Pulmonary Health Management Quiz

Study Notes

Thoracocentesis:
- Primarily indicated for pleural effusion.
- Involves fluid removal via a needle inserted at the upper border of a rib under the 10th rib at the scapular line.
- Must be performed under strict aseptic conditions.
- Possible complications: hemothorax, pneumothorax, neurogenic shock, pulmonary edema.
Intercostal Chest Tube (Under Water Seal):
- Indicated for pneumothorax (open, bilateral, or tension), empyema, and hemothorax.
Tension Pneumothorax:
- Classified as a medical emergency.
- Requires immediate decompression via wide-bore needle in 2nd intercostal space, followed by intercostal chest tube placement.
- Oxygen and analgesics are also provided.

Definition and Aetiology:
- Characterized by bronchial narrowing due to bronchospasm, inflammatory infiltrate (eosinophils), and mucus plugs.
Pathophysiology:
- Can be extrinsic (allergic) or intrinsic (bronchial hyper-reactivity).
Clinical Picture:
- Patients are symptom-free between attacks.
- Symptoms: night and early morning attacks featuring wheeze, non-productive cough, dyspnea, and viscid sputum at the end of an attack.
- Signs during attack include restricted respiratory movement, palpable rhonchi, bilateral hyper-resonance on percussion, and harsh vesicular breathing with prolonged expiration.
Complications:
- Respiratory: status asthmaticus (severe asthma), respiratory failure.
- General: treatment complications such as diabetes mellitus and hypertension from steroid use.
- Chronic cough complications: myositis, rib fractures, pneumothorax, hemoptysis, puffy eyelids, hernia.
Investigations:
- Increased eosinophils in sputum and blood.
- Elevated serum IgE in extrinsic asthma.
- Skin prick tests to identify allergens.
- Chest X-ray shows hyperinflation during attacks.
- Spirometry results indicate obstructive hypoventilation.
Treatment:
- Reliever medication: Inhaled short-acting B2-agonists (e.g., Salbutamol) as needed.
- Controller medications: Inhaled corticosteroids (ICS), long-acting B-agonists (LABA), oral leukotriene receptor antagonists (LTRA), and oral or parenteral steroids.
- IgE monoclonal antibodies such as Omalizumab.

Clinical Picture:
- Symptoms include fever, anorexia, headache, malaise, cough, dyspnea, and rusty sputum.
- Signs: limited respiratory movement, increased tactile vocal fremitus, dullness upon percussion, bronchial breathing with crepitations on auscultation.
Special Types of Pneumonia:
- Staphylococcal Pneumonia:
  - Caused by Staphylococcus aureus, treated with nafcillin or vancomycin.
- Fridlander's Pneumonia:
  - Caused by Klebsiella in immunosuppressed patients, mainly in apical lung regions, treated with ceftriaxone.
- Pneumocystis carinii (jiroveci) Pneumonia:
  - Caused by Pneumocystis jiroveci in AIDS patients, treated with Septrin or pentamidine.
- Mycoplasma Pneumonia:
  - Atypical pneumonia mainly in children and young adults, associated with systemic infections. Diagnosed via cold agglutination test, treated with macrolides (e.g., erythromycin).
- Legionella Pneumonia (Legionnaire Disease):
  - Caused by Legionella pneumophila, linked to contaminated water. Diagnosed with urine antigen test, treated with macrolides, causes hyponatremia.
Viral Pneumonia:
- Atypical pneumonia from various viruses such as influenza, CMV, EBV, RSV, measles, and coronaviruses (including SARS).