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Questions and Answers
What is the best initial treatment for asthma during an attack?
Which type of pneumonia is specifically associated with Staphylococcus aureus?
What is a common symptom of pneumonia?
Which treatment is recommended for Pneumocystis carinii pneumonia?
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Which pneumonia primarily affects immunosuppressed patients, particularly diabetics?
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What lab test is typically used to diagnose Mycoplasma pneumonia?
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What is the primary indication for performing a thoracocentesis?
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Which of the following is a common sign detected during the auscultation of pneumonia?
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Which medication is classified as a controller medication for asthma?
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Which of the following is a complication associated with thoracocentesis?
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Legionella pneumonia is primarily diagnosed using which of the following tests?
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Which physiological mechanism leads to bronchial narrowing in asthma?
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Which symptom is characteristic of cough in pneumonia?
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In which phase of an asthma attack might a patient expect to expel small viscid sputum?
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Which type of asthma is characterized by bronchial hyper-reactivity without a clear allergen?
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What can result from chronic coughing in asthma patients?
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Which diagnostic finding is specific to extrinsic asthma?
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What immediate action is necessary to treat a tension pneumothorax?
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Which sign is typically observed during an asthma attack?
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What is a significant complication of asthma treatment often associated with steroid use?
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Study Notes
Pleural Diseases Treatment
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Thoracocentesis
- Indicated for pleural effusion; involves needle insertion superior to the rib at scapular line below the 10th rib.
- Must be performed under strict aseptic conditions to prevent complications such as hemothorax or pneumothorax.
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Intercostal Chest Tube
- Used for conditions like pneumothorax (open, bilateral, or tension), empyema, and hemothorax.
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Tension Pneumothorax Management
- A medical emergency requiring immediate wide-bore needle insertion in the 2nd intercostal space for decompression, followed by intercostal chest tube insertion, and administration of oxygen and analgesics.
Bronchial Asthma
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Definition and Aetiology
- Characterized by bronchial narrowing due to bronchospasm, eosinophil infiltration, and mucus accumulation.
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Pathophysiology
- Can be triggered by allergens (extrinsic or atopic asthma) or bronchial hyper-reactivity (intrinsic asthma).
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Clinical Presentation
- Symptom-free between episodes; common symptoms include nocturnal attacks, wheezing, non-productive cough, and dyspnea.
- End of attack may involve expectoration of thick, viscid sputum.
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Signs During an Attack
- Inspection reveals restricted respiratory movement; palpable rhonchi noted on palpation.
- Percussion shows bilateral hyper-resonance; auscultation presents prolonged expiration and generalized rhonchi.
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Complications
- Respiratory: status asthmaticus and respiratory failure.
- General complications of treatment (e.g., steroid side effects).
- Chronic cough can lead to thoracic (myositis, rib fractures) and extra-thoracic issues (hernia).
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Investigations
- Sputum examination shows increased eosinophils; blood tests reveal eosinophilia.
- Elevated serum IgE in extrinsic asthma; skin prick tests identify allergens.
- Chest X-ray may show hyperinflation during an attack; pulmonary function tests reveal obstructive hypoventilation.
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Treatment
- Short-acting B2-agonists (SABA) (e.g., Salbutamol) for immediate relief.
- Inhaled corticosteroids (ICS) (e.g., Beclomethasone) for control.
- Long-acting B2-agonists (LABA) (e.g., Salmeterol) for ongoing management.
- Oral leukotriene receptor antagonists (LTRA) (e.g., Montelukast) and oral steroids (e.g., prednisolone) for severe cases.
- IgE monoclonal antibodies (e.g., Omalizumab) as an additional treatment option.
Pneumonia
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Clinical Picture
- Constitutional symptoms: fever, anorexia, headache, malaise, alongside cough and dyspnea with rusty sputum.
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Signs of Pneumonia
- Inspection shows limited respiratory movement on the affected side; palpation reveals increased tactile vocal fremitus.
- Percussion indicates dullness; auscultation findings include bronchial breathing and crepitations.
Special Types of Pneumonia
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Staphylococcal Pneumonia
- Caused by Staphylococcus aureus; treated with nafcillin or vancomycin.
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Friedlander's Pneumonia
- Caused by Klebsiella, especially in immunocompromised patients (e.g., diabetics); treated with ceftriaxone.
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Pneumocystis Carinii Pneumonia
- Fungal pneumonia in AIDS patients; treated with Septrin or pentamidine.
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Mycoplasma Pneumonia (Atypical)
- Common in children and young adults; associated with systemic infections; diagnosed by cold agglutination test and treated with macrolides (e.g., erythromycin).
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Legionella Pneumonia
- Caused by Legionella pneumophila from contaminated water; leads to hyponatremia; diagnosed via urine antigen test and treated with macrolides.
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Viral Pneumonia
- Atypical pneumonia caused by various viruses including influenza, CMV, EBV, RSV, measles, and coronaviruses.
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Description
Test your knowledge on the treatment of pleural diseases, focusing on procedures like thoracocentesis and intercostal chest tube placement. This quiz covers complications and indications for various treatments related to pleural effusion, pneumothorax, and more. Perfect for medical students and healthcare professionals.
