Respiratory Flashcards
A young lady was travelling to countryside at spring, after arriving; she began to develop awakening at night with difficulty breathing She also had chest pain with productive cough of scanty, viscid whitish odorless sputum. She took her usual rescue medications but without response. So she went to emergency department (ED). This is second visit to ED with same symptoms; in 6 years. Chest and heart examination revealed tachycardia with bilateral diminished breath sounds. Diffuse expiratory rhonchi in addition to pulsus paradoxus. She is afebrile. No arrhythmia, no murmur and no crackles. Chest x-ray and ECG were done but revealed no serious abnormalities. ABG analysis and report confirm moderate hypoxemia, hypercapnea. The patient was categorized as severe and admitted to ICU Oxygen inhalation with medical treatment were started with frequent re-evaluations till improvement clinically and ABG became normal after 6 hours. He was under observation in ward for 24 hours and then discharged on home medication and daily self-evaluation using peak-flow meter. Moreover, she was advised for hospital follow up after a week for pulmonary functions assessment and spirometry evaluation.
What is the most likely diagnosis?
A.Pneumothorax
B.Bronchial asthma
C.COPD
D.Pneumonia
E. Bronchogenic carcinoma
B. Bronchial asthma
While working in a laboratory, a medical student accidentally opens a canister of highly corrosive gas and inhales a large quantity of the gas. He immediately goes to the ER department for evaluation and treatment. Physical examination shows labored breathing and tachypnea as well as scattered insp. crackles bilaterally and tachycardia. Respiratory rate of 24 breaths/min. Arterial blood gas (reservoir mask of 6 L/min) showed that the pH was 7.44, PCO2was 41.1 mmHg, PO2was 69.2 mmHg. With Pao2/Fio2 less than 200. CT chest showed bilateral diffuse alveolar infiltrations.Swan-Ganz catheter showed PCWP was less than 18 mmHg. Patient was mechanically ventilated low tidal volume+ PEEP. for 2 days and discharged after 1 week.
What conditions should be included in the differential diagnosis?
A.Cardiogenic pulmonary edema
B.ARDS
C.Bronchial asthma
D.Interstitial lung fibrosis
E. Bilateral pneumothorax
B. ARDS
A 60-year-old man comes to his primary care physician because of dyspnea on exertion that has been worsening over the past several years. He also reports a nonproductive cough that he has had almost daily in the same period. On questioning, the man says he worked for 30 years stripping insulation on ships. On physical examination, chest expansion appears markedly restricted, and fine inspiratory crackles are heard that are most pronounced at the lung bases. The man also has multiple firm subcutaneous nodules on his hands. X-ray of the chest findings was calcified pleural plaques. with reticulonodular opacities seen throughout prominently at the bases of lung fields.
What is the most likely diagnosis?
A.Bronchial asthma
B.Coal worker’s pneumoconiosis
C.Asbestosis.
D.Community acquired Pneumonia.
E.Berylliosis
C. Asbestosis
A 14-year-old child presented to the clinic with a daily productive cough large greenish amount of sputum. Chest auscultation revealed wheeze sounds. Child was small for his age, ‟failure to thrive” and had history of meconium ileus at birth. He had a history of recurrent respiratory tract infections, sinusitis, malabsorption, chronic malnutrition, and frequently missed school due to exacerbations. Chest radiograph from an ED visit, there was subtle airway dilation and thickening, but only in the upper lobes. Chest CT revealed upper lobe (right > left) dilated airways with bronchial wall thickening and small-airway mucus plugs in a “tree-in-bud” pattern. Spirometry revealed (FEV1) of 73 percent of predicted, no response to bronchodilators. Sweat chloride levels ≥ 60 mmol/L.
What is the most likely diagnosis?
A.COPD
B.Kartagener syndrome
C.Cystic fibrosis
D.Pneumonia
E. Pleural effusion
C. Cystic fibrosis
