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Questions and Answers
What is the primary indication for thoracocentesis?
During an asthma attack, which of the following symptoms is NOT expected?
What complication can arise from performing thoracocentesis?
Which of the following is considered a medical emergency in the context of pneumothorax?
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Eosinophilia in blood picture is primarily associated with which condition?
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What is a common trigger for intrinsic asthma?
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What specific investigation can indicate extrinsic asthma?
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In bronchial asthma, mucus plugs are most likely to contribute to which of the following?
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What is the best initial treatment for asthma attacks?
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Which type of pneumonia is primarily caused by Staphylococcus aureus?
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Which treatment is recommended for Pneumocystis carinii pneumonia?
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Which pneumonia presents with cough and rusty sputum?
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Which of the following is NOT classified as a controller medication for asthma?
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What is a common method for diagnosing Mycoplasma pneumonia?
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Which condition is characterized by dullness on percussion and limited respiratory movements?
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Which organism is most commonly associated with Legionella pneumonia?
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Study Notes
Pleural Diseases Treatment
- Thoracocentesis: Procedure to remove fluid from pleural cavity, mainly for pleural effusion; performed under aseptic conditions to avoid complications like hemothorax and pneumothorax.
- Intercostal Chest Tube: Used for pneumothorax (open, bilateral, or tension), empyema, and hemothorax; maintains under water seal.
- Tension Pneumothorax Treatment: Requires immediate intervention with a wide-bore needle insertion in the 2nd intercostal space, followed by chest tube insertion and administration of oxygen and analgesics.
Bronchial Asthma
- Definition: Characterized by bronchial narrowing leading to difficulty in breathing.
- Etiology: Caused by bronchospasm, inflammatory infiltrate (eosinophils), and thick mucus in bronchi.
- Pathophysiology: Differentiates between extrinsic (allergy-related) and intrinsic (bronchial hyper-reactivity) asthma.
Clinical Presentation
- Symptoms: Attacks typically occur at night or early morning, characterized by wheeze, non-productive cough, and dyspnea; may expectorate viscid sputum post-attack.
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Signs During Attack:
- Inspection: Limited respiratory movement bilaterally.
- Palpation: Central trachea alignment with palpable rhonchi.
- Percussion: Hyper-resonance bilaterally.
- Auscultation: Harsh vesicular breathing, prolonged expiration, generalized rhonchi.
Complications
- Respiratory: Status asthmaticus and respiratory failure.
- General: Treatment complications from steroids, leading to diabetes mellitus and hypertension.
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Chronic Cough Complications:
- Thoracic issues: myositis, rib fractures, pneumothorax, hemoptysis.
- Extra-thoracic issues: puffy eyelids, hernias.
Investigations
- Sputum Examination: Elevated eosinophil levels.
- Blood Tests: Eosinophilia present.
- Serum IgE: Increased in extrinsic asthma.
- Skin Prick Test: Identifies allergens through intradermal antigen injection.
- Chest X-ray: Shows hyperinflation signs during attacks.
- Pulmonary Function Tests: Indicate obstructive hypoventilation through spirometry.
Treatment
- Reliever Medications: Inhaled short-acting beta-2 agonists (SABA) like Salbutamol for immediate symptom relief.
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Controller Medications:
- Inhaled corticosteroids (ICS) like Beclomethasone or Budesonide.
- Long-acting beta agonists (LABA) like Salmeterol.
- Oral leukotriene receptor antagonists (LTRA) like Montelukast.
- Oral/parenteral steroids such as prednisolone.
- IgE monoclonal antibodies like Omalizumab.
Pneumonia
- Symptoms: Include constitutional signs (fever, anorexia, malaise) and respiratory complaints (cough, dyspnea, rusty sputum).
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Signs:
- Inspection: Limited respiratory movement on diseased side.
- Palpation: Increased tactile vocal fremitus (TVF).
- Percussion: Dullness over affected lung area.
- Auscultation: Bronchial breath sounds with crepitations.
Special Types of Pneumonia
- Staphylococcal Pneumonia: Caused by Staphylococcus aureus; treated with nafcillin or vancomycin.
- Friedlander's Pneumonia: Caused by Klebsiella; prevalent in immunosuppressed patients; treated with ceftriaxone.
- Pneumocystis Jiroveci Pneumonia: Seen in AIDS patients; treated with Septrin or pentamidine.
- Mycoplasma Pneumonia: Atypical pneumonia mainly in younger populations; can cause systemic infections; treated with macrolides like erythromycin.
- Legionella Pneumonia: Caused by Legionella pneumophila from contaminated water; diagnosed with urine antigen test and treated with macrolides.
Viral Pneumonia
- Atypical pneumonia linked to viruses such as influenza (including H1N1, H5N1), CMV, EBV, RSV, measles, and coronaviruses (e.g., SARS).
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Description
Test your knowledge on the treatment of pleural diseases, including procedures like thoracocentesis and intercostal chest tube insertion. Understand the indications, techniques, and possible complications associated with these treatments. This quiz will help reinforce your understanding of important concepts in managing pleural diseases.
