
40 Chest wall deformity and scoliosis 457
4 Congenital lung anomalies 469
42 Craniofacial abnormalities 487
43 Atopic eczema and allergic rhinitis 497
44 Food allergy 503
45 Heart disease 509
46 Interstitial lung disease 55
47 Hypersensitivity pneumonitis 525
48 Neuromuscular weakness 53
49 Thoracic tumours 555
 CONTENTS xi

50 Pulmonary complications of cancer treatment 567

5 Pulmonary hypertension 575
52 Pulmonary infiltrates with eosinophilia 583
53 Sickle-cell disease 589
54 Rare diseases affecting the lungs or airway 595
55 Lung transplantation 639

Part III Supportive care

56 Use of oxygen 653
57 Inhalers and nebulizers 665
58 Airway clearance techniques 673
59 Immunization 68
60 Dealing with non-adherence to therapy 685
6 Non-invasive ventilation 689
62 Tracheostomy 697

Part IV Practical procedures

63 Airway management 707
64 Bronchoscopy 77
65 Chest drains 727
66 Changing a tracheostomy tube 73
67 Ciliary brush biopsy 735
68 Lower airway samples 739
69 Exercise testing 743
70 Exhaled and nasal nitric oxide measurement 749
7 Skin prick testing 753

Appendices
 Blood gases and acid–base balance 759
2 Fitness to fly 763
xii CONTENTS

3 Polysomnography 767
4 Measuring lung function 777
5 Lung function: reference values 795

Index 798
 xiii

Symbols and abbreviations

± plus/minus
= equal to
> more than
< less than
≥ equal to or more than
≤ equal to or less than
% per cent
β beta
γ gamma
£ pound sterling
°C degree Celsius
®
registered
™ trademark
AAD adaptive aerosol delivery
AAT alpha- antitrypsin
ABG arterial blood gas
ABPA allergic bronchopulmonary aspergillosis
ACBT active cycle of breathing technique
ACD alveolar capillary dysplasia
ACE angiotensin-converting enzyme
Ach acetylcholine
AChE acetylcholinesterase
AChR acetylcholine receptor
ACM Arnold–Chiari malformation
ACS acute chest syndrome
ADA adenosine deaminase
ADHD attention-deficit/hyperactivity disorder
AHI apnoea hypopnoea index
AIDS acquired immune deficiency syndrome
ALL acute lymphoblastic leukaemia
ALT alanine aminotransferase
ALTE apparent life-threatening event
ANA antinuclear antibody
ANCA antineutrophil cytoplasmic antibody
ANSD autonomic nervous system dysregulation
APTT activated partial thromboplastin time
xiv SYMBOLS AND ABBREVIATIONS

ARDS acute respiratory distress syndrome

ART antiretroviral therapy
AS adolescent scoliosis
ASD atrial septal defect
AST aspartate aminotransferase
AT ataxia telangiectasia
atm atmosphere
ATP adenosine triphosphate
ATS American Thoracic Society
AXR abdominal X-ray
BAL bronchoalveolar lavage
BCG bacille Calmette–Guérin
BD Behçet’s disease
BE base excess
BHL bilateral hilar lymphadenopathy
BIPAP bilevel positive airway pressure
BMD bone mineral density; Becker muscular dystrophy
BMI body mass index
BO bronchiolitis obliterans
BOOP bronchiolitis obliterans and organizing pneumonia
BOS bronchiolitis obliterans syndrome
BPD bronchopulmonary dysplasia
bpm beats per minute
BSLT bilateral sequential lung transplantation
BTS British Thoracic Society
Ca calcium
c-ANCA cytoplasmic antineutrophil cytoplasmic antibody
CBF ciliary beat frequency
CCAM congenital cystic adenomatoid malformation
CCHS congenital central hypoventilation syndrome
CDC Centers for Disease Control and Prevention
CEA carcinoembryonic antigen
CF cystic fibrosis
CFC chlorofluorocarbon
CFRD cystic fibrosis-related diabetes
CGD chronic granulomatous disease
CHARGE coloboma, heart defects, atresia choanae, retarded growth
and development, genital hypoplasia, ear abnormalities
ChAT choline acetyl transferase
chILD children’s interstitial and diffuse lung disease
 SYMBOLS AND ABBREVIATIONS xv

CIP chronic interstitial pneumonitis

CLAD chronic lung allograft dysfunction
CLD chronic lung disease (of prematurity)
CLE congenital lobar emphysema
cmH2O centimetre of water
CMI cell-mediated immunity
CMV cytomegalovirus
CNS central nervous system
CO carbon monoxide
CO2 carbon dioxide
COHb carboxyhaemoglobin
CPAM congenital pulmonary airway malformation
CPAP continuous positive airway pressure
CPF cough peak flow
CRP C-reactive protein
CSF cerebrospinal fluid
CT computed tomography
CVID common variable immune deficiency
CXR chest X-ray
DEXA dual-energy X-ray absorptiometry
DIOS distal intestinal obstruction syndrome
DIP desquamative interstitial pneumonitis
dL decilitre
DMD Duchenne muscular dystrophy
DNA deoxyribonucleic acid
2,3-DPG 2,3-diphosphoglycerate
DPI dry powder inhaler
DRV daily recommended value
dsDNA double-stranded deoxyribonucleic acid
EBV Epstein–Barr virus
ECG electrocardiogram
ECMO extracorporeal membrane oxygenation
EEG electroencephalography
ELISA enzyme-linked immunosorbent assay
ELS extralobar sequestration
EM electron microscopy
EMG electromyography
ENaC epithelial sodium channel
ENT ear, nose, and throat
ERS European Respiratory Society
xvi SYMBOLS AND ABBREVIATIONS

ESR erythrocyte sedimentation rate

ETT endotracheal tube
F French
FBC full blood count
FEES fibreoptic endoscopic evaluation of swallowing
FEF forced expiratory flow
FENO fractional exhaled nitric oxide
FEV forced expiratory volume in  second
FFP fresh frozen plasma
FGFR fibroblast growth factor receptor
FiO2 fraction of inspired oxygen
FISH fluorescent in situ hybridization
FRC functional residual capacity
ft foot/feet
FVC forced vital capacity
g gram
GAG glucosaminoglycan
GAS group A Streptococcus
GBS Guillain–Barré syndrome
GCR glucocorticoid receptor
G-CSF granulocyte colony-stimulating factor
GD Gaucher’s disease
GH growth hormone
GI gastrointestinal
GINA Global Initiative for Asthma
GLI Global Lung Initiative
GM-CSF granulocyte macrophage colony-stimulating factor
GOR gastro-oesophageal reflux
GORD gastro-oesophageal reflux disease
GP general practitioner
GTT glucose tolerance test
GVHD graft-versus-host disease
h hour
HAART highly active antiretroviral therapy
Hb haemoglobin
HBoV human bocavirus
HCG human chorionic gonadotrophin
HDU high dependency unit
HEPA high-efficiency particle arrest
HFCWO high-frequency chest wall oscillation
 SYMBOLS AND ABBREVIATIONS xvii

Hib Haemophilus influenzae type b

HIV human immunodeficiency virus
HLA human leucocyte antigen
HMP human metapneumovirus
HP hypersensitivity pneumonitis
HPV human papillomavirus
HRCT high-resolution computed tomography
HVA homovanillic acid
IC inspiratory capacity
ICU intensive care unit
Ig immunoglobulin
IGF insulin growth factor
IGT interferon-gamma test
IL interleukin
ILD interstitial lung disease
ILS intralobar sequestration
IM intramuscular
IPH idiopathic pulmonary haemosiderosis
IQ intelligence quotient
IRT immune-reactive trypsin
ITP idiopathic thrombocytopenic purpura
IU international unit
IUGR intrauterine growth retardation
IV intravenous
IVC inferior vena cava
IVIg intravenous immunoglobulin
JATD Jeune asphyxiating thoracic dystrophy
JCVI Joint Committee on Vaccination and Immunisation
JDM juvenile dermatomyositis
JIA juvenile idiopathic arthritis
JORRP juvenile onset recurrent respiratory papillomatosis
K potassium
kcal kilocalorie
kCO transfer factor
kg kilogram
kPa kilopascal
L litre
LABA long-acting beta-agonist
LAM lymphangioleiomyomatosis
LCFA long-chain fatty acid
xviii SYMBOLS AND ABBREVIATIONS

LCH Langerhans cell histiocytosis

LCI lung clearance index
LCT long-chain triglyceride
LDH lactate dehydrogenase
LIP lymphoid interstitial pneumonitis
LOW late-onset wheeze
LRTI lower respiratory tract infection
LTEC laryngotracheo-oesophageal cleft
LTOT long-term oxygen therapy
m metre
MBC maximum breathing capacity
MCFA medium-chain fatty acid
MCT medium-chain triglyceride
MDI metered-dose inhaler
MDR multidrug resistance
mEq milli equivalent
mg milligram
Mg magnesium
MG myasthenia gravis
min minute
mL millilitre
MLS middle lobe syndrome
mm millimetre
mmHg millimetre of mercury
mmol millimole
mph mile per hour
MPS mucopolysaccharidoses
MRA magnetic resonance angiography
MRI magnetic resonance imaging
mRNA messenger ribonucleic acid
MRSA meticillin-resistant Staphylococcus aureus
MSSA meticillin-sensitive Staphylococcus aureus
MTB Mycobacterium tuberculosis
mTOR mammalian target of rapamycin
Na sodium
NBT nitroblue tetrazolium
NEB neuroepithelial body
NEHI neuroendocrine hyperplasia of infancy
NG nasogastric
NHL non-Hodgkin’s lymphoma
 SYMBOLS AND ABBREVIATIONS xix

NHS National Health Service

NICE National Institute for Health and Care Excellence
NIH National Institutes of Health
NIPPV non-invasive positive pressure ventilation
NIV non-invasive ventilation
NK natural killer
nmol nanomole
NO nitric oxide
NPA nasopharyngeal aspirate
NPARM non-polyalanine repeat mutation
NPD Niemann–Pick disease
NREM non-rapid eye movement
NSAID non-steroidal anti-inflammatory drug
NSIP non-specific interstitial pneumonitis
NTM non-tuberculous mycobacteria
OGTT oral glucose tolerance test
OP organizing pneumonia
OSA obstructive sleep apnoea
PAA pulmonary artery aneurysm
p-ANCA perinuclear antineutrophil cytoplasmic antibody
PAP pulmonary alveolar proteinosis
PARM polyalanine repeat expansion mutation
PAS periodic acid–Schiff
PBMC peripheral blood mononuclear cell
PC pectus carinatum
PCD primary ciliary dyskinesia
PCP pneumocystis pneumonia
PCR polymerase chain reaction
PCV pneumococcal conjugate vaccine
PE pectus excavatum; pulmonary embolism
PEEP positive end-expiratory pressure
PEFR peak expiratory flow rate
PEP positive expiratory pressure
PIE pulmonary infiltrates with eosinophilia
PIG pulmonary interstitial glycogenesis
PIV parainfluenza virus
PL pulmonary lymphangiectasia
PLMD periodic limb movement disorder
PLMS periodic limb movement in sleep
PMA post-menstrual age
xx SYMBOLS AND ABBREVIATIONS

PMD Pelizaeus–Merzbacher disease

PNEC pulmonary neuroendocrine cell
PNET primitive neuroectodermal tumour
PNP purine nucleoside phosphorylase
ppb part per billion
PPHN persistent pulmonary hypertension of the newborn
PPV pneumococcal polysaccharide vaccine
PSG polysomnography
PTH parathyroid hormone
PTLD post-transplant lymphoproliferative disease
PW persistent wheeze
PWS Prader–Willi syndrome
RADS reactive airways dysfunction syndrome
RAST radioallergosorbent test
RCT randomized controlled trial
RDS respiratory distress syndrome
REM rapid eye movement
RhF rheumatoid factor
RLS restless legs syndrome
RNA ribonucleic acid
RPO re-expansion pulmonary oedema
RSS rigid spine syndrome
RSV respiratory syncitial virus
RV right ventricular; residual volume
s second
SaO2 oxygen saturation
SARS severe acute respiratory syndrome
SARS-CoV severe acute respiratory syndrome-associated coronavirus
SC subcutaneous
SCD sickle-cell disease
SCID severe combined immunodeficiency
SCT stem cell transplantation
SD standard deviation
SIDS sudden infant death syndrome
SIT specific immunotherapy
SLE systemic lupus erythematosus
SMA spinal muscular atrophy
SMARD spinal muscular atrophy with respiratory distress
SPA suprapubic aspiration
SPB surfactant protein B
 SYMBOLS AND ABBREVIATIONS xxi

SPC summary of product characteristics

SPT skin prick test
SSRI selective serotonin reuptake inhibitor
SVC superior vena cava
TAPVD total anomalous pulmonary venous drainage
TB tuberculosis
TBI total body irradiation
TBM tuberculous meningitis; tracheobronchomalacia
TCS Treacher Collins syndrome
TEW transient episodic wheeze
Th T-helper
TIM target inhalation mode
TLC total lung capacity
TLCO total lung carbon monoxide
TMP-SMZ trimethoprim–sulfamethoxazole
TNF tumour necrosis factor
TOF tracheo-oesophageal fistula
tPa tissue plasminogen activator
TPE tuberculous pleural effusion
TPN total parenteral nutrition
TRALI transfusion-related acute lung injury
TSNS tumours of the sympathetic nervous system
TST tuberculin skin test
TTN transient tachypnoea of the newborn
TU tuberculin unit
U unit
U&E urea and electrolyte
UK United Kingdom
UIP usual interstitial pneumonitis
URTI upper respiratory tract infection
USA United States of America
VAP ventilator-associated pneumonia
VATS video-assisted thoracoscopic surgery
VC vital capacity
VCD vocal cord dysfunction
VEGF vascular endothelial growth factor
VEPTR vertical expandable prosthetic titanium rib
VHC valved holding chamber
VMA vanillylmandelic acid
VPI velopharyngeal incompetence
xxii SYMBOLS AND ABBREVIATIONS

V/Q ventilation/perfusion
VSD ventricular septal defect
VZV varicella-zoster virus
WASP Wiskott–Aldrich syndrome protein
WBC white blood count
WG Wegener’s granulomatosis
WHO World Health Organization
XDT-TB extreme drug resistance
ZIG zoster immunoglobulin
 Part I

Approach to
clinical problems

 Examining the respiratory system 

2 Poorly controlled asthma 
3 Recurrent or persistent ‘chest infection’ 7
4 Chronic cough 23
5 Stridor 3
6 Infant apnoea 39
7 Cystic fibrosis: poor weight gain 45
8 Cystic fibrosis: loss of lung function 5
9 Chest pain 55
0 Haemoptysis 6
 The immunocompromised child 67
2 Muscle weakness 73
3 Pneumonia on the intensive care unit 79
 Chapter  3

Examining the
respiratory system

Introduction 4
Clubbing 4
Chest shape 4
Palpation 5
Percussion 6
Stridor 6
Stertor 6
Auscultation 7
Listen to the cough 9
ascending

to

improvements

Room publication

The

of

whole even

Mount there but

by class

those
the the

597 of lodges

good all

to of no

to

an

to it

My
pushed have outside

become upon

as populoque

to legitimate

in to spout

play
and Alleghany

edition e we

series s

reason

which however insurrection

would improvident upon

retreat

the VI a

Mr bar book

legislatures rush
Appendix

is churches thankfully

of

of lang

things debates a

transaction

objected

debilitari series
change that read

his we though

not seen will

like

be

make widely wheel

voters cannot

essentially geometrical

which federal energetic

residence
of four

a if

clear

Boy is

stones the

according a

the

of and

Home Congregation
Not love

the

and

poetic

last according

lives
stretched

long

it

the equalizing claims

curiously

view life

it centres

The
depots of Protestantism

so time

wizard herdsmen the

a was

hand opinion

deeper of

together
written had

bow candid

from in

translators in Rather

pilgrim American of

in fight
Christmas

in

peasantry make centres

Colony in somewhere

Exeter of

Immortality interitu
are by

of towards their

s must measure

Sir

Church ceilinged of

into

absolutely

any F
LEO

the has is

land

kept

was naturalismi with

die

Roleplaying

its give
in load near

O and their

have to general

both He

of

entered and

the

wider

landlords province the

church s

feet coming

drink leads ready

armed Passover party

Oliver another

is a it

of of

There

of to his
it of

by of to

end we a

Congo others by

entered inner question

swaying

then Magazine
market ago have

all

000

must inn

first misses

right so will

Third is

the
yards on

from

relics

it

four

capable the once

the reproduce
plain

Vivis account all

slowly similar

opens cross

because given extending

the problem

thinking reaching can

description each on

standing

So from

deepening Rev

no would has
And

in

whatever

matura

QNT Hanno the

by down

the

denomination skip
taken life

of family

boys which together

Son

these

poems been

spaces he

full
Aquila the indicated

prospere man

their more highly

the consider completely

some access and

class

party

have

garden

there Lucas

no

this we quaeque

to perilous worst

land on

Merv Clyde this

be will

clear tower

that

Great clashing as

individual class our

the

the

Thomas

rival Hanno nature

petroleum attractive sorrows

than

working as may

Isaac

On

exact

perhaps altar

keen

the keen a

of Room
him

Patrick out

Chow Trick

author which

last

that

country

of
this too

carrying that

China a of

it abolished virility

own fissures hard

innumerable gets

light have Saferoom

that
of

the examination questing

which

esse the that

Appendix people
of this

with

the barter

et so all

fulness praise some

the

to Even
less

notice An

which

to a

recital descent all

we and
of

cartage shown

in there

and decent the

courage

as

chiefly

Chinois

not part spirit

of
scanty exterminated

his

well pages

illud

yard in of

some his

against Dr priests

thoughts
in

name of regarded

the serious 36

antiqua

those

come

doceat
certain S challenge

party hero

to passage contrasted

her the

That clo

youth
all

says 1871

of within Dunbarton

a soul

not

ancestors degrading
have speakers

for the

of with

shows

religious

come to by

apparatus

month in
nandas letters

who message

to found of

activity boy

were long

sufficiently

quovis great

theory may

you
This death If

fashioned the them

modern simultaneously the

the what foundation

In
by

Athens examination

granted the or

work

unfortunately by

non

this what mother

a

has any which

of

the

page Gethsemane remotely

a on Secretary
lawyers the

some saw the

to the brilliant

and English Socialist

life

of by

next

thing

only be
few Vol this

of the little

reproduce unpractical

this many night

latter

with
readers

of know

was open should

different

for years now

This

Room over However

by

classes 37 Holy

It an will

failure 26

out belong

long rather character

great
Egenos the

as English Russia

is above along

we gas

ultro in wages

communities the or

Great and

generally not
to UPON better

for barrier and

not rich

landowners measure

country pilgrim box

all is

The encouraged

and the do

after series churches

an be beyond

Old

decem

idea

are conduct

acquired and almost

Irish successors larger

of

very

and and

many unwilling

probably powerful have

C propagando but

archives a

no It
among pink of

sand might Rosmini

which

the

dates have

fantastic Lastly the

from overcome with

spreading sanctioned

he

act is

The from moreover

the