Pulmonary Health Management Quiz

Pleural Diseases Treatment

• 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.

Bronchial Asthma

• 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.

Pneumonia

• 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).