Chest

..............................................................
:

: : :
:
K3revision
( COPD (chronic obstructive pulmonary disease

chronic obstructive lung disease
chronic bronchitis emphysema
character character
decrease in forced expiratory one expired
air expiration
chronic bronchitis
disease of trachea-bronchial tree characterized by
chronic productive cough

exclusion bronchiectasis
etiology
chronic irritation chronic infection
smoking , air pollution
smoking smoking
Irritant trigger release of cytokines
1

..............................................................
interleukin , tumor necrosis factors
chronic smoking released
Muco ciliary surfactant
stagnation secretion
exacerbation role infection
chronic acute chronic bronchitis
Inflammatory chronic disease from the start
smoking
exacerbation role of infection
pneumococci , hemophilus two organisms
pathology
simple bronchitis pathology

mucus secretion early stage
surfactant cilia Mucus
muco Liable to recurrent infection
purulent stage
chronic air way obstruction

bronchial tree irritation, chronic inflammation
obstructive collagen fibers
reversible
almost irreversible
mainly clinical case COPD
clinical ...........
clinical pictures
2

..............................................................
male male
chronic productive cough sputum small
amount whitish mucous odor

advanced case
emphysema Late
element of broncho spasm
exacerbation
exacerbation chest infection
problem cough
sputum ....... chest infection
chest infection
sputum fever
chest infection

sputum sputum discolored

sputum Infection
Infection
respiratory failure

COPD Inter current infection
chest infection respiratory failure

..............................................................
Examination
general examination
puffiness
advanced cyanosis
clubbing COPD Unusual clubbing

common It may lead to clubbing
COPD clubbing common
brochiectiasis broncho genic carcinoma
enlarged tender liver , lower limb edema ,
Right Cor-pulmonal congested neck vein
sided heart failure
epigastric pulsations
CO2 retention chest disease pulse
Big pulse vasodilatation CO2 retention
volume
symmetrical chest clinically
antero-posterior diameter
TVF palpation emphysema
dullness resonant equal on both sides
emphysema hyper resonance
auscultation
harsh vesicular breathing breath sounds
expiration prolonged
expiration prolonged expiration
expiration air way obstruction active
resistance expiration
active passive expiration
harsh vesicular breathing expiration
rhonchi
4

..............................................................
rhonchi broncho spasm rhonchi
generalized sibilant.... Persistent
after cough
rhonchi secretion
scattered ...
.... secretion
crepitating secretion
course crepitation Inspiration
expiration low pitched low frequency
non consonating consonating
Local examination
complications of COPD complications of

chronic bronchitis
COPD
respiratory failure
complications
complications respiratory failure
type2 hypoxic hypercapnea

........ broncho genic carcinoma
.... peptic ulcers originally
hypoxia and hyper capnea viability

of gastric mucosa
irritant

..............................................................
aminophylline Irritant Peptic
ulcer
smoking , hypoxia and hypercapnia
corticosteroid
COPD polycythemia
COPD polycythemia
COPD
bronchiectasis anemia of chronic disease
peptic ulcer bleeding
investigations
X-ray ,ECG
ECG right ventricular enlargment cor-
pulmonale cor-pulmonal right ventricular
enlargment right axis deviation
cor-pulmonal ECG ECG
ECHO
emphysema
emphysema
emphysema ECG Low
voltage complexes ......
right ventricular enlargement ECHO
blood examination blood gases
normal hypoxia hypercapnia
respiratory failure type 2

brochial drainage
6

..............................................................
mucolytic expectorants , brocho dilators
brochial tree
brochodilator aminophylline Beta 2
agonist Anti cholinergic ipratropium bromide
inhaler COPD Inhaler
bronchial asthma 100%
COPD
inflammatory ...
steroid ....anti inflammatory

sever brocho spasm
broncho dilators
B2 agoinst
allergic element ......
shifting to steroid ...
..... benefit
steroid
B2 agonist steroid
inhaler
Inhaler bronchial asthma
step 4 medications
systemic
Intercurrent infection
anti biotic amoxacilline ,
ampicillin organism H.influenza or pneumococci

..............................................................
chronic chest disease chest
infection viral or bacterial
pneumococcal vaccine
influenza vaccine H.influenza vaccine vaccines
advanced COPD
take care chest infection

transplantation
treatment of excerbation of COPD

chest infection chronic
brochitits anti biotics broncho dilator
steroid
.... diuretics diuretics
right sided heart failure
border line right sided heart failure right sided failure

excerbation more hypoxia more hypoxia
more pulmonary hyper tension hypoxia
pulmonary vasoconstriction
polycythemia
pulmonary pressure
pulmonary pressure right
sided failure diuretics
Emphysema
8

..............................................................
definition abnormal dilatation air
spaces distal to terminal bronchioles
emphysema with rupture of the inter
alveolar septum
emphysema hyper inflation
hyper inflation bronchile asthma
alveoli
distended rupture of inter alveolar septa
...
.... clinical
clinical
definition
hyper inflation emphysema rupture of the
inter alveolar septa
emyphsema
senile compensatory compensatory
emphysema unilateral lung disease
Lung hyper inflated
compensatory emphysema
compensatory hyper inflation
emphysema alpha
one anti trypsin deficiency alpha one anti trypsin
deficiency alveoli proteases anti
proteases
proteases enzymes collagenase
digest alveolar wall
9

..............................................................
anti proteases alpha one anti
trypsin
alpha one anti trypsin deficiency
proteases dominant anti proteases
alveolar wall
congenital emphysema

exclusion emphysema
COPD
smoking emphysema
smoking inflammation in bronchial tree
inflammation Lung chronic irritation
neutrophils lungs
Increased ploy morph influx lung
macrophages
irritant
neutrophils proteases neutrophils

smoking air way obstruction in
bronchial tree proteases directly
smoking emphysema
smoking chronic bronchitis
chronic bronchitis .... emphysema
chronic bronchitis emphysema partial
bronchial obstruction air way
distended mechanical factor
Inflammatory factor smoking
10

..............................................................
cytokines proteases neutrophils
chronic bronchitis

emphysema
process
chronic bronchitis factor mechanical
emphysema trapping of air
clinical pictures
emphysema dyspnea
history ........... COPD
..... COPD COPD
emphysema
by exclusion alpha one anti trypsin
deficiency

liver cirrhosis Liver
Lung
Liver cirrhosis emphysema alpha
one anti trypsin deficiency
Investigations
chest X-ray lung hyper inflated
heart ribbon shaped heart
investigations ECG
low voltage ECHO cor-pulmonal
alpha one anti trypsin assessment
11

..............................................................
blood gases hypoxia hyper capnia
respiratory failure
non specific
COPD Originally
alpha one anti
trypsin injection early
pink puffer blue bloater
COPD chronic bronchitis emphysema
dominant .....

chronic bronchitis emphysema
blue bloater pink puffer
blue bloater
blue cyanosis

bloater edema
cyanosed right sided failure

edema blue bloater chronic bronchitis
dominant

chronic bronchitis dominant
air way air way

obstructive hypo ventilation hypoxia

hyper ventilation compensatory
12

..............................................................
obstructive hypo
ventilation air way hyper
ventilation
air way already hyper
ventilation hypoxic
hypoxia cyanosis vasoconstriction in
pulmonary arterioles pulmonary hyper tension
right sided failure
blue bloater Hypo ventilation

obstruction compensatory hyper
ventilation
obstructive ventilation defect
pink puffer emphysema dominant

emphysema hypoxia hypoxia
emphysema alveoli rupture alveoli
healthy gas diffusion blood
capillaries emphysema Hypoxia mild
hypoxia hyper ventilation
emphysema
diffusion defect alveoli healthy
exchange gases

alveoli healthy hyper inflated
hyper ventilation hyper
ventilation hypoxia
Hypoxic
13

..............................................................
hypoxia
polycythemia pink
puffer expired air

pursed lips alveoli interstitial
tissue
emphysema pathology
emphysema
high pressure alveoli high pressure
interstitium tissue small bronchiole
to keep small bronchioles
patent expired air
small bronchiole collapsed
obstructed rapidly high pressure surrounding
alveoli interstitium tissue

intra bronchial pressure high bronchiole
obstructed collapsed

clinical criteria of sever COPD

COPD sever
increase of the antero-posterior
diameter
accessory muscles sterno mastoid

positive littin sign Inter costal suction
( (indrwaing during inspiration
expiratory filling of neck vein
14

..............................................................
sever case of COPD
Brochial asthma
bronchial asthma tracheo bronchial
tree inflammatory
tracheo bronchial tree increased responsiveness to
multiplicity of stimuli
brochial tree brocho spasm
antigen

bronchial asthma presented by proxysmal
attacks dyspnea broncho spasm attacks
subsides
bronchial asthma written
treatment
bronchial asthma Oral
COPD emphysema discussion COPD -
Cor pulmonal
bronchial asthma intrinsic

Extrinsic
age onset
History of allergy
allergic rhinitis family history of atopy

extrinsic sesonal serum
Ig E
15

..............................................................
extrinsic family history
sesonal allergy Ig E
Intrinsic
Atopy sesonal varitation
family history

presentation
extrinsic episodic extrinsic
attacks of dyspnea In between attacks
free
intrinsic persistent asthma
) (
excerbation asthmatic bronchitis
term
asthmatic bronchitis
cough
expectoration .........
.......... chronic bronchitis super added
broncho spasm asthmatic bronchitis
COPD broncho spasm
.....
attacks of bronchial asthma attacks
free asthmatic bronchitis
persistent asthma chronic persistent asthma
intrinsic bronchial ashtma

chronic bronchitis
16

..............................................................
attacks of dyspnea , wheezy chest In
between attacks free bronchial asthma
chronic bronchitis broncho
spasm COPD broncho spasm
bronchial asthma
episodic in
between free persistent
asthma common in intrinsic type
clinical pictures
Triggering factors

chest infection
trigger factor
chest infection viral or bacterial
bronchial
asthma inflammatory disease
interleukin
Infection Inflammatory ........... it will aggrevate
the inflammatory process bronchial tree
Infection broncho spasm

chest infection

dry broncho spasm following chest
infection viral infection bacterial
virus RSV
exercise induced asthma
17

..............................................................
cooling of the
bronchial tree dryness of the bronchial tree
brocho spasm
Aspirin sensitive asthma
block prostaglandins
arachidonic acid arachidonic acid
prostaglandins leukeutrins ....
you will block prostaglandins synthesis ............you will
promote leukotrienes synthesis leukotrienes
mucosal congestion broncho spasm

broncho
spasm commonly allergy
allergy
non
broncho
steroidal anti inflammatory
spasm allergic rhinitis with nasal polyps
nasal polyps nasal polyps
Mediators ...........

precipitated asthma occupational asthma

wood
stress
triggering factor
bronchial asthma
bronchial asthma
antigens pollens exercise dust
triggering factor
18

..............................................................
clinical picutres
episodic asthma bouts of cough , dyspnea
and wheezy chest in between attack
non episodic cough asthma

wheezy chest
excerbation
extrinsic extrinsic
episodic
intrinsic non episodic

.........
intrinsic
form of persistent asthma
excerbation
attack wheezy
chest wheezy chest generalized
rhonchi sibilant expiratory
generalized persistent after cough
broncho spasm
complications bronchial asthma acute

sever asthma penumo thorax
alveoli
spontenous pneumo thorax air trapping
19

..............................................................
investigations
X-ray bronchial asthma exclude the
pneumo thorax
attack of bronchial asthma .......
pneumothorax
pneumo thorax chest x-ray
blood gases
brochial asthma
struggling attack hyper ventilation

air way obstruction hyper
ventialtion
hyper ventilation CO2 normal low
washed
hypo capnia during asthmatic attack good
sign normo capnia bad sign hyper capnia

Indication
ventilator
Hyper capnia hyper capnia CO2
wash CO2
hypoxic hyper capnic
ventilator

X-ray blood gases
............. esinophilia
allergy
20

..............................................................
sputum Chuschmann's spirals
Mucous bronchial asthma
inflammatory mucous bronchial
tree evaporation
dehydration secretion mucous
bronchial tree
attack
sputum

small bronchiole mucous
sputum mucous small
bronchiole ......... cast
Churschmann's spirals
allergic esinophilia esinophils
sputum degenerative esinophils Charcot
leyden crystals
Ig A intrinsic Ig
E extrinsic
cough varient asthma bronchial

asthma dyspnea , wheezy chest

paroxysmal
broncho spasm challenge
test
challenge test for example
Metacholine test metacholine
Metacholine acetyl choline
21

..............................................................
inhale cold air
bronchial asthma precipitate broncho spasm

cough varietnt asthma

steps
during the attack during the attack B2
agonist inhaler ..........
system ........ in between attack
hydro cortisone Hydrocortisone
200
aminophylline anti cholinergic
Step 1
stabilized steps In between
attacks attacks
Step 1 Mild B2 agonist on
demand asthmatic attack
Mild dyspnic
.......... B2
agonist rapid relief of asthmatic attack
satisfied .........
....
steroid inhaler attack
Beclomethasone unit 800
200 puff 250
mirc gram micro gram/ day 800

22

..............................................................

B2 agonist
..........

Step 3 beclomethasone Step 2
peak micro gram /day 2000 B2 agonist
systemic Step 4
aminophylline oral Ipratropium
bromide
B2 agonist oral
B2 agonist systemic arrhythmogenic
tremors palpitation

B2 agonist
B blocker for long time
receptor
B blocker
sympathetic

hypertensive .....
tachycardia
thyrotoxic B blocker
B blocker
pulsation tremors tachycardia

B blocker

23

..............................................................
B2 agonist B2 agonist
bronchial
asthma medications arrhythmogenic
aminophylline B2 agonist

systemic stabilized
withdrawal Inhalers

steroid dependant
glomerulonephritis vasculitis lupus
COPD
....... blood
pressure peptic ulcers
osteoporosis vitamin D
......

Pharmacology

bronchial asthma
quick relief medications broncho
dilators aminophylline , B2 agonist , anticholinergics
24

..............................................................
anti inflammatory relief
Long run bronchial asthma
inflammatory anti inflammatory
anti inflammatory ::: steroid
leukotriene inhibitors mast cell stabilizer

B2 agonist
trbutaline , salbutamol Inhaler
inhaler rapidly acting
side effects usually very low
inhaler of B2 agonist side effects
tremors palpitations
Aminophylline
loading dose 5 very
slowly
During attack
hydro cortisone
200

Anticholinergic
anticholinergic during attack
Onset ipratrobium bromide
B2 agonist ipratrobium bromide
inhaler
25

..............................................................

cardiac ......... hypertensive

asthmatic attack stress -180
200 ....... cerebral hemorrhage

In between attacks
Aminophylline
aminophylline long acting aminophylline
anhydrous aminophylline
long acting less GIT irritation 200-100
12
) (Quibron
systemic B2 agonist
salbutamol terbutaline
tremors , palpitations
anti inflammatory
(ketotifen (zaditen mast cell stabilizer
release of mediators
26

..............................................................
leukotriene receptor antagonist montelukast
) ( singulair

leukotriene receptor antagonist
attacks systemic steroid inhaler

systemic steroid inhaler

withdrawal
stable steroid
emergency
Acute sever asthma
sever asthmatic attack and prolonged
relief
acute sever asthma criteria
criteria of sever asthmatic attack
sever asthmatic attack
tachycardia
Exhausted from hypoxia
dehydrated hyper ventilation
cyanosis
cyanosis
pulse pulsus paradoxius
27

..............................................................
pulsus paradoxius Acute
sever asthma sever asthmatic attack
pericardial effusion with tamponade
pulsus paradoxius
Inspiratory decline in systolic blood pressure more than
15 mmHg
systolic
inspiration systolic blood pressure

peaked expiratory flow rate

60
% or 50 expected value
silent chest
air way obstruction
chest silent ....
rhonchi
Hospitalization

oxygen

28

..............................................................
asthmatic
attack

....

mask
first aid

hospitalization high flow
%100 %60
hydrocortisone Inhaler
B2 agonist nebulizer 2.5
5

asthmatic attack attack B2
agonist aminophylline
...... acute sever asthma
B2 agonist nebulizer
.... .... B2 agonist
B2 agonist inhaler nebulizer
B2 agonist
mask

inhaler
Inspiration

pressure
nebulizar
mask escaped

29

..............................................................

asthma
..... B2 agonist ipratrobium
bromide Mix B2 agonist
ipratrobium bromide
mix

reserviour
saline
.
B2agonist ipratrobium bromide

B2 agonist systemic
ventilator
occupational byssinosis

occupational
history
challenge test
differential diagnosis
dyspnea wheezy chest
bronchial asthma
cardiac asthma
30

..............................................................
dyspnea and esinophilc pneumonia
wheezy chest
broncho spasm
Paroxysmal attack of dyspnea
extrinsic cardiac asthma bronchial asthma
extrinsic allergic alveolitis allergic alveolitis
no wheezy chest wheezy chest
Paroxysmal cough

bronchial asthma , whooping cough, showers of
pulmonary emboli
Causes of wheezy chest with hemptysis

Churg-strauss vasculitis vasculitis
cardic asthma cardic asthma
pulmonary pulmonary venous congestion
venous congestion
wheezy chest bronchiectasis
wheezy chest obstructive element brochiectasis
mucosal ulceration
wheezy chest problem
vasculitis hemoptysis
31

..............................................................
Respiratory function tests

tidal volume
under basal condition
residual volume lung after forced
expiration cc 1200
tidal volume 500 residual volume cc 1200
vital capacity lung
forced inspiration 4600cc
(forced expiratory volume 1(FEV1

vital capacity 5
vital capacity
inspiration
vital capacity
expiration
forced expiratory volume one
normally vital capacity % 80
vital capacity vital capacity 5
expiration 4
forced expiratory volume 1

chest obstructive restrictive
obstruction air way obstruction
vital capacity vital
capacity

long time
32

..............................................................
vital capacity

expiration
total vital % 20 expiration
forced expiratory volume 1 capacity
obstruction
forced obstructive chest
Low expiratory volume 1
fibrosis effusion restrictive
total vital capacity
pulmonary function
Ventilation , perfusion and diffusion

hypo ventilation ventilation
obstructive or restrictive
chronic bronchial asthma obstructive
bronchitis
effusion , pneumo restrictive
fibrosis thorax
lung hypo ventilation
chest wall disease restriction obstruction
obesity ankylosing spondylitis
kyphoscoliosis
myasthenia , Guillain Barre neuro
syndrome ,myopathy and respiratory centre depression
hypo ventilation
33

..............................................................
hypo ventilation obstruction
restrictive
forced expiratory volume 1 chronic
bronchitis vital capacity forced
expiratory volume 1
residual volume
restrictive pleural effusion pulmonary
fibrosis vital capacity residual
volume
air way obstruction
diminished forced expiratory volume 1
restrictive hypo ventilation diminished
vital capacity
perfusion
pulmonary angio Lung scan
diffusion
blood gases
diffusion
alveoli capillaries
diffusion defect blood gases diffusion
exchange
oxygen CO2
CO2 diffusion
O2 diffusion defect interstitial lung
disease alveoli capillaries
CO2 CO2 normal O2
34

..............................................................
ventilation defect
inspiration expiration
inspiration hypoxic
expiration hyper capnic
diffusion defect hypoxic defect

respiratory failure
It is adecline in the respiratory performance leading to
hypoxia +or- hypercapnea

respiratory failure

PO2<60
or PCO2 > 45 or 50+
laboratory
shunt
Fallot hypoxia
... lung
35

..............................................................
oxygen tension
definition
hypoxic normo capnea hypo capnea

Hypoxic diffusion defect
hypoxic
hypoxia hyper ventilation
hyper ventilation CO2
hypoxic normo capnic Hypoxic hypo capnic

diffusion
intersititial lung disease pneumonia
pulmonary edema alveoli exchange of
gases
pure emphysema diffusion defect
healthy available alveoli for gas exchang
capillaries
respiratory failure

Hypoxic hyper capnea ventilation defect
obstructive and restrictive
obstructive restrictive

36

..............................................................

forced expiratory volume 1
air way obstruction
clinical pictures
chest COPD
respiratory failure Hypoxic hyper capnea

respiratory failure
case of COPD chronic bronchitis ,
emphysema no manifestations of cor-pulmonal , no
manifestations of respiratory failure
respiratory failure
respiratory failure
respiratory failure by definition
laboratory diagnosis arterial blood
sample
clinical failure
clinically we can suspect respiratory failure clinically
confirm arterial blood gases

ventilator
ventilators
ventilator Indicated
ventilator ventilator
weaning
....
37

..............................................................

ventilator
criteria respiratory failure
PO2 PCO2
we can suspect hypoxia acute
chronic
hypoxia tachycardia tachypnea
cyanosis
hypoxia chronic clubbing
polycythemia
CO2 narcosis
flapping termors CO2
retention rather than hypoxia
flapping termors hypoxia
CO2 retention papilledema
some-times by fundus examination
papilledema
CO2 retention headache
Big pulse volume
cyanosed clubbing
hypoxia flapping termors hyper capnea
Hypoxic hyper cpanea
38

..............................................................
arterial blood gases laboratory diagnosis
respiratory failure

blood gases
type one respiratory failure hypoxia
oxygen with high concentration
........
ventilator
type two in respiratory failure hypoxic

hypercapnea
hyper capnea
CO2 driving force
pure normal CO2
CO2 respiratory failure type two chronic
respitatory centre sensitivity to CO2
driving force hypoxia
hypoxic drive
chronic hyper capnea type two respiratory failure
respiratory centre not sensitive to CO2
respiration hypoxia
hypoxia
hypoxic drive
39

..............................................................
oxygen type two respiratory failure
oxygen with low concentration
....... hypoxia
..... hypoxia
under correction of hypoxia

hypoxia oxygen
hypoxia
respiration CO2
Causes of exacerbation
exacerbation COPD
chest infection
pulmonary embolism
pneumo thorax

hyper ventilation syndrome

MCQ
hypoxia high altitude
pulmonary venous congestion , hypo tension ,anaxity
wash of CO2 tetany
with un-explained hyper ventilation
hyper ventilation
lung provided that
40

..............................................................
examination
dyspnea
decision in medicine

hospitalization

chest
shower of pulmonary emboli
neurosis
Under
investigations
........... !!!!!

aminophylline
paroxysmal
shower of pulmonary emboli
lung scan lung infraction showers

pleurisy
Inflammation in pleura : viral very common
viral
41

..............................................................
tuberculs malignancy systemic disease
pleurisy
lupus
FMF
problem rheumatoid
pain in axilla pain in axilla .............
Pain stitching in character
pleurisy
cases

Lung pneumonia abscess

mediastinum

Pleura , systemic disease mediastinum
diaphragm ambeic liver
disease in lung parenchyema pneumonia Lung
abcess malignancy irritate
pleura medistinum
lung lung sub diaphragmatic
pleurisy disease signify underlying

disease chest pain dyspnea dyspnea
false dyspnea

pulmonary infraction missed
Missed pleurisy viral
non specific
42

..............................................................
pulmonary infraction
massive pulmonary embolism
search for the cause
pulmonary infraction

lung scan .......

Effusion
exudates transudates
trasnudates part of generalized edema
heart failure , nephritic syndrome , liver cirrhosis
.etc
exudate Inflammatory and malignancy
chylous haemorrhagic
haemorrhagic and bloody
haemorrhagic exudates RBCs .T.B
malignancy
bloody blood haemo thorax

heart big blood vessel
blood vessel

43

..............................................................
chest x-ray Massive effusion
pleura
examination dyspnea
multiple negative signs
No movement , no Tvf , no resonance , diminished breath
sounds

effusion effusion rising to
axilla
effusion
border axilla

Percussion
above downward mid calvicular line
resonant , resonant , resonant dullness
anterior axillary line Percussion resonant ,
resonant , dullness
Mid axillary line percussion resonant ,
resonant, dullness
rising to axilla
sign rising to axilla radiological sign

Percussion

effusion dullness in traub's area..........

44

..............................................................
Skodiak resonance just
compensatory emphysema compensatory
hyper inflation
Investigation
X-ray pleural biopsy transudate ,
exudates
exudate LDH
specific gravity 1018 PH low
effusion fluid
malignant effusion
.T.B rheumatoid
effusion
C3& C4 C3& C4
lupus Pleural effusion

malignant cells

LDH

Amylase pancreatitis pleural effusion
.Z.N. or PCR for T.B
PH 7.2 highly suggested for empyema
C3&C4
Amylase
effusion
aspiration
45

..............................................................
Empyema
pus in pleura
pneumonia, lung abscess Pus in pleura
empyema , broncheciasis
infra diaphragmatic mediastinum
Pleural effusion
Pleural clinical pictures empyema

toxic symptoms dyspnea effusion

fever, rigor toxic symptoms
pleural effusion
Manifestation
dullness TVF movement
diminished intensity of breath
pleural effusion sounds
Multiple negative signs
pleural effusion multiple negative signs
empyema toxemia multiple negative signs
complications 2 empyema

Broncho pleural fistula
Empyema necessitans
swelling in the inter costal space subcutaneous
expansile impulse on cough
46

..............................................................
test blue
broncho pleural fistula
pleura blue sputum
empyema anti biotic inter costal tube

for free drainage
inter costal tube open drainage
open drainage rib resection
chest wall pleura .........
pus
cardio thoracic surgery
empyema anti biotic
Intercostal tube
open drainage
Decortication
pneumo thorax

spontaneous pneumothorax trauma
pneumo thorax rupture bleb

rupture emphysematous bullae
sever asthmatic attack pneumo thorax
trauma
47

..............................................................
traumatic pneumothorax problem trauma

Artificial pneumothorax
collapse therapy collapse therapy
aritificial pneumothorax
pleura air lung collapsed
healing T.B. cavity
pneumo thorax
closes , open and tension pneumothorax
closed lung bleb
bleb subpleural
bleb alveoli bleb
subpleural Primary
primary pneumothorax secondary
secondary pneumothorax secondary to lung disease

rupture belb primary pneumothorax
young normal chest
suddenly pneumothorax
bleb exertion
) (
closed pneumothorax isolated in pleura

absorption
open pneumothorax
48

..............................................................
chest wall lung parenchyema
bronchial tree stab wound track
pleura bronchus

trachea bronchial tree
Lumen of bronchial tree fistula
pleura
fistula .....
pleura pleura
air traping benign condition
tension pneumothorax

pneumothorax
pleura lung
Lung .....
Mediastinum ........ pleura
air under pressure heart
big vessels tamponade
tension pneumthorax collapsed
Clinical pictures of pneumothorax

problem
pneumothorax sudden chest
pain sudden chest pain
anginal pain
Pneumothorax
49

..............................................................
rupture emphysematous bullae rupture bleb

acute dyspnea chest
pain very anxious
17
chest pain dyspnea
rupture bleb
common
chest x-ray pneumothorax
pneumothorax
movement TFV hyper resonant intensity of
breath sounds
chest X-ray
pneumothorax chest X-ray
differential diagnosis of chest pain and shock
massive pulmonary embolism
extensive myocardial infraction heart failure
tension pneumothorax chest pain and
shock
pneumothorax
intercostal tube under water seal
under water seal under water seal

decompression pneumothorax
gradual under water seal
50

..............................................................
Under pressure resistane
sudden decompression
pneumothorax under water seal
rapid decompression lung ........unilateral
pulmonary edema

pulmonary edema
pneumothorax pleural effusion
sudden lung decompression decompression
pneumothorax
recurrent pneumothorax
pleural space
pleurodesis
tetracycline
provided one side
pleurodesis
Lung expansion
bleb
intercostal tube
pneumothorax
died ) (
intercostal tube 72
pneumothorax relief tube
tension pneumothorax trauma
sever chest pain shock
51

..............................................................
first aid
wide board needle Mid clavicular line
closed pneumo thorax open pneumothorax

needle second
mid clavicular line
inter costal space
Mid clavicular line Heart

medial pulmonary trunk
Mid clavicular line plura

Intercostal tube under
water seal 72 care
tube anti biotic
Infection , total leucocytic count
, ESR , C-Reactive protein
Infection

anti pyretic
rupture esophagus rupture in

trachea ........
..... ..... pneumomediastinum
crunching sound synchronous
heart beat
Hamman's.....
sign
hydropneumothorax hydrothorax
52

..............................................................
pleural effusion
hydropneumothorax effusion
pleural effusion
needle ....
lung cavity very
superficial
cavity drained bronchus
cavity secretion air
X-ray cavity with fluid level
gas producing organism cavity
draining bronchus
cavity bag of pus air cavity
pyogenic infection tuberculosis erode in lung
parenchyema pleura pleura
hydropneumothorax
pyopneumothorax
manifestation of pleural effusion
shifting dullness , succussion splash
pleural effusion shifting dullness in chest
succussion splash
intercostals tube

pneumonia
written problem Pneumonia
pneumonia Inflammation in lung parenchyma
alveoli
53

..............................................................
alveoli inflammatory exudates
alveoli out of function alveoli consolidated
parenchyma consolidation conduct and
magnify under lined bronchus
lobe of lung pneumonia bronchus
bronchus conducted
under lined bronchus
bronchial breathing 44
vibration conducted
ceripitation ) ( magnified
signs pneumonia
dull TFV bronchial breathing
consenating ceripitation
pneumonia
predisposing factors
pneumonia
pneumonia
Pneumonia
pneumonia para influenza
pneumonia

aspiration COPD IV abusers
staph pneumonia
Pneumonia staph
addicted staph
lung
Pneumonia
pneumonia category
54

..............................................................
commmunity pneumonia
acquired pneumonia
community acquired pneumonia
Nosocomial pneumonia pneumonia

immunecompromised patient pneumonia
pneumonia in immuncompromsied patient

pathology
lobar pneumonia and broncho
lung lobar pneumonia pneumonia
parenchyma inflamed and consolidated
lobe part inflammation limited to one lobe
acute bronchitis broncho-pneumonia

spread infection brocholitis
.... lung parenchyma bronchial tree
patchy bilateral
broncho lobar pneumonia

pneumonia pneumonia
lobar pneumonia
broncho pneumonia
Immune system broncho pneumonia

lobar pneumonia
pneumonia lobar pneumonia chest

lobar and brocho
55

..............................................................
lobar and brocho pathological classification
clinical
pneumonia
pneumonia acute bronchitis
sputum
fever acute bronchitis usual or
unusual unusual
pneumonia fever
parenchymal inflammation
chest infection
....... sputum

anti biotic
pneumonia toxemia ........

...... ....... cough chest pain
..... pleurisy dyspnea
fever chest pain chest
pain pleurisy Pneumonia
pneumonia
chest pain
Atypical pneumonia
calssic pneumonia
fever toxemia chest pain
on examination
56

..............................................................
pneumonia
Pneumonia lobar pneumonia broncho
pneumonia movement side
TFV dull bronchial breathing
underlying bronchus
hollow breathing
hollow breathin bronchial breathing
vocal resonance
vocal resonance
normal abnormal

bronchophony
whispering whispering
pneumonia .......crepitation
coasre consonating crepitation
crepitation coarse inspiration
pneumonia
fever chest pain pleurisy dyspnea
dull TFV
bronchophony whispering brochial
breathing coarse consonating crepitation
investigation
lobar One lobe patchy broncho
pneumonia
toxemia
pneumonia CBC leucocytosis ESR
C-Reactive protein pneumonia
pneumonia infection culture sensitivity
sputum serology
57

..............................................................
pneumo coccal antibody Leginonella anti
body organism serology

sputum culture and sensitivity
unresolving pneumonia
.......
unresolving pneumonia
dose
anti biotic
Atypical pneumonia
atypical pneumonia antibiotic
Legionella Mycoplasma
specific organism .T.B
MRSA MRSA infection
vancomycin
.T.B Anti tuberculos
atypical Legionella Mycoplasma
erythromycin Clarithromycin
pneumonia
Immunocompromised
pencillin

.T.B MRSA atypical
58

..............................................................
pneumonia injection
pneumonia injection
injection fever subside oral

cephalosporin macrolides
pneumonia
combination

MRSA
.T.B .T.B fever pleural effusion
pneumonia
anti pyretic , analgesic pleurisy

staph pneumonia cavitation
it is necrotizing pneumonia
tissue necrosis hemoptysis
pneumonia hemoptysis staph
staph vancomycin
Klebsiella
apical
apical chest lesion .T.B
Klebsiella pneumonia pancost tumor
klebsiella gram negative third
generation cephalosporin
59

..............................................................
atypical pneumonia
atypical viral , mycoplasma ,legionella and
Chlamydia pneumoniae
atypical symptoms
dyspnea

chest pain pleuritic chest pain typical
vague extra pulmonary
manifestations toxic myalagia
myalagia

signs
viral
consolidation ..... alveolar wall
exudates alveoli signs of
consolidation
investigations
Chest x-ray serology
Pneumonia chest x-ray
Leucocytosis sputum
culture ........ serology mycoplasma
antibody
legionella anti body legionella
mycoplasma
........
viral anti viral
mycoplasma legionella macrolides
infusion ....erythromycin Clarithromycin
60

..............................................................
qinolone qinolone

ciprofloxacin
ciprofloxacin atypical pneumonia
mycoplasma and legionella
Pneumonia
Actinomycosis MCQ
gram positive branching bacteria fungus
actinomycosis immunocomromised person

actinomycosis suppurative
granuloma
granuloma
granuloma granuloma pus cells
actinomycosis
pneumonia in immunocompromised patients

........... immunocompromised
patients .... leukemia Lymphoma
HIV immune supperessive .... cytotoxic
diabetes diabetes Immunocompromised
patients
diabetes susceptible

neutrophils
61

..............................................................
neutrophils agranulocytosis
acute leukemia
lymphocyte lymphoma chronic
lymphocytic leukemia
HIV leukemia
Organism fungal .T.B
.T.B Mycobacterium avium
pneumocystis carinii
)
( sulpha
immunocompormised CMV
) (
itis encephalitis , pericarditis ,
meningitis , mylitis, hepatitis retina
retinitis

Pneumocystis Carinii
Pneumonia Pneumonia
.
Immunocompromised persons
pneumocystis Carinii fungus
Protozoa
fungus protozoa
fungus .... fungus
62

..............................................................
pneumocystis Carinii infection
Immunocompromised chest infection
HIV
pneumocystis Carinii chest infection cough
expectoration dyspnea ..
adult respiratory distress syndrome
prophylactic measurements
Immunocompromised patients transplant
blood Co-trimoxazole

pneumocystis Carinii
Prophylaxis aginst pneumoncystis Carinii

transplantation
immunesppresed
Nosocomial pneumonia

nosocomial pneumonia
reduced host defences post operative
chest infection reduced conscious of level

Maneuver .....
endotracheal tube oxygen mask
nosocomial infection

intensive care

63

..............................................................
nosocomial infection
48

infection
mask oxygen ventilatory

ventilator compressive
ventilator
ventilator
ventilator .... ventilator

intensive care
.... .... Intensive care
ventilator
ventilator Organism Organism
ventilator ventilator
organism
ventilator organism

ventilator masks
ventilator central line in jugular
vein
....
........ 48
central line
bed sores
ventilator pseudomonas
very powerful antibiotic infusion
feverish infection
64

..............................................................
nosocomial infection Infection control
causes of
...... recurrent pneumonia
pneumonia
bronchial obstruction broncho genic carcinoma
COPD Emyphysema
recurrent loss of conscious
recurrent syncope .......
aspiration
addicted
Lung abscess
suppurative infection in lung
lung abscess Primary secondary
Primary lung normal
normal person lung abscess
aspiration lung abscess Loss of consciousness
recurrent syncope what ever
general anesthesia
gastro esophageal reflux
alcohol abuse conscious Impaired
aspirate
65

..............................................................
secondary to lung disease secondary
malignant cavity abscess pneumonia
amobic liver abscess
amobic lung abscess right lung parenchyma
stages of lung abscess
necrosis Pleurisy stage of pneumonia
cavitation
acute abscess
chronic abscess
super added pulmonary fibrosis
Interstitium parenchyma fibrosis
acute Pneumonic stage clinical
chronic abscess stage abscess stage
fever , Pneumonia Pneumonic stage
local signs ) dyspnea , cough , pleurisy
bronchial dullness TFV ( of pneumonia
coarse whispering bronchophony breathing
consonating crepitation
pus cavitation
rigor
very huge amount of sputum
anaerobes bad odor bad odor
signs of pneumonia
signs of pneumonia acute lung abscess
Lung abscess history
sputum
acute stage relation to posture

chronic
66

..............................................................
chronic retention syndrome
cavity
cavity ........ draining
bronchus mucous Mucous
cavity
cavity
cavity
lobe Lung
medical treatment
hope pneumonic and acute stage chronic
hope
acute stage
chronic retention
syndrome cough expectoration Large amount
related to posture
signs cavity
chronicity retracted chest wall
..... pulmonary fibrosis clubbing
Investigations
X-ray CT scan culture aeroboes and
anaerobes
... to exclude malignancy
foreign body abscess
acute lung abscess
... malignancy
foreign body

67

..............................................................
Investigations CBC leucocytosis
neutrophilia C-Reactive protein Positive
Lung abscess
lung abscess Onset acute
retention syndrome
retention syndrome
suddenly
sputum
symptoms
abscess cavity
retention syndrome
abscess bronchiectasis
healthy side
bronchiectasis
Onset bronchiectasis gradual onset
abscess acute onset retention syndrome
lung abscess

clindamycin Dalacin-C
clindamycin
clindamycin
(
(
Lung abscess Infusion

clindaymcin
68

..............................................................
MRSA vancomycin
vancomycin resistant VRSA
VRSA ....vancomycin resistant staph aureus
targosid
response lobectomy
segmentectomy
bronchiectasis
Lung abscess bronchiectasis

. Patinent with chronic lung abscess.or borchiectasis
.... lung abscess cough
huge amount of sputum bad odor related to posture

abscess
bronchiectasis
cavitary lung syndrome
edema in lower limb...
differential diagnosis in this edema
hypo proteniemia
brochiectasis cor-pulmonal
nephrotic syndrome
key proteinuria
amyloidosis
69

..............................................................

Pneumonia
stitching chest pain dyspnea fever
pneumonia ......
difficulty on examination headache
in flexion of the neck of the patient
diagnosis pain associated
meningitis pneumonia
Meningitis diagnostic
meningitis
neuro CSF examination
Bronchiectasis
abnormal persistent dilatation of bronchiole and
bronchi
pus
pathogenesis
obstruction partial
partial bronchial obstruction
emphysema bronchi bronchiectasis
alveoli
Lung collapse complete bronchial obstruction
first part
bronchile obstruction Discuss
70

..............................................................
emphysema COPD bronchiectasis
medicine
obstruction
obstructive COPD
COPD bronchiectasis
infection infection wall
bronchial tree
obstruction stasis Infection
Infection secretion obstruction
infection wall bronchial tree
obstruction intra bronchial pressure
obstruction stasis infection Infection
secretion obstruction
obstruction infection Infection obstruction
obstruction intra bronchial pressure dilate of
the bronchial tree
Infection wall of bronchial tree dilated
bronchi and bronchiole pus

causes of bronchiectasis
Congenital and acquird

congenital Immotile cilia secretion
71

..............................................................
Kartagner's syndrome
( dextro cardia(situs inversus totalis sinusitis absent
frontal air sinus infertility
congential immune deficiency
acquired
obstruction
Partial obstruction COPD
Infection .T.B
pneumonia abscess
pneumonia Infection drained
into bronchial tree bronchus infection
infection
bronchiectasis
.T.B broncho stenosis
bronchiectasis COPD
Kartagner
Problem Kartagner's syndrome
young adult ............ bronchiectasis
....
sputum sputum bad odour
bronchiectasis apex directed to the right
married with no children
infertile
)
( immotile sperm
pathology sites of bronchiectasis
bronchial tree with
bilateral and basal
bad drainage
72

..............................................................
apical bronchiectasis
bronchiectasis apical drainage
retention
bronchiectasis bilateral and basal
base of the lung ......
apical drained sputum

bronchiectasis Hemoptysis
apical bronchiectasis dry sicca
secretion hemorrhagica hemoptysis
bronchiectasis
hemoptysis dry sicca hemorrhagica
bronchiectasis hemoptysis
mucosal ulcers inflammation
bronchiectasis right middle lobe

bronchi bronchiole
obstructed secretion lymph node
lymphoid tissue highly
reactive upper respiratory tract infection
cervical lymph node
lymphoid tissue reactive
chest infection
lymph node lung
Lung Lymph node ..... lymph node

bronchus right middle bronchus
73

..............................................................
anatomically lymph right middle bronchus
nodes
recurrent chest infection whooping cough
right middle bronchus lymph node

partial Obstruction in right middle bronchus
obstruction
dilated suppurative bronchi infection
right middle lobe syndrome
bronchiectasis
On apical apical bilateral and basal
Friedlander T.B top of apical infection
Klebsiella pneumonia pneumonia
clinical pictures
sputum toxemia , cough , expectoration
hemoptysis , mucosal ulcers
air way bronchiectasis dyspnea
pulmonary fibrosis obstruction
obstructive suppurative bronchiectasis
cough, suppurative symptoms
related to posture bad odor sputum
wheezy obstruction symptoms
bronchial episodal chest
asthma
asthmatic bronchiectasis
suppurative obstructive
episodal broncho spasm

74

..............................................................
chest pain pleurisy
signs
air way base dilated and
suppurative multiple cavitation basal infra
scapular
lung signs of obstruction
bronchiole infra mammary Infra scapular
... ..
mid lung zone mammary area
air way manifestation of obstruction
obstruction cavitation
base
obstruction mid lung
zone
compensatory
emphysema

Inspection bilateral diminished
movement TFV infra mammary and
infra scapular
TFV
palpation palpable ronchi
palpable ronchi
ronchi palpable crepitation palpable

percussion Infra scapular dullness
hyper resonance compensatory hyper inflation
75

..............................................................
compensatory hyper inflation
compensatory emphysema
Auscultation
coarse consonating crepitations
bilateral basal
sign bilateral
manifestation of coarse consonating crepitations
bronchiectasis
pulmonary bilateral basal fine crepitation
hyper volumia venous congestion

bilateral basal coarse consonating crepitations
bronchiectasis
pulmonary venous bilateral basal fine crepitations
hyper volumia congestion
nephritic hyper volumia
hyper oliguric syndrome
fine basal crepitation volumic

hyper volumic pulmonary venous congestion
dyspnea , orthopnea
fine basal crepitations liable
hyper volumia pulmonary venous congestion
pulmonary edema
bubbling crepitation pulmonary edema
crepitation
heart failure pulmonary venous congestion

crepitations bubbling frank
76

..............................................................
bronchial breathing signs of cavitations
Obstruction harsh vesicular
CT scan bronchiectasis early

postural drainage
bronchiectasis lung abscess
expectorant bronchodilator
bronchial drainage
bronchial tree
bronchial drainage ........broncho chronic bronchitis
dilator ,expectorant and mucolytic
bronchiectasis lung abscess
lung abscess Broncho dilator ,expectorant
posture drainage bronchiectasis
drained cavity
anti biotic aerobes anaerobes
Lung abscess bronchiectasis
Lobectomy localized Localized
lung and heart transplantation
organisms 2
cavitation anaerobes
staph anaerobes abscess
pseudomons staph anaerobes

77

..............................................................
abscess infection pneumonia
bronchiectasis
single organism pneumonia
pneumonia organism
mixed empyema abscess bronchiectasis
anaerobes aerobes infection
lung abscess Organism
bornchiectasis
staph anaerobes aerobes
pseudomonas VRSA MRSA
complication complication
k4revision.1aim.net
written Problem cystic lung
pathogensis
systemic autosomal dominant
exocrine glands affect exocrine gland
goblet cells lung lung include
mucous
secretion target organ lung
secretion retention viscid
dilated bronchi and Infection stasis
suppurative infection bronchiole
bronchiectasis cystic lung
presentation
air way obstruction chest infection clinical pictures
wheezy chest , cough ,dyspnea
expectoration
78

..............................................................
extra pulmonary problem
sloving
MCQ
extra pulmonary manifestation liver
stasis in bile biliary obstruction biliary
cirrhosis
cystic pancreas cystic
exocrine gland pancreatic function
digestive
malabsorption so late
endocrine exocrine Infertility
vas deferens secretion
female cervical secretion cervix so
viscid sperm uterus
meconium ileus
suppurative lung disease
most likely differential

lung abscess bronchiectasis cystic lung

cystic lung extra pulmonary manifestations
cystic lung complicated Cor-

pulmonal respiratory failure
bronchiectasis
investigation
X-ray cavitation soap bubble
CT scan
79

..............................................................
exocrine function disturbance sweat
Na Sweat reflect exocrine
function disturbed
management salt depletion
fluids salts
nutritional supplementation
pancreatic secretion digestive
enzymes
late diabetic
specific Dornase
late stages
Dornase secretion
mucolytic mucolytic
secretion
anti biotic
early stages amiloride diuretic
secretion more or less fluid
secretion viscid effect amiloride
.....particulary K retention diuretics
lung transplantation
heart and lung
complications
lung abscess pneumonia brochiectasis

empyema systemic complication
Meningitis meningtitis
amyloidosis
amyloidosis lung abscess
bronchiectasis
80

..............................................................
meningitis Pneumonia
local complication
infection pleura pleurisy
empyema
Pneumonia
lung abscess pneumonia
Pneumonia lung abscess
Infection in parenchyma Pneumonia
Lung abscess fibrosis late
bronchi bronchiectasis
complications of pneumonia
systemic complications
amyloidosis
Local complication pneumonia
Lung
pneumonia
Pneumonia pleura Pleurisy
pleural effusion ....... empyema fibrosis
pneumonia bronchiectasis
parenchyma Lung infected main bronchus
infected
complications of lung abscess
systemic Local
abscess bronchiectasis
abscess drained bronchus bronchus
Local area of bronchiectasis
81

..............................................................
bronchiectasis
hypoxia Cor-pulmonale
lung collapse
written Lung collapse
problem post operative lung collapse

secretion bronchus collapse
collapse
collaspe obstruction
pleural effusion collapse
compression collapse
pneumothorax compression collapse
pleural effusion pleural effusion
compression lung collapse
pneumothorax pneumothorax
compression lung collapse
collapse Lung collapse
obstrcutive lung collapse
massive pleural effusion

pneumo thorax lung collapse
lung collapse obstructive lung collapse
obstruction of bronchial tree
secretion
secretion
82

..............................................................
chest infection
secretion preparation
secretion
Operation dyspnea
.....postoperative dyspnea
examine Lung collapse
collapse ...... lung retraction
movement
movement TFV resonant Intensity of
breath sounds
exception TFV collapse

underlying bronchus patent
lung collapse chest X-ray

.... diagnostic and therapeutic collapse

bronchoscope bronchus
foreign body inlation ....
at the
secretion collapse
same time
lung collapse bronchoscope
bronchial tree respiratory
execise Lung lung expantion
chest infection
urgent antibiotic
83

..............................................................
bronchodilator .....

fracture neck femur

operation dyspnea chest pain
aspiration pulmonary
embolism dyspnea pleurisy hemoptysis
dyspnea chest pain hemoptysis
aspiration lung
abscess
aspiration data right
and basal
right lung lung zone
aspiration
Pumonary infraction DVT

duplex scan lung lung scan
lung scan pulmonary embolism
pulmonary fibrosis
parenchymatous pulmonary fibrosis
interstitium
parenchymal lung fibrosis chronic
inflammation Lung chronic inflammation
in lung parenchyma lung abscess,
bronchiectasis ,empyema
.T.B
84

..............................................................
.T.B post tuberculos pulmonary fibrosis
pulmonary fibrosis parenchymatous past
.history of T.B Lung abscess
.T.B
....
.... fibrous tissue
movement retraction TFV
resonance Intensity of breath sounds
multiple negative signs collapse

fibrosis collapse retraction

collapse homogenous negative signs
lobe lung dull , dull ,dull

fibrosis heterogenous mid
clavicular line resonant midaxillary line
dull
x-ray
fibrosis exceptions fibrosis
trachea TFV
TFV ... TFV
cavitation , consolidation ..... bronchophony
whispering
TFV
bronchophony
whispering
85

..............................................................
just deviation of the trachea
cavitation consolidation magnified
bronchial breathing bronchophony whispering
TFV
X-ray pulmonary fibrosis
trachea
obacity ...heterogenous
diaphragm ) (
tenting in diaphragm
.T.B complications
lung pulmonary fibrosis
end stage .... symptomatic
bronchodilator
... antitussive
late end stage extensive
bilateral transplantation
Parenchymatous Interstitium
lung disease
Bronchogenic carcinoma
written problem long case
COPD COPD complaining
hemoptysis bronchogenic
bronchogenic carcinoma COPD
COPD
etiology old male heavy smoker
male carcinogenic 3,4
Benzpyrine
86

..............................................................

air pollution cadium and
radon
occupation asbestos , nickel and arsenic

Cigarette pack years

cor-pulmonale
cor-pulmonale COPD
barrel shaped chest
coronary
cancer
urinary bladder
histology of bronchogenic carcinoma
squamous cell carcinoma
carinomas
small cell carcinoma
small cell carcinoma aggressive
squamous Mass obstruction

small cell carcinoma para malignant
87

..............................................................
para malignant syndrome
bronchogenic carcinoma small cell carcinoma
adenocarcimona females
asbestos
Lymphatic spread
bronchogenic carcinoma cor-pulmonale
COPD... .....
lymphangitis carcinomatosa
Lung spread
lymph node cervical
Lung retrograde lymphatic spread
lung
spread retrograde lung lymphatics
lymphatics Infiltrated malignancy
diffusion defect
lymphatic capillaries
alveolar wall diffusion defect
sever hypoxia pulmonary hyper tension cor-
pulmonale
Lymphangitis carcinomatosa
clinical pictures
Old male, heavy smoker Pattern of
cough

old male , heavy smoker
hemoptysis
chest infection
bronchogenic
88

..............................................................
bronchopulmonary manifestations
chest cough, hemoptysis
Bronchial obstruction bronchial obstruction
complete Lung collapse
partial bronchial obstruction
alveoli emphysema.... ..... bronchiole
brochiectasis
pneumonia
immune system local
defence lung obstruction in bronchus
stagnation ..... stasis Pneumonia
pneumonia recurrent
..... stagnation
lung abscess
pneumonia abscess
Malignant tissue cavitation
malignancy areas of hemorrhage
areas of necrosis blood supply
necrosis cavity cavity
infected
Pneumonia
Lung abscess pneumonia
underlying malignancy
Pneumonia
65
Pneumonia
89

..............................................................
CT
pneumonia
thoracic inlet
...... spuerior vena
cava obstruction ptosis .........
horner syndrome sympathetic chain
left upper limb
ptosis
male

bronchogenic carcinoma
bronchogenic
paramalignant
paramalignant syndrome endocrine neuro
.......... ...
pleura
peripheral pleural involvement
pleural effusion
effusion problem
COPD 65
rapidly progressive dyspnea

chest X-ray massive pleural effusion
massive pleural effusion character
malignant effusion massive hemorrhagic rapidly
accumulating
bronchogenic pneumonia
90

..............................................................
massive effusion
COPD
acute insult

clinical picture
chest
medistinum syndrome
dysphagia
Medistinum
Para malignant syndrome

clubbing
neurological myopathy neuropathy
Eaton lambet syndrome Myasthenia gravis
secondary para malignant
endocrinal ACTH like PTH like
Hypercalcaemia
ACTH cushing syndrome

Acanthosis nigricans insulin
resistance insulin resistane
insulin resistant associated
acanthosis nigricans
thrombophlebitis migrans
malignancy Liable DVT
91

..............................................................
thrombophlebitis migrans
recurrent DVT recurrent DVT Para
malignant cancer
pancreas
) (

hypercalcemia common in squamous cell carcinoma
syndrome of inappropriate ADH secretion
clubbing most often with non small cell carcinoma

investigations

X-ray chest
CT scan
bronchoscopy
chest x- ray back ground
COPD ... massive effusion
Pneumonia Abscess sign nodule
spiky CT
nodule in lung mass Lung
coin .... Lung focal
lesion
focal lesion in lung in chest x-ray indication for
CT CT with contrast spiral CT
malignant
92

..............................................................
biopsy
small cells squamous
Investigation
Scalene lymph node between two heads
of sternomastoid Involved
bronchogenic biopsy
medistinum supra sterna
notch tumor spread
CT medistinum
differential diagnosis lung abscess,
pneumonia Lung abscess
suppurative infective malignant effusion
malignant effusion

bronchogenic carcinoma Presentation
operable
by luck chest x-ray
.... bronchogenic carcinoma
localized carina bifurcation
of the trachea pneumonectomy irradiation

common bronchogenic carcinoma
hepatoma aggressive ........
Hepatoma
aggressive COPD
coronary
93

..............................................................
bronchogenic carcinoma Para malignant

Radiation therapy for cure
irradiation
results squamous
symptomatic radiation treatment )
( bronchus
collapse superior vena cava
radio therapy

dysphagia
esophagus bronchus
superior vena cava ....
variant
chemotherapy
small cell carcinoma chemosensitive
small cell carcinoma chemosenitive
chemotherapy
laser

bronchus
clinical pictures investigations
...
94

..............................................................
diagnosis clinical
pictures investigation )
(
Endobronchial irradiation
irradiation bronchi
radio therapy implantation
... .... tumor
tracheobronchial stent
bronchus .... stent
bronchus ... ...

bronchial adenoma
female recurrent hemoptysis
male female
female
clinical pictures
cough , recurrent hemoptysis bronchial
obstruction
bronchial adenoma
carcinoid
hemoptysis hemoptysis
flushing wheezy chest
diarrhea
carcinoids
systemic diseases broncho spasm
vasculitis
95

..............................................................
carcinoid syndrome carcinoid syndrome
carcinoid tumor
carcinoid syndrome adenoma
carcinoid tumor appendix Intestine

serotonine carcinoid syndrome
carcinoid syndrome systemic
para malignant serotonine
systemic circulation carcinoid syndrome
systemic disease
bronchial adenoma systemic disease
serotonine circulation carcinoid
syndrome systemic disease
diarrhea
recurrent
hemoptysis
Investigation
x-ray coin shadow
bronchoscope hydoxy indole acetic acid in urine
((HIAA
specific
mesothelioma
mesothelioma pleura
Localized form diffuse form
96

..............................................................
chest pain pleurisy Pleural
effusion effusion hemorrhagic clubbing
fingers
mesothelioma chest pain
dyspnea ) ( pleural effusion clubbing

chest x-ray , pleural biopsy
benign Localized form diffuse form
form Localized fibrous
Prognosis
Mesothelioma diffuse malignant fatal

mesothelioma history of
asbestos
young persons
interstitial lung disease

MCQ ... written
chapter sarcoidosis

disease in interstitium of the lung tissue
capillaries alveoli
inflammatory process

Acute stage cellular component
chronic stage fibrosis
97

..............................................................
end stage ...
respiratory failure cor-pulmonale
pathogenesis
Insult lung
abstestos silica
Inflammatory reaction
Immune mediated reaction
interstitium tissue inflammatory cells, poly
morph
macrophages

growth factors
growth factors collagen fibroblast

Interstitium pulmonary fibrosis
Interstitium diffusion defect
respiratory failure cor-
pulmonale
early diagnosis
early diagnois early diagnosis
CT
high resolution CT scan
option
Interstitium

interstitum

98

..............................................................

Medical physics

physics )
(
CT & MRI

CT scan
... ... ...
... ...

CT

Interstitial lung disease
dust occupational
dust organic Hyper sensitivity
pneumonitis
Inorganic pneumoconiosis
sarcoidosis
collagen diseases Lupus , scleroderma ,
rheumatoid
idiopathic
features
dyspnea

99

..............................................................
)
(
chronic cough

chest infection

broncho spasm cough variant asthma
anti tussive expectorant
anti tussive broncho dilator
test

bronchiectasis
brochiectasis brochiectasis
sputum
...
CT scan chronic bronchitis

Interstitium lung disease
tuberculosis
ACE inhibitor
chest X-ray CT
scan chest brochiectasis interstitium lung
disease
100

..............................................................
psychogenic
extra pulmonary causes
peptic ulcer

meninges
small brain tumor
extra pulmonary causes of cough
symptomatology
clinical pictures
cough , cyanosis
cyanosis Late
crepitations
fine with leathery character
clubbing Late
early
interstitium lung disease

bronchial asthma
.... ..... bronchodilator
end stage Lung
transplantation Lung
investigation
x-ray
CT scan
101

..............................................................
Lung biopsy
bronchoalveolar lavage Lymphocyte
pulmonary function test
diffusion defect blood gases
late hypoxia diffusion
late
honey comb appearance late
cor-pulmonale late
early very irritant
CT scan
bronchodilator

systemic steroid
) (
full dose gradual withdrawal.....
..... Low dose maintainace
azathioprine cyclophosphamide

separate types of interstitial pulmonary disease

Asbestos Interstitium lung disease
pleural effusion non malignant
bronchogeic carcinoma
102

..............................................................
mesothelioma
Silicosis interstitium lung disease

Interstitium
T.B. may modify the silicotic process by
enhancement of caseation and calcification . Also patients
with silicosis are at higher risk for tuberculosis
Extrinsic allergic alveolitis or hypersensitivity
pneumonitis
Organic dust farmer's lung
hay
actinomycetes
Inhale antigen dyspnea
no wheezy chest recurrent exposure
Bagassosis

toxic

Byssinosis
occuptional bronchial
asthma byssinosis
103

..............................................................
humidifier fever

reserviour
pump

Inhale it
legionella

Sarcoidosis

systemic granuloma
granuloma non caseating granuloma
non caseating
immune system impaired
cell mediated immunity
impaired incompetent

humoral immunity normal
cell mediated immunity
humoral immunity
cell mediated immunity skin
test negative
104

..............................................................
negative tuberculin test skin test
susceptible to infection
immune category sarcoidosis
incompetent cell mediated immunity deficiency
susceptible to infection humoral
tuberculosis anergy
negative tuberculin test
clinical pictures
extra pulmonary crepitations
liver , spleen , lymph node extra pulmonary
generalized
hepatosplenomegaly lymphadenopathy
HIV lymphoma
acute
generalized chronic lymphocytic lymphoblastic
lymphadenopathy
generalized part hepatosplenomegaly
lymphadenopathy
lymphoma
tumors
infectious mono nucleuosis Infection
HIV brucella
sarcoidosis
105

..............................................................
generalized lymphadenoptahy .T.B
generalized Lymphadenopathy
spleen liver
chest hepatosplenomegaly
Lymph nodes troubles
clinical pictures
nervous system
Bilateral fascial paralysis , space occupying lesion
skin
lupus pernio Erythema nodosum
heart
Cardiomyopathy
D secretion hypercalciemia
active vitamin D macrophages
hypercalciemia
calcification kidyney hypercalciemia
diabetes insipidus stones

liver, spleen and lymph cough , dyspnea
poly depsia poly uria node enlargement
with normal blood sugar
diabetes with normal blood sugar
Posterior pituitary sarcoidosis
106

..............................................................

liver , spleen , lymph node
diabetes insipidus
sarcoidosis tuberculosis

erythema nodosum
dyspnea
erythema nodosum

erythema nodosum
sarcoidosis tuberculosis
uveitis
.T.B phylectinular conjunctivitis
hypersensitivity
Phylectinular conjunctivitis .T.B
Eye
retinitis , uveitis , hypertrophy of lacrimal gland
erythema nodosum red eye

diagnosis chest X-ray
hilar lymphadenopathy
107

..............................................................
mediastinum lymph node enlargement
lymphoma sarcoidosis .T.B
dyspnea
chest X-ray mediastinal lymph node
enlargement possibilites
Mediastinum lymph node enlargement
sarcoidosis lymphoma

.T.B ..... .T.B mediastinal
lymph node enlargement
... 25

bronchoalveolar lavage
Lymphocyte biopsy Non caseating
granuloma
angiotensin converting enzyme

reflect the severity and acitivity
tuberculin test negative
.T.B
Anergy
108

..............................................................
tuberculin test .... positive
vaccinated
immune system Incompetent anergy

main line of treatment
steroid
cryptogenic fibrosing alveolitis

interstitium lung disease
Hamman Rich syndrome
crepitations clubbing cyanosis chest X-ray
CT scan Interstitium lung disease
idiopathic ....Hamman Rich syndrome
sarcoidosis
collagen disease lupus , scleroderma
rheumatoid
Silicosis asbestosis

X-ray , CT scan Interstitium lung disease

109

..............................................................
collagen ANA , rheumatoid factor
ESR
silica , asbestosis
sarcoidosis .....
Hamman Rich syndrome idiopathic
pulmonary fibrosis
cryptogenic
pulmonary tuberculosis
atypical mycobacterium
mycobacterium Avium
HIV mycobacterium Avium
pathology
.T.B .Pathology of primary T.B
.T.B oppertunistic
.T.B
diabetic
diabetes .T.B
Liver cirrhosis renal failure
malignancy HIV T.B
contact tuberculus
tuberculosis
.T.B
.T.B diabetic liver
cirrhosis blood pictures

110

..............................................................
contact
.T.B
.Fate of primary T.B

Hypersensitivity Pleural effusion
hypersensitivity
phylectin eye

sarcoid .T.B erythema
nodosum

clinical pictures
pathology
clinical pictures of primary complex pass un-
noticed
.T.B

hypersensitivity erythema nodosum
erythema nodosum pathology
inflammation of subcutaneous fat erythema
nodosum :
.T.B sarcoidosis post strepto coccal
inflammatory bowel disease leukemia
erythema nodosum hairy cell leukemia
progression primary complex : night fever
night sweating loss of weight
111

..............................................................

T.B cavity pneumonia
broncho genic carcinoma

... presentation bronchogenic carcinoma
pneumonia .... effusion ...
lung abscess
old male
.T.B .T.B
manifestation pneumonia pleural
effusion
mediastinal syndrome cavity
.T.B
immunocompromised
Immunocompromised
diabetic
diabetes chest infection
.T.B .T.B !!!!
.T.B
.T.B ...
pneumonia
MRSA Atypical
pneumonia
.T.B ...

night fever night sweating
.T.B
Abscess infection night fever night
sweating

.T.B effusion pneumonia
112

..............................................................
cavity mediastinal syndrome
bronchopneumonia
.... .T.B Liver
cirrhosis Liver cirrhosis Left sided
pleural effusion
cirrhosis ascites right pleura effusion
ascites right pleural effusion
effusion
cirrhosis
chest infection Lung effusion
.T.B
diabetic pleural effusion

Diabetic patient left sided pleural effusion
T.B. must be....
considered
Diabetic... bilateral pleural effusion
.... bilateral Lower limb edema
diabetes
diabetic nephropathy very common
patient with liver cirrhosis and ascites right sided
pleural effusion ascites effusion
left sided effusion

.T.B
commonest cause of pleural effusion
pneumonia
effusion Pneumonia

silicosis )
....
113

..............................................................
silica
Asbestosis (
history of silicosis cavity
Lung tuberculosis
silica ........ .T.B Diabetes ..... .T.B
cirrohosis, uremic, malnutrition .T.B

written written Problem
solving
written differential diagnosis
hematemesis

haemtemesis definition
causes of hematemesis
....
varices duodenal ulcers peptic ulcers cancer
esophagus
Paragraph
peptic ulcer clinical picture investigations
cancer esophagus clinical picture Investigations
clinical pictures in short
investigation in short
management ..... management
diagnosis treatment
diagnosis clinical picture Investigation
treatment
treatment rupture varices
Peptic ulcer
approach to acase of hematemesis ....
114

..............................................................
approach to acase of hematemesis
approach
approach
hematemesis

approach diagnosis
clinical pictures investigations causes

approach
no.1 history
.... epigastric
pain pain suggestive Peptic
ulcer
Liver spleen rupture varices

history examination
)
( ) (
management approach headache
approach to acase of acute chest pain
approach to acase of hematemesis , melena
.... acute chest pain acute chest pain
chest pain pulmonary embolism
pneumothorax
angina Infraction pericarditis
paragraph
paragraph
clinical pictures specific investigations
115

..............................................................
How can you suspect acase of
suspect examination history ...symptoms and
signs
Investigations
How can you confirm

confirm investigations
confirm symptoms signs
Investigations
.T.B
cavity haemoptysis
effusion
tuberculosis
fever toxemia
... diabetic Liver cirrhosis
silicosis
tuberculosis
.T.B
... bronchogenic carcinoma

child contact diabetic cirrhotic
uremic HIV immunosuppression
.T.B
lupus .T.B
lupus immune system

cyclophosphamide Infection
116

..............................................................
Miliary Tuberculosis
blood porne fever dyspnea
crepitations
fundus examinations tubercles in choroid
fundus examinations fever
spots endocarditis
tubercles in choroids .T.B
chest X-ray Miliary
.miliary T.B Immune system
tuberculin test negative
.Miliary T.B Tuberculin test
negative
complications of pulmonary tuberculosis
.T.B ..
diabetic type 1 diabetes sputum
night fever night sweating haemoptysis
cavity rigth lung
..
.diabetes complicated with T.B
Investigations
.T.B Chest X-ray
sputum PCR
... complications
.T.B ...
Problem
.T.B
.T.B ... .T.B

complications .T.B
117

..............................................................
pneumothorax
respiratory failure .extensive T.B
Plumonary fibrosis
constrictive pericarditis
constrictive pericarditis Problem
.T.B
.T.B dyspnea orthopnea neck vein
.T.B Constrictive .
pericarditis
atrial fibrillation 3rd heart sound
Pericardial knock fibrous pericardium
Myocardium atrium ventricle
Peicardial knock

chest infection
cardiology AF
.T.B Constrictive pericarditis
.T.B cardiovascular system
* dyspnea orthopnea
* .T.B adrenal gland
hypotension problem
.T.B ----- .T.B constrictive pericarditis
very common
T.B. meningitis
Meningeal irritation
meningeal irritation
neuro Meningitis
.T.B
meningeal irritation Meningitis viral
bacterial
subarachonoid hemorrhage
118

..............................................................
fever
typhoid fever )( fever itself
irritation meninges
... meningitis Irritation
meninges fever meningitis
leukemias lymphoma meningeal
deposit
liver , spleen and lymph
node
Leukemia , lymphoma tuberculosis
Problems
.... meningitis fever neck
rigidity meningitis meningococcal
liver , spleen and lymph node !!!
liver, spleen and lymph node
meninges
Leukemia tuberculosis

meningeococcal meningitis Liver,
spleen and lypmph nodes !!!
associated
associated diseases of causing hepatosplenomegaly
Plus associated causes Lymph adenopathy

problem .T.B .T.B
ascites problem ..... problems
.T.B
Peritonitis T.B. peritonitis

unilateral shifting dullness
119

..............................................................
T.B. peritonitis
investigations
.T.B Bacteriological examinations
sputum Organism sputum Urine

bone marrow Ziehl-Neelsen
culture middle brook
lowenstien Jensen media

X-ray apical .T.B
basal immunocompromised
HIV basal tuberculosis apical
presentations
Tuberculin skin test
Values
negative .... negative
negative negative
negative .... good positive
good negative test
tuberculin intradermal injection of the

purified protein derivatives (PPD) of the bacilli
antigen needle skin
test 72 abscess test
organisms
.... tuberculin
abscess .... ..... strong positive
staph
Positive ... infection
practice
negative tuberculosis
anergy
tuberculin negative
120

..............................................................
chest infection tuberculin
positive .... ...
.T.B endemic
tuberculin negative
chest infection infection tuberculin
positive infection
tuberculin positive contacts
tuberculin positive Infection
tuberculin test
tuberculin negative

...... chest infection .... ....
. ..... tuberculin test
.. positive .T.B
.. tuberculin test positive
history of contact
.T.B contact tuberculin positive
contact recent infection
mycobacterium sputum chest X-ray
Investigations
... tuberculin test positive ...
negative negative Infection
infection Infection .... tuberculin
.... test negative ... ...
negative ... Infection tuberculin negative
antigen technique
..
ESR .T.B
ESR disease activity
Blood pictures
lecopenia relative lymphocytosis .T.B
viral infection Brucella typhoid
typhoid Leucopenia relative lymphocytosis
121

..............................................................
Brucella
viral infection ... viral infection
... Atypical lymphocytosis viral
infection mononucleuosis
PCR
Biopsy

drugs
INH polyneuropathy
hepatotoxicity
Streptomycin
Rifampicin hepatotoxicity
... idiosyncrasy
Ethambutol
Pyrazinamid
PAS
:

cavity PAS
Ethambutol Streptomycin
.T.B INH Rifampicin
.T.B
cavity
.... pleura Lung .... cavity
healing

122

..............................................................
artificial pneumothorax lobectomy
lobectomy lobectomy

.Chemo prophylaxis of T.B
classic
INH contact
diabetes contact
tuberculosis ..... INH
Immunocompromised
.... transplanted persons transplanted persons
contact prophylaxis
Liver Kidney

.T.B
Anti tuberculosis INH and
Rifampicin
.T.B cyclosporine cortisone

cyclosporine cortisone
Immune suppression
bone marrow depression

.T.B organism .T.B
disseminated
BCG
protocols
nine months six months
nine six
nine months ..... Ethambulol and
Streptomycin INH and Rifampicin
Six months Rifampicin
123

..............................................................
.T.B
Rifampicin .T.B
pyrazinamid
Monitor
rules of treatment of tuberculosis

rules
... rules ..
treatment of tuberculosis
rules
rules
rules
Medical treatment rest Isolation
durgs long course 2
drugs relapse ...
resistance rules
rule rule
rules
..
Iron deficiency iron deficiency

malnutrition
iron deficiency malabsoroption
syndrome diet
malabsorption syndrome
Non dietic deficiencies
deficiencies ... Intake
malabsoroption iron
9 essay

1993 Problem solving

124

..............................................................
diabetes diabetes
Investigation Investigation
specific non invasive investigation
Paper

rules response
tuberculus clinical response

.T.B

sputum analysis negative
relapse
liver cirrhosis Rifampicin
chronic renal failure anti tuberculus
Streptomycin Pyrazinamid
Pryazinamid teratogenic Streptomycin
deafness

diagnosis theraputic test
tuberculus anti tuberculus

Cor pulmonale
definition
Right ventricular hypertrophy due to parenchymal lung
disease, chest wall disease or vascular lung disease with
or without right sided failure

Cor pulmonale discussion ..
diagnose COPD .......chronic bronchitis and
emphysema no manifestation of Cor pulmonale
respiratory failure
125

..............................................................
cor respiratory failure
.... pulmonale
paranchymal lung , COPD , Interstitium ,
vascular , Bilharziasis , thrombo emblic
morbid obesity
Pickwickian syndrome
hypoventilation obesity
hypoventilation very obese
right pulmonary vasoconstriction hypoxia
epigastric pulsation ventricular enlargement
2nd sound Pulmonary hypertension
Pulmonary area Pulsation
emphysema .... emphysema
chest left para sterna pulmonary area pulsation
Hyper inflated
auscaltation epigastric pulsation
Pulmonary area
Loud
diuretics heart failure
ACE inhibitor
effective Cor pulmonale digitalis
susceptible arrhythmia
liable to hypoxic hypoxic arrhythmia
arrhythmia
arrhythmogenic
Adult Respiratory Distress syndrome

cardiogenic pulmonary edema
cardiogenic pulmonary edema
pressure pulmonary venous congestion
capillary pressure pulmonary veins
high hydro alveoli
pulmonary capillaries static pressure
Left sided failure cardiogenic pulmonary edema
126

..............................................................
mitral valve disease On top atrial
fibrillation

diuretics
...... pathology insult Lung
capillary permeability capillary alveoli

pulmonary edema non cardiogenic
pulmonary edema written
.. discuss pulmonary edema
cardiogenic non cardiogenic
.N.B unilateral pulmonary edema
rapid decompression Pneumothorax
causes capillary permeability

alveoli ...
inhalation of irritant gas
Gram negative septicemia
Fat embolism fat fatty
acids fat embolism circulation fatty acids
very irritant capillary
endothelium
toxins septicemia
toxins of pancreatitis
toxins of uremia
toxins viral pneumonia
pneumocystis carnii
............

secretion marked sever
diffusion
hypoxia hypoxia oxygen
therapy
ARDS
respiratory failure type 1 cyanosis
127

..............................................................
investigations PO2 ECHO
normal exclude exclude left sided failure

oxygen PEEP Positive end
expiratory pressure oxygenation
steroid
diuretics effective High pulmonary
venous pressure capillary permeability
capillary
Inflammatory toxins
capillary endothelium Permaebility
wall capillary steroid

.... ventilator
inspiration expiration
expiration
capillaries alveoli
alveoli collapsed
alveoli patent expiration
expiration

pneumothorax
ARDS pneumothorax
central line Infection
setpticemia ...
mediastinum syndrome

superior mediastinum Thymomas
Thymomas myasthenia gravis
blood pure red cell aplasia
128

..............................................................
neurogenic tumor posterior
mediastinum pheochromocytoma
3tubes 3vessels 3tubes
3vessels
Investigation

Drug induced respiratory disease
hepatotoxic drugs
toxic Lung
opiates streptokinase ARDS
interstitial lung disease Amiodarone
anti arrhythmic Nitrfurantion Urinary
anti septic
pleural diseases Hydralazine Lupus like
pulmonary eosinophilia
hypersensitivity sulpha , penicillin

Sleep Apnea Syndrome
central , obstructive and mixed

* central In peace
* obstructive snoring

* mixed
Partner

129

..............................................................
Cor pulmonale
hypoxia
polycythaemia ...cor pulmonale
Sleep Apnea syndrome
sleep disorder

lung transplantation
single lung transplantation can be done
in emphysema , pulmonary fibrosis and pulmonary
hypertension
bilateral lung transplantation is done usually done in
infective conditions bronchiectasis
Heart and lung transplantation Eisenmenger's
syndrome
Histiocytosis X
granuloma
granuloma Lung X-ray skull
Multiple defects
sarcoidosis granuloma
diabetes insipidus granuloma
histiocytes Proliferation histiocytes Inclusion
bodies X-bodies

skull multiple defects
130

..............................................................

multiple myeloma hyper para osteolytic metastasis
Histiocytosis X common


Histiocytosis X
exophalmous
Hand Schuller Christian Syndrome
Kyphoscollosis
Cor pulmonale
Eosinophilic pneumonia

eosinophilia eosinophils in lung
Pneumonia bronchospasm
Pneumonia wheezy chest
pneumonia
tropical eosinophilia Ascaris and
ankylostoma
drugs vasculitis
Churg Strauss vasculitis
Lung vasculitis eosinophilic
pneumonia
131

..............................................................
interstitium tissue inflammatory cells
eosinophilia
hemoptysis
.... approach to acase of frank
hemoptysis
differential diagnosis of frank hemoptysis
how can you manage acase of frank hemoptysis

Frank hemoptysis
rupture bronchial varices , mitral stenosis , bronchogenic
carcinoma , bronchial adenoma and bronchiectasis

hemoptysis
specific hemoptysis frank hemoptysis

systemic diseases causing
hemoptysis
frank hemoptysis
mitral stenosis bronchial varices

.T.B

systemic
...
hemophilia bleeding tendency

purpura

vasculitis
vasculitis Chrug Strauss vasculitis
Wegener's granuloma
Good pasture
132

..............................................................

.T.B
systemic
Investigation hemoptysis
hemoptysis
Investigations
ECHO mitral valve
chest X-ray
ANCA
Antiglomerular basement membrane antibody
Massive Hemoptysis 600 over 48

hours
Definitive therapty
tamponade of the bleeding segment with aballoon
catheter
Endobronchial cold saline lavage
Embolization of the bronchial artery supplying the
bleeding segment through pulmonary catheter
I.V. vasopressine
Surgical resection of the bleeding site
MCQ

disease and infection of the upper respiratory tract
MCQ
oral
(Acute corysa ( common cold
Chrug Strauss corysa
!!! oral
Bacillay dysentery oral

133

..............................................................
( Acute Corysa (common cold
rhinovirus
Incubation period 12
burning sensation Nose
sneezing sore throat blocked nose with
watery discharge eventually becoming thick and
mucopurulent
) (
common cold
complications
sinusitis Lower respiratory tract infection
bacteria
bacterial infection
pneumonia
pneumonia

No specific therapy
paracetamol nasal decongestant
antibiotic
) (
antipyretic rest
Acute laryngitis
viral hoarseness of voice
,
hoarseness of voice Laryngitis
complications
bronchitis pneumonia
viral MCQ commonest cause of upper
respiratory tract infection is .viral
134

..............................................................
descending bacterial
rest voice

inalation of steam
Tincture benzoine

...
...... ....
...

Inalation
steam
steam

Croup
Acute laryngo-tracheobronchitis
Organism parainfluenza virus
common cold rhinovirus
laryngitis viral
croup parainfluenza virus
cough stridor cyanosis
tracheostomy
)
(
.... tonsillitis
pharyngitis Otitis media
laryngitis laryngitis
tracheostomy

135

..............................................................

hoarseness of voice
anti histamine
anti histamine
anti inflammatory

anti histaminic anti inflammatory

drops
anti histaminic

stridor
stridor

Acute epiglottitis
H.Influenza

stridor hoarseness of voice
Upper respiratory tract
air way vocal cords

tongue depressor
epiglotis you will
cause vaso vagal attack !!!!!!!
136

..............................................................
Influenza
organism corysa rhinovirus
influenza Myxoviruses type A, B

clinical pictures
common cold
....... ...... sore thorat
upper
Influenza
Pyrexia generalized aches anorexia nausea and
vomiting
complications
broncho pneumonia
malnutrition

cardiomyopathy toxic
myocarditis
encephalitis
influenza

common cold
influenza

viral influenza what ever
myocarditis
pneumonia
prophylaxis
influenza vaccine
chronic heart disease , chronic chest disease
137

..............................................................
Rhinitis
seasonal rhinitis hay fever

rhinitis sneezing nasal discharge
seasonal
anti histaminic steroid spray

nasal drops atrophy of nasal
mucosa
saline
saline ...

nasal drops

taste

Acute bronchitis
bacterial infection
viral infection
acute bronchitis chronic bronchitis
Acute bronchitis Acute chronic

bronchitis
chronic bronchitis chronic from the start
acute bronchitis
cough , expectoration sputum dry
cough mucoid mucopurulent
138

..............................................................
low grade fever

Investigation
total leucocytic count neutophils
normal CBC
complications
pneumonia
COPD pneumonia
antibiotic
common cold
influenza acute bronchitis

chest COPD asthmatic
parenchymatous Interstitial pulmonary
fibrosis
COPD bronchial asthma persistent
asthma Internisic interstitial pulmonary
disease parenchymatous
common cold Influenza
vaccine acute chest infection
otherwise
Rheumatic heart , congenital heart
, ischemic heart

139

..............................................................

**** !!!!!
"..... ,
" *****
140

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..............................................................

( COPD (chronic obstructive pulmonary disease

chronic air way obstruction

clubbing COPD Unusual clubbing

complications of COPD complications of

.... peptic ulcers originally

hypoxia and hyper capnea viability

treatment of excerbation of COPD

alpha one anti trypsin deficiency

cyanosed right sided failure

air way air way

blue bloater Hypo ventilation

pink puffer emphysema dominant

puffer expired air

clinical criteria of sever COPD

bronchial asthma intrinsic

precipitated asthma occupational asthma

non episodic cough asthma

complications bronchial asthma acute

struggling attack hyper ventilation

cough varient asthma bronchial

attacks systemic steroid inhaler

pulse pulsus paradoxius

peaked expiratory flow rate

B2agonist ipratrobium bromide

Causes of wheezy chest with hemptysis

(forced expiratory volume 1(FEV1

forced expiratory volume 1

hypoxic normo capnea hypo capnea

type two in respiratory failure hypoxic

under correction of hypoxia

hyper ventilation syndrome

Lung pneumonia abscess

pleurisy disease signify underlying

bloody blood haemo thorax

sign rising to axilla radiological sign

Pleural clinical pictures empyema

empyema anti biotic inter costal tube

secondary pneumothorax secondary to lung disease

closed pneumothorax isolated in pleura

Clinical pictures of pneumothorax

rupture esophagus rupture in

Nosocomial pneumonia pneumonia

acute bronchitis broncho-pneumonia

broncho lobar pneumonia

pneumonia toxemia ........

pneumonia in immunocompromised patients

mask oxygen ventilatory

Lung abscess Infusion

Congenital and acquird

bronchiectasis right middle lobe

lymph node lung

Lung Lymph node ..... lymph node

heart failure pulmonary venous congestion

CT scan bronchiectasis early

cystic lung complicated Cor-

lung abscess pneumonia brochiectasis

massive pleural effusion

exception TFV collapse

lung collapse chest X-ray

.... diagnostic and therapeutic collapse

fracture neck femur

Pumonary infraction DVT

squamous Mass obstruction