Course 04: Respiratory Medicine and Infectious Disease
Lesson 11 of 14. Explore the diagnostic and management frameworks, work through the case, and finish the linked 10-question practice set. Urgent presentations require an emergency-care pathway and review of local professional scope.
Obstructive sleep apnea (OSA)
- Snoring, witnessed apnea, choking, daytime sleepiness, resistant hypertension and impaired concentration raise OSA suspicion; assess sleep and safety consequences.
- Confirm diagnosis with appropriate sleep testing; wearable snore reports do not establish severity.
- CPAP, weight-related strategies where appropriate, positional therapy and specialist alternatives should be personalized; review adherence and mask tolerability.
Pulmonary hypertension
- Progressive dyspnea, presyncope, edema, elevated JVP and loud pulmonic component of S2 may reflect pulmonary hypertension; causes include left heart and chronic lung disease.
- Echo can estimate right-heart pressure strain but right-heart catheterization establishes hemodynamic diagnosis when indicated.
- Avoid treating all pulmonary hypertension with pulmonary arterial hypertension-specific drugs; classification and specialty care matter.
Lung cancer assessment
- Persistent or unexplained cough, hemoptysis, weight loss, unilateral wheeze, recurrent same-site pneumonia or imaging nodule requires appropriate investigation.
- Lung cancer screening in asymptomatic high-risk individuals differs from diagnostic imaging in a symptomatic person; use applicable provincial screening criteria.
- Assess smoking history in pack-years, prior exposure and family preferences; discuss false positives, overdiagnosis and benefits in screening conversations.
Integrated prevention and function
- Smoking/vaping cessation support, occupational controls, vaccines, exercise and symptom-directed referral are shared prevention priorities.
- Monitor driving and public safety when significant untreated sleepiness is present and follow local standards.
- Be attentive to stigma, accessibility, health literacy and financial barriers to CPAP or investigations.
Applied clinical case
A 59-year-old with 40 pack-years has new hemoptysis, 8 kg weight loss and a persistent focal opacity on chest radiography.
Show model clinical reasoning and disposition
This is a diagnostic work-up for possible lung malignancy, not an asymptomatic screening situation. Arrange expedited chest CT and specialist assessment in the appropriate pathway.
Clinical self-check
- What confirms OSA?
- Why does screening differ from symptom investigation?
- What test confirms pulmonary-hypertension hemodynamics?
Current guidance and further learning
- Canadian Task Force: Lung cancer screening clinician FAQ (external)
- Canadian Thoracic Society guideline library (external)