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Pulmonology

Pulmonology

by safinousss, Aug 2019

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	بسم الله	الرحمن الرحيم
	ربي اشرح لي صدري	و يسر لي أمري
	و احلل عقدة من لساني	يفقهوا قولي
	8, low grade fever with persistent cough, subcutaneous emphysema, next ?	Chest X-ray
	8, low grade fever with persistent cough, subcutaneous emphysema, next ?	Chest X-ray
	Pulmonary auscultation page 7	7
	Pleural effusion auscultation?	Decreased ( breath sound and tactile fremitus ) , Dullness
	Child, cystic fibrosis, recurrent severe pulmonary symptoms , given cefepime and oseltamivir , which empiric antibiotic ???	IV vancomycin ( staph infection )
	52, wakes repeatedly at night with choking sensation, fall asleep when reading or watching tv, BMI 34, hypertension ???	Obstructive sleep apnea ( transient obstruction due to laxity of pharyngeal tissue)
	FEV1/FVC ratio ? FEV1 normal?	75% FEV1= 80-120%
	60, SOB, mucoid cough for 5 months, oxygen saturation 92%, FEV1= 75%, FEV1/FVC< 70% , which measure decrease mortality in this patient?	Smoking cessation ( not oxygen because the saturation is normal to mild )
	60, severe SOB, severe weight loss, X-ray: pleural effusion, next ?	Thoracentesis except patients with clear CHF symptoms those the first step is diuretics
	28, bronchial asthma, the episodes on average twice a week, he takes albuterol inhaler which doing well, next?	Continue current regimen
	Pleural effusion auscultation?	Decreased ( breath sound and tactile fremitus ) , Dullness
	Postoperative, mild hypoxemia ( 90%), decreased breath sounds at bases, pO2 is decreased and pCO2 is decreased??	Impaired cough and shallow breathing due to atelectasis Rx: early mobilization, incentive spirometry.... Ps: pO2 and pCO2 refer to gas on the arterial side.
	7, difficulty in breathing, asthma symptoms ( عرصات عم يخدعوك), hypotension, history of allergy to food, initial treatment??	IM epinephrine ( anaphylaxis)
	Accident, systolic pressure is 60 , pulse 130, after putting on mechanical ventilator he developed cardiac arrest why ?	Decreased right ventricular preload due to hypovolemic shock and positive pressure made by ventilator
	Child, cystic fibrosis, recurrent severe pulmonary symptoms , given cefepime and oseltamivir , which empiric antibiotic ???	IV vancomycin ( staph infection )
	52, wakes repeatedly at night with choking sensation, fall asleep when reading or watching tv, BMI 34, hypertension ???	Obstructive sleep apnea ( transient obstruction due to laxity of pharyngeal tissue)
	FEV1/FVC ratio ? FEV1 normal?	75% FEV1= 80-120%
	Accident, vital signs are normal, mild respiratory distress, bruises on anterior chest and abdomen, breath sounds decreased at left lung base ??	Diaphragm injury
	60, severe SOB, severe weight loss, X-ray: pleural effusion, next ?	Thoracentesis except patients with clear CHF symptoms those the first step is diuretics
	28, bronchial asthma, the episodes on average twice a week, he takes albuterol inhaler which doing well, next?	Continue current regimen
	Accident, vital signs are normal, mild respiratory distress, bruises on anterior chest and abdomen, breath sounds decreased at left lung base ??	Diaphragm injury
	65, COPD exacerbation, central venous catheter in right subclavian vein and placed on mechanical ventilation, even all treatment the pulse oximetry is 83%, BP 80/50, tracheal deviated to left, breath sound is absent on right, next ?????	Needle thoracostomy (at the second intercostal space in the midclavicular line ) followed by emergent tube thoracostomy This patient has tension pneumothorax
	Place of needle thoracostomy??	2nd intercostal space in midclaviclular line , if failed use fifth intercostal space in midaxillary line
	Pleural effusion auscultation?	Decreased ( breath sound and tactile fremitus ) , Dullness
	Postoperative, mild hypoxemia ( 90%), decreased breath sounds at bases, pO2 is decreased and pCO2 is decreased??	Impaired cough and shallow breathing due to atelectasis Rx: early mobilization, incentive spirometry.... Ps: pO2 and pCO2 refer to gas on the arterial side.
	7, difficulty in breathing, asthma symptoms ( عرصات عم يخدعوك), hypotension, history of allergy to food, initial treatment??	IM epinephrine ( anaphylaxis)
	Accident, systolic pressure is 60 , pulse 130, after putting on mechanical ventilator he developed cardiac arrest why ?	Decreased right ventricular preload due to hypovolemic shock and positive pressure made by ventilator
	اللهم فهمني و علمني	و ارزقني تذكر المعلومات و الاجابة الصحيحة في الامتحان يا رحيم يا الله
	Child, cystic fibrosis, recurrent severe pulmonary symptoms , given cefepime and oseltamivir , which empiric antibiotic ???	IV vancomycin ( staph infection )
	52, wakes repeatedly at night with choking sensation, fall asleep when reading or watching tv, BMI 34, hypertension ???	Obstructive sleep apnea ( transient obstruction due to laxity of pharyngeal tissue)
	Accident, vital signs are normal, mild respiratory distress, bruises on anterior chest and abdomen, breath sounds decreased at left lung base ??	Diaphragm injury
	60, SOB, mucoid cough for 5 months, oxygen saturation 92%, FEV1= 75%, FEV1/FVC< 70% , which measure decrease mortality in this patient?	Smoking cessation ( not oxygen because the saturation is normal to mild )
	60, severe SOB, severe weight loss, X-ray: pleural effusion, next ?	Thoracentesis except patients with clear CHF symptoms those the first step is diuretics
	28, bronchial asthma, the episodes on average twice a week, he takes albuterol inhaler which doing well, next?	Continue current regimen
	Accident, vital signs are normal, mild respiratory distress, bruises on anterior chest and abdomen, breath sounds decreased at left lung base ??	Diaphragm injury
	65, COPD exacerbation, central venous catheter in right subclavian vein and placed on mechanical ventilation, even all treatment the pulse oximetry is 83%, BP 80/50, tracheal deviated to left, breath sound is absent on right, next ?????	Needle thoracostomy (at the second intercostal space in the midclavicular line ) followed by emergent tube thoracostomy This patient has tension pneumothorax
	Place of needle thoracostomy??	2nd intercostal space in midclaviclular line , if failed use fifth intercostal space in midaxillary line
	Pleural effusion auscultation?	Decreased ( breath sound and tactile fremitus ) , Dullness
	Postoperative, mild hypoxemia ( 90%), decreased breath sounds at bases, pO2 is decreased and pCO2 is decreased??	Impaired cough and shallow breathing due to atelectasis Rx: early mobilization, incentive spirometry.... Ps: pO2 and pCO2 refer to gas on the arterial side.
	7, difficulty in breathing, asthma symptoms ( عرصات عم يخدعوك), hypotension, history of allergy to food, initial treatment??	IM epinephrine ( anaphylaxis)
	Accident, systolic pressure is 60 , pulse 130, after putting on mechanical ventilator he developed cardiac arrest why ?	Decreased right ventricular preload due to hypovolemic shock and positive pressure made by ventilator
	اللهم فهمني و علمني	و ارزقني تذكر المعلومات و الاجابة الصحيحة في الامتحان يا رحيم يا الله
	Child, cystic fibrosis, recurrent severe pulmonary symptoms , given cefepime and oseltamivir , which empiric antibiotic ???	IV vancomycin ( staph infection )
	52, wakes repeatedly at night with choking sensation, fall asleep when reading or watching tv, BMI 34, hypertension ???	Obstructive sleep apnea ( transient obstruction due to laxity of pharyngeal tissue)
	Accident, vital signs are normal, mild respiratory distress, bruises on anterior chest and abdomen, breath sounds decreased at left lung base ??	Diaphragm injury
	60, SOB, mucoid cough for 5 months, oxygen saturation 92%, FEV1= 75%, FEV1/FVC< 70% , which measure decrease mortality in this patient?	Smoking cessation ( not oxygen because the saturation is normal to mild )
	60, severe SOB, severe weight loss, X-ray: pleural effusion, next ?	Thoracentesis except patients with clear CHF symptoms those the first step is diuretics
	28, bronchial asthma, the episodes on average twice a week, he takes albuterol inhaler which doing well, next?	Continue current regimen
	Accident, vital signs are normal, mild respiratory distress, bruises on anterior chest and abdomen, breath sounds decreased at left lung base ??	Diaphragm injury
	65, COPD exacerbation, central venous catheter in right subclavian vein and placed on mechanical ventilation, even all treatment the pulse oximetry is 83%, BP 80/50, tracheal deviated to left, breath sound is absent on right, next ?????	Needle thoracostomy (at the second intercostal space in the midclavicular line ) followed by emergent tube thoracostomy This patient has tension pneumothorax
	Place of needle thoracostomy??	2nd intercostal space in midclaviclular line , if failed use fifth intercostal space in midaxillary line
	56, sudden SOB, left sided pain worsen with cough, DM, hypertension, smoking, fever, leukocytosis, hypoxemia, ECG ( irregular PR intervals, no P wave , narrow QRS ) ???	Pulmonary embolism caused by atrial fibrillation
	Dyspnea on exertion, choking at night , BMI 48 , which additional findings related to electrolytes??	Obstructive sleep apnea with obesity hypoventilation syndrome . Decreased chloride due to Bicarbonate retention ( compensatory kidney for the respiratory acidosis)
	Adult, SOB with cough and blood in sputum, no weight loss or fever, bilateral rales, creatine 2.6, dysmorphic red cells in urinalysis ??	Goodpasture’s diseases Dx: renal biopsy : basement membrane IgG antibodies
	56, sudden SOB, left sided pain worsen with cough, DM, hypertension, smoking, fever, leukocytosis, hypoxemia, ECG ( irregular PR intervals, no P wave , narrow QRS ) ???	Pulmonary embolism caused by atrial fibrillation
	Dyspnea on exertion, choking at night , BMI 48 , which additional findings related to electrolytes??	Obstructive sleep apnea with obesity hypoventilation syndrome . Decreased chloride due to Bicarbonate retention ( compensatory kidney for the respiratory acidosis)
	Adult, SOB with cough and blood in sputum, no weight loss or fever, bilateral rales, creatine 2.6, dysmorphic red cells in urinalysis ??	Goodpasture’s diseases Dx: renal biopsy : basement membrane IgG antibodies
	رب اشرح لي صدري	و يسر لي أمري
	Nonproductive cough, night sweats, weight loss, right upper lobe cavity with infiltrate , what is the epidemiology?	Emigration from endemic area because it’s a TB
	Left sided Pulmonary symptoms without night sweet or fever or weight loss, history of Hodgkin lymphoma treated with chemo and radiation???	Secondary malignancy
	45 with HIV, SOB, left sided chest pain with green phlegm, fever, the pain is worse with deep inspiration???	Empyema
	Pleural effusion features from CHF ??	Transudative effusion, the pH of it is 7.4-7.55 Ps: normal pH of pleura is 7.60
	Elderly( 68) , confusion, high fever, productive cough, leukocytosis, right lower lobe infiltrate, BUN 24 ??	Community acquired pneumonia Rx: hospitalization ( inpatient due to high CURB-65 criteria), administration of abx( fluoroquinolone: moxifoxacin, or ceftriaxone plus azithromycin)
	58, smoking history, persistent cough for 3 months, weight loss, hemoptysis, no night sweat or fever, the mucus membranes are moist, no edema, hyponatremia, Rx?	Fluid restriction because the hyponatremia is due to SIADH ( the membranes are moist) Mostly the patient has small cell lung cancer Ps: didn’t give hypertonic saline because the symptoms aren’t severe.
	Small cell lung cancer complication related to fluids ??	Hyponatremia due to SIADH Rx: fluids restriction
	Front (Term)	Pulmonary compliance
	Patient with asthma exacerbation, oximetry 84%, given albuterol, ipratropium, methylprednisolone, after one hour the lab results ( pH: 7.32, PaCO2: 50, PaO2: 65), next ?	Endotracheal intubation ( elevated PaCO2 or even normal)
	34, dyspnea, severe left chest pain increases with inspiration, hemoptysis, using OCP ??	Pulmonary embolism due pulmonary infarction
	Exudative is defined by one of Light criteria	Fluid patient Protein / serum > 0.5 Fluid LDH/ serum > 0.6 Fluid LDH > 2/3 of the upper limit for LDH of serum
	45 with HIV, SOB, left sided chest pain with green phlegm, fever, the pain is worse with deep inspiration???	Empyema
	Low glucose levels in exudate due to ??	High Metabolic activity of leukocytes and bacteria in pleural fluid
	Nasal breathing, stuffy nose, occasional dry cough for a year , no allergies, not relieved by loratadine , boggy erythematous nasal mucosa??	Nonallergic rhinitis (vasomotor) Rx: intranasal corticosteroids , intranasal antihistamines
	Burning building, 15% Burn, oropharynx erythema, carboxyhemoglobin is 20%, best management?	Endotracheal intubation to prevent upper airway obstruction by edema
	Dry cough for 8 weeks, history of chronic rhinorrhea , skin rash, improved after chlorpheniramine , why ??	Decreased nasal secretions because this patient has upper airway cough syndrome ( postnasal drip) Rx: H1 histamine antagonist
	Front (Term)	Pulmonary compliance
	Hemoptysis, cough, weight loss, X-ray: irregular nodule in the peripheral right upper field, no lymph node enlargement???	Adenocarcinoma of the lung Associated with clubbing, hypertrophic osteoarthropathy
	Palpitations, headache, vomiting, had COPD treated with theophylline..etc, a week ago treated for a wound with ciprofloxacin, ECG shows atrial tachycardia, next ???	Serum theophylline levels ( toxicity caused by inhibition of cytochrome oxidase by cipro)
	70, fever and cough, fever, leukocytosis, no cervical lymphadenopathy, X-ray: right lower lobe infiltration ???	Community acquired pneumonia caused by strep pneumoniae
	On ventilator, respiratory rate 18, tidal volume 450, FiO2 40%, PEEP 5 cm H2O, his pH : 7.51, PCo2: 22, best next ?	Decrease respiratory rate ( to reduce the respiratory alkalosis)
	9, difficulty breathing from nose for 6 months, recurrent sinus infection and pneumonias, vit D deficiency, nasal polyps, digital clubbing, thin girl ????	Cystic fibrosis Ps: primary ciliary dyskinesia is similar to CF in respiratory symptoms but it has reversed visceral organs , normal growth.
	Bacterial pneumonia causing pleural effusion (parapneumonic empyema ) characterized by ?	Exudate { Low glucose ( <60), low pH( <7.2), high protein }. Rx: drainage ( chest tube), abx
	Clubbing and sudden onset of joint arthropathy in chronic smoker suggest ??	Hypertrophic osteoarthropathy Do chest X-ray to role out malignancy
	Chest pain and progressive dyspnea, after intubation at the site the breath sounds on the left are decreased,why ?	Because the endotracheal tube is placed into the right main bronchus Rx: reposition of the tube
	Asthma exacerbation treated with the medications, positive airway pressure is started in the second day, after 2 hours the patient becomes agitated, respiratory acidosis, next ?	Endotracheal intubation
	Collision, no distress, developed tachypnea, tachycardia after 2 hours, hypoxemia, right patchy irregular alveolar infiltrate on X-ray???	Pulmonary contusion
	55, pulmonary symptoms, FEV1= 67%, FEV1/FVC=65%, after bronchodilator the FEV1= 82% ???	Asthma ( because the patient is improved) Not COPD: because the patient doesn’t improve after bronchodilator in COPD.
	The indicator of asthma in PFTs is	FEV1
	Child, High fever, noisy breathing, stridor, drooling, had runny nose, oximetry 86% ???	Epiglottis ( H influenza type b ) Dx: lateral neck X-ray ( thumbprint sign) Rx: endotracheal intubation, abx
	ARDS features	Hypoxemia, bilateral alveolar infiltrate leading to impaired gas exchange, decreased lung compliance and pulmonary hypertension
	Postoperative, syncope, decreased lung sounds, hypotension, right bundle branch block, he died why ??	Massive pulmonary thromboembolism Dx:CT pulmonary angiography
	CREST syndrome	Calcinosis cutis, Raynaud phenomenon, esophageal dysmotility with reflux, sclerodactyly , telangiectasia
	Exertional SOB, lightheaded, no pulmonary symptoms, had Raynaud phenomenon, heartburn, which other fundings ???	CREST syndrome associated with limited cutaneous systemic sclerosis ( right ventricular enlargement, right sided heart failure)
	Nonproductive cough, night sweats, weight loss, right upper lobe cavity with infiltrate , what is the epidemiology?	Emigration from endemic area because it’s a TB
	Left sided Pulmonary symptoms without night sweet or fever or weight loss, history of Hodgkin lymphoma treated with chemo and radiation???	Secondary malignancy
	45 with HIV, SOB, left sided chest pain with green phlegm, fever, the pain is worse with deep inspiration???	Empyema
	Pleural effusion features from CHF ??	Transudative effusion, the pH of it is 7.4-7.55 Ps: normal pH of pleura is 7.60
	Elderly( 68) , confundion, high fever, productive cough, leukocytosis, right lower lobe infiltrate, BUN 24 ??	Community acquired pneumonia Rx: hospitalization ( inpatient due to high CURB-65 criteria), administration of abx( fluoroquinolone: moxifoxacin, or ceftriaxone plus azithromycin)
	58, smoking history, persistent cough for 3 months, weight loss, hemoptysis, no night sweat or fever, the mucus membranes are moist, no edema, hyponatremia, Rx?	Fluid restriction because the hyponatremia is due to SIADH ( the membranes are moist) Mostly the patient has small cell lung cancer Ps: didn’t give hypertonic saline because the symptoms aren’t severe.
	Small cell lung cancer complication related to fluids ??	Hyponatremia due to SIADH Rx: fluids restriction
	Front (Term)	Pulmonary compliance
	Patient with asthma exacerbation, oximetry 84%, given albuterol, ipratropium, methylprednisolone, after one hour the lab results ( pH: 7.32, PaCO2: 50, PaO2: 65), next ?	Endotracheal intubation ( elevated PaCO2 or even normal)
	34, dyspnea, severe left chest pain increases with inspiration, hemoptysis, using OCP ??	Pulmonary embolism due pulmonary infarction
	Exudative is defined by one of Light criteria	Fluid patient/ serum > 0.5 Fluid LDH/ serum > 0.6 Fluid LDH > 2/3 of the upper limit for LDH of serum
	45 with HIV, SOB, left sided chest pain with green phlegm, fever, the pain is worse with deep inspiration???	Empyema
	Low glucose levels in exudate due to ??	High Metabolic activity of leukocytes and bacteria in pleural fluid
	Nasal breathing, stuffy nose, occasional dry cough for a year , no allergies, not relieved by loratadine , boggy erythematous nasal mucosa??	Nonallergic rhinitis (vasomotor) Rx: intranasal corticosteroids , intranasal antihistamines
	Burning building, 15% Burn, oropharynx erythema, carboxyhemoglobin is 20%, best management?	Endotracheal intubation to prevent upper airway obstruction by edema
	Dry cough for 8 weeks, history of chronic rhinorrhea , skin rash, improved after chlorpheniramine , why ??	Decreased nasal secretions because this patient has upper airway cough syndrome ( postnasal drip) Rx: H1 histamine antagonist
	Front (Term)	Pulmonary compliance
	Hemoptysis, cough, weight loss, X-ray: irregular nodule in the peripheral right upper field, no lymph node enlargement???	Adenocarcinoma of the lung Associated with clubbing, hypertrophic osteoarthropathy
	Palpitations, headache, vomiting, had COPD treated with theophylline..etc, a week ago treated for a wound with ciprofloxacin, ECG shows atrial tachycardia, next ???	Serum theophylline levels ( toxicity caused by inhibition of cytochrome oxidase by cipro)
	70, fever and cough, fever, leukocytosis, no cervical lymphadenopathy, X-ray: right lower lobe infiltration ???	Community acquired pneumonia caused by strep pneumoniae
	On ventilator, respiratory rate 18, tidal volume 450, FiO2 40%, PEEP 5 cm H2O, his pH : 7.51, PCo2: 22, best next ?	Decrease respiratory rate ( to reduce the respiratory alkalosis)
	9, difficulty breathing from nose for 6 months, recurrent sinus infection and pneumonias, vit D deficiency, nasal polyps, digital clubbing, thin girl ????	Cystic fibrosis Ps: primary ciliary dyskinesia is similar to CF in respiratory symptoms but it has reversed visceral organs , normal growth.
	Bacterial pneumonia causing pleural effusion (parapneumonic empyema ) characterized by ?	Exudate { Low glucose ( <60), low pH( <7.2), high protein }. Rx: drainage ( chest tube), abx
	Clubbing and sudden onset of joint arthropathy in chronic smoker suggest ??	Hypertrophic osteoarthropathy Do chest X-ray to role out malignancy
	Chest pain and progressive dyspnea, after intubation at the site the breath sounds on the left are decreased,why ?	Because the endotracheal tube is placed into the right main bronchus Rx: reposition of the tube
	Asthma exacerbation treated with the medications, positive airway pressure is started in the second day, after 2 hours the patient becomes agitated, respiratory acidosis, next ?	Endotracheal intubation
	Collision, no distress, developed tachypnea, tachycardia after 2 hours, hypoxemia, right patchy irregular alveolar infiltrate on X-ray???	Pulmonary contusion
	أستغفر الله و أتوب إليه	ربي اغفر لي يا غفور
	55, pulmonary symptoms, FEV1= 67%, FEV1/FVC=65%, after bronchodilator the FEV1= 82% ???	Asthma ( because the patient is improved) Not COPD: because the patient doesn’t improve after bronchodilator in COPD.
	The indicator of asthma in PFTs is	FEV1
	Child, High fever, noisy breathing, stridor, drooling, had runny nose, oximetry 86% ???	Epiglottis ( H influenza type b ) Dx: lateral neck X-ray ( thumbprint sign) Rx: endotracheal intubation, abx
	ARDS features	Hypoxemia, bilateral alveolar infiltrate leading to impaired gas exchange, decreased lung compliance and pulmonary hypertension
	Postoperative, syncope, decreased lung sounds, hypotension, right bundle branch block, he died why ??	Massive pulmonary thromboembolism Dx:CT pulmonary angiography
	CREST syndrome	Calcinosis cutis, Raynaud phenomenon, esophageal dysmotility with reflux, sclerodactyly , telangiectasia
	Exertional SOB, lightheaded, no pulmonary symptoms, had Raynaud phenomenon, heartburn, which other fundings ???	CREST syndrome associated with limited cutaneous systemic sclerosis ( right ventricular enlargement, right sided heart failure)
	Nonproductive cough, night sweats, weight loss, right upper lobe cavity with infiltrate , what is the epidemiology?	Emigration from endemic area because it’s a TB
	In systemic sclerosis the mechanism of pulmonary arterial hypertension is ???	Hyperplasia of the intimal smooth muscle layer The FEV1/FVC is normal
	45 with HIV, SOB, left sided chest pain with green phlegm, fever, the pain is worse with deep inspiration???	Empyema
	Pleural effusion features from CHF ??	Transudative effusion, the pH of it is 7.4-7.55 Ps: normal pH of pleura is 7.60
	Elderly( 68) , confundion, high fever, productive cough, leukocytosis, right lower lobe infiltrate, BUN 24 ??	Community acquired pneumonia Rx: hospitalization ( inpatient due to high CURB-65 criteria), administration of abx( fluoroquinolone: moxifoxacin, or ceftriaxone plus azithromycin)
	58, smoking history, persistent cough for 3 months, weight loss, hemoptysis, no night sweat or fever, the mucus membranes are moist, no edema, hyponatremia, Rx?	Fluid restriction because the hyponatremia is due to SIADH ( the membranes are moist) Mostly the patient has small cell lung cancer Ps: didn’t give hypertonic saline because the symptoms aren’t severe.
	Small cell lung cancer complication related to fluids ??	Hyponatremia due to SIADH Rx: fluids restriction
	Front (Term)	Pulmonary compliance
	Patient with asthma exacerbation, oximetry 84%, given albuterol, ipratropium, methylprednisolone, after one hour the lab results ( pH: 7.32, PaCO2: 50, PaO2: 65), next ?	Endotracheal intubation ( elevated PaCO2 or even normal)
	34, dyspnea, severe left chest pain increases with inspiration, hemoptysis, using OCP ??	Pulmonary embolism due pulmonary infarction
	Exudative is defined by one of Light criteria	Fluid patient/ serum > 0.5 Fluid LDH/ serum > 0.6 Fluid LDH > 2/3 of the upper limit for LDH of serum
	Left sided Pulmonary symptoms without night sweet or fever or weight loss, history of Hodgkin lymphoma treated with chemo and radiation???	Secondary malignancy
	Low glucose levels in exudate due to ??	High Metabolic activity of leukocytes and bacteria in pleural fluid
	Nasal breathing, stuffy nose, occasional dry cough for a year , no allergies, not relieved by loratadine , boggy erythematous nasal mucosa??	Nonallergic rhinitis (vasomotor) Rx: intranasal corticosteroids , intranasal antihistamines
	Burning building, 15% Burn, oropharynx erythema, carboxyhemoglobin is 20%, best management?	Endotracheal intubation to prevent upper airway obstruction by edema
	Dry cough for 8 weeks, history of chronic rhinorrhea , skin rash, improved after chlorpheniramine , why ??	Decreased nasal secretions because this patient has upper airway cough syndrome ( postnasal drip) Rx: H1 histamine antagonist
	The 3 common causes of chronic cough > 8 weeks???	Upper airway cough syndrome Asthma GERD
	Hemoptysis, cough, weight loss, X-ray: irregular nodule in the peripheral right upper field, no lymph node enlargement???	Adenocarcinoma of the lung Associated with clubbing, hypertrophic osteoarthropathy
	Palpitations, headache, vomiting, had COPD treated with theophylline..etc, a week ago treated for a wound with ciprofloxacin, ECG shows atrial tachycardia, next ???	Serum theophylline levels ( toxicity caused by inhibition of cytochrome oxidase by cipro)
	70, fever and cough, fever, leukocytosis, no cervical lymphadenopathy, X-ray: right lower lobe infiltration ???	Community acquired pneumonia caused by strep pneumoniae
	On ventilator, respiratory rate 18, tidal volume 450, FiO2 40%, PEEP 5 cm H2O, his pH : 7.51, PCo2: 22, best next ?	Decrease respiratory rate ( to reduce the respiratory alkalosis)
	9, difficulty breathing from nose for 6 months, recurrent sinus infection and pneumonias, vit D deficiency, nasal polyps, digital clubbing, thin girl ????	Cystic fibrosis Ps: primary ciliary dyskinesia is similar to CF in respiratory symptoms but it has reversed visceral organs , normal growth.
	Bacterial pneumonia causing pleural effusion (parapneumonic empyema ) characterized by ?	Exudate { Low glucose ( <60), low pH( <7.2), high protein }. Rx: drainage ( chest tube), abx
	Clubbing and sudden onset of joint arthropathy in chronic smoker suggest ??	Hypertrophic osteoarthropathy Do chest X-ray to role out malignancy
	Chest pain and progressive dyspnea, after intubation at the site the breath sounds on the left are decreased,why ?	Because the endotracheal tube is placed into the right main bronchus Rx: reposition of the tube
	Asthma exacerbation treated with the medications, positive airway pressure is started in the second day, after 2 hours the patient becomes agitated, respiratory acidosis, next ?	Endotracheal intubation
	Collision, no distress, developed tachypnea, tachycardia after 2 hours, hypoxemia, right patchy irregular alveolar infiltrate on X-ray???	Pulmonary contusion
	أستغفر الله و أتوب إليه	ربي اغفر لي يا غفور
	55, pulmonary symptoms, FEV1= 67%, FEV1/FVC=65%, after bronchodilator the FEV1= 82% ???	Asthma ( because the patient is improved) Not COPD: because the patient doesn’t improve after bronchodilator in COPD.
	The indicator of asthma in PFTs is	FEV1
	Child, High fever, noisy breathing, stridor, drooling, had runny nose, oximetry 86% ???	Epiglottis ( H influenza type b ) Dx: lateral neck X-ray ( thumbprint sign) Rx: endotracheal intubation, abx
	ARDS features	Hypoxemia, bilateral alveolar infiltrate leading to impaired gas exchange, decreased lung compliance and pulmonary hypertension
	Postoperative, syncope, decreased lung sounds, hypotension, right bundle branch block, he died why ??	Massive pulmonary thromboembolism Dx:CT pulmonary angiography
	CREST syndrome	Calcinosis cutis, Raynaud phenomenon, esophageal dysmotility with reflux, sclerodactyly , telangiectasia
	Exertional SOB, lightheaded, no pulmonary symptoms, had Raynaud phenomenon, heartburn, which other fundings ???	CREST syndrome associated with limited cutaneous systemic sclerosis ( right ventricular enlargement, right sided heart failure)
	62, exertional dyspnea and dry cough for year, carpenter for navy ships, FEV1 decreased, FEV1/FVC normal, diffusion capacity lung for carbon monoxide is decreased???	Interstitial lung disease caused by occupational exposure pulmonary fibrosis ( asbestos)
	Beclomethasone inhaler complication in asthma patient	Thrush ( oral candidiasis)
	Using ACEi , after a week has cough, next step ?	Discontinue ACEi
	ARDS management	Mechanical ventilation ( low tidal volume, high PEEP, high FiO2)
	Bronchiectasis( bronchial wall thickened and bronchial dilation) pathophysiology ?	Prolonged Infectious insult with impaired clearance
	Patient with bronchiectasis should be evaluated for ?	Immunity and CF
	Symptoms of CAP, next ?	Chest X-ray , if confirmed give empiric abx
	62, history of surgery 2 weeks ago, now: suddenly dyspnea, no productive cough, tachycardia, mild hypoxia, low grade fever, next ??	CT angiogram of the chest ( PE)
	Diseases classified according FEV1/FVC and diffusion capacity of lung for carbon monoxide ( DLCO) ??	Low FEV1/FVC(obstructive lung disease) , if decreased DLCO >> COPD , if DLCO doesn’t decrease >>asthma. Normal FEV1/FVC (restrictive disease), if DLCO decreased >> interstitial lung disease, if DLCO doesn’t decrease>> chest wall weakness.
	Postoperative pneumonia prevention by ??	Incentive spirometry
	ARDS management	Mechanical ventilation ( low tidal volume, high PEEP, high FiO2)
	87, fever, foul smelling, productive cough, history of recurrent pneumonia, dementia symptoms, decreased breath sounds in right upper lobe ???	Aspiration pneumonia due to impaired swallowing and cough reflex in advanced dementia patients.
	2 years of episodic cough productive yellow sputum, her condition improves with abx but she continues to have persistent cough, coarse crackles bilaterally, diffuse rhonchi , X-ray reveals atelectasis , confirmation???	High resolution CT scan ( bronchiectasis )
	MS, sudden SOB with left sided chest pain worsen in 2 days, no fever, reduced breath sounds and dullness at left base lung ??	Pulmonary embolism
	71, seizures tonic clonic, his Blood gases demonstrate Respiratory acidosis, why ?	Hypoventilation
	Dullness to percussion , increased breath sounds especially during expiration, increased tactile fremitus ???	Consolidation of the lung ( lobar pneumonia)
	Male, Pulmonary symptoms, weight loss, large anterior mediastinal mass, elevated B-hCG, a- fetoprotein ??	Nonseminomatous germ cell tumors Ps: AFP elevation distinguished between this tumor and seminoma (only rise B-hCG )
	62, exertional dyspnea and dry cough for year, carpenter for navy ships, FEV1 decreased, FEV1/FVC normal, diffusion capacity lung for carbon monoxide is decreased???	Interstitial lung disease caused by occupational exposure pulmonary fibrosis ( asbestos)
	Beclomethasone inhaler complication in asthma patient	Thrush ( oral candidiasis)
	Using ACEi , after a week has cough, next step ?	Discontinue ACEi
	ARDS management	Mechanical ventilation ( low tidal volume, high PEEP, high FiO2)
	Bronchiectasis( bronchial wall thickened and bronchial dilation) pathophysiology ?	Prolonged Infectious insult with impaired clearance
	Patient with bronchiectasis should be evaluated for ?	Immunity and CF
	Symptoms of CAP, next ?	Chest X-ray , if confirmed give empiric abx
	62, history of surgery 2 weeks ago, now: suddenly dyspnea, no productive cough, tachycardia, mild hypoxia, low grade fever, next ??	CT angiogram of the chest ( PE)
	اللهم ذكرني ما أقرأ	و دلني على الاجابة الصحية في الامتحان يا مقتدر
	Diseases classified according FEV1/FVC and diffusion capacity of lung for carbon monoxide ( DLCO) ??	Low FEV1/FVC(obstructive lung disease) , if decreased DLCO >> COPD , if DLCO doesn’t decrease >>asthma. Normal FEV1/FVC (restrictive disease), if DLCO decreased >> interstitial lung disease, if DLCO doesn’t decrease>> chest wall weakness.
	Postoperative pneumonia prevention by ??	Incentive spirometry
	ARDS management	Mechanical ventilation ( low tidal volume, high PEEP, high FiO2)
	2 years of episodic cough productive yellow sputum, her condition improves with abx but she continues to have persistent cough, coarse crackles bilaterally, diffuse rhonchi , X-ray reveals atelectasis , confirmation???	High resolution CT scan ( bronchiectasis )
	Child, pneumonia symptoms with minimal fluid on lateral decubitus film , next ?	Abx because it’s pneumonia with parapneumonic pleural effusion Ps: large effusion require drain
	MS, sudden SOB with left sided chest pain worsen in 2 days, no fever, reduced breath sounds and dullness at left base lung ??	Pulmonary embolism
	71, seizures tonic clonic, his Blood gases demonstrate Respiratory acidosis, why ?	Hypoventilation
	Dullness to percussion , increased breath sounds especially during expiration, increased tactile fremitus ???	Consolidation of the lung ( lobar pneumonia)
	Male, Pulmonary symptoms, weight loss, large anterior mediastinal mass, elevated B-hCG, a- fetoprotein ??	Nonseminomatous germ cell tumors Ps: AFP elevation distinguished between this tumor and seminoma (only rise B-hCG )
	62, exertional dyspnea and dry cough for year, carpenter for navy ships, FEV1 decreased, FEV1/FVC normal, diffusion capacity lung for carbon monoxide is decreased???	Interstitial lung disease caused by occupational exposure pulmonary fibrosis ( asbestos)
	Beclomethasone inhaler complication in asthma patient	Thrush ( oral candidiasis)
	Using ACEi , after a week has cough, next step ?	Discontinue ACEi
	2 years of episodic cough productive yellow sputum, her condition improves with abx but she continues to have persistent cough, coarse crackles bilaterally, diffuse rhonchi , X-ray reveals atelectasis , confirmation???	High resolution CT scan ( bronchiectasis )
	Bronchiectasis( bronchial wall thickened and bronchial dilation) pathophysiology ?	Prolonged Infectious insult with impaired clearance
	Patient with bronchiectasis should be evaluated for ?	Immunity and CF
	Symptoms of CAP, next ?	Chest X-ray , if confirmed give empiric abx
	62, history of surgery 2 weeks ago, now: suddenly dyspnea, no productive cough, tachycardia, mild hypoxia, low grade fever, next ??	CT angiogram of the chest ( PE)
	اللهم ذكرني ما أقرأ	و دلني على الاجابة الصحية في الامتحان يا مقتدر
	Diseases classified according FEV1/FVC and diffusion capacity of lung for carbon monoxide ( DLCO) ??	Low FEV1/FVC(obstructive lung disease) , if decreased DLCO >> COPD , if DLCO doesn’t decrease >>asthma. Normal FEV1/FVC (restrictive disease), if DLCO decreased >> interstitial lung disease, if DLCO doesn’t decrease>> chest wall weakness.
	Postoperative pneumonia prevention by ??	Incentive spirometry
	ARDS management	Mechanical ventilation ( low tidal volume, high PEEP, high FiO2)
	87, fever, foul smelling, productive cough, history of recurrent pneumonia, dementia symptoms, decreased breath sounds in right upper lobe ???	Aspiration pneumonia due to impaired swallowing and cough reflex in advanced dementia patients.
	Child, pneumonia symptoms with minimal fluid on lateral decubitus film , next ?	Abx because it’s pneumonia with parapneumonic pleural effusion Ps: large effusion require drain
	MS, sudden SOB with left sided chest pain worsen in 2 days, no fever, reduced breath sounds and dullness at left base lung ??	Pulmonary embolism
	71, seizures tonic clonic, his Blood gases demonstrate Respiratory acidosis, why ?	Hypoventilation
	Dullness to percussion , increased breath sounds especially during expiration, increased tactile fremitus ???	Consolidation of the lung ( lobar pneumonia)
	Male, Pulmonary symptoms, weight loss, large anterior mediastinal mass, elevated B-hCG, a- fetoprotein ??	Nonseminomatous germ cell tumors Ps: AFP elevation distinguished between this tumor and seminoma (only rise B-hCG )
	Immigrant, Persistent cough, dyspnea for 3 months, E: crackles, enlarged cardiac silhouette with vascular congestion, left main bronchus is elevated, irregular rhythm on ECG ??	Mitral stenosis caused by rheumatic heart disease
	8, chronic smoker, have progressive SOB and wheezing for 2 days, E: using accessory muscle in breathing, normal vital, auscultation: decreased???	Chronic obstructive pulmonary disease exacerbation.
	Accident, Respiratory distress, bilateral coarse breath sounds, X-ray: multiple ribs fractures ?	Flail chest
	Sleep apnea treatment	Weight reduction, avoid sleep in supine .
	Recurrent sinusitis and otitis despite antibiotics, joint and back pain, urinary symptoms???	Granulomatosis with polyangiitis Dx: ANCA( quantitive serum autoantibodies
	Compensation of respiratory acidosis ???	Renal bicarbonate retention ( metabolic alkalosis)
	Newborn, preterm, delivered at 28 weeks, has central cyanosis, bilateral breath sounds are diminished , grunting,flaring, retraction, X-ray: diffuse reticular granular opacities bilaterally ??	Respiratory distress syndrome Rx: early continuous positive air pressure
	6 months of dry cough and worsening dyspnea, late expiratory crackles, digital clubbing, no accompanying etiology , what is the abnormality???	Increased alveolar-arterial gradient ( interstitial lung disease) due to idiopathic fibrosis
	Front (Term)	Laryngeal edema ( fixed upper airway obstruction) due to food allergies Rx: epinephrine, corticosteroids, antihistamines
	Front (Term)	Back (Definition)
	Child, difficulty breathing development, rhinorrhea, congestion dry cough ( barking dog ), stridor at rest, Rx ???	Racemic epinephrine ( croup) Ps: if no stridor ( humidified air )
	Accident, Respiratory distress, bilateral coarse breath sounds, X-ray: multiple ribs fractures ?	Flail chest
	Management of ARDS treated with mechanical ventilation complications	Low tidal volume ventilation which leads to decreased overdistending alveoli ( improves mortality)
	63, cough , wheezing, yellow sputum, lost weight, smoking history, prominent fingers clubbing that wasn’t 6 months ago, why the digital clubbing ??	Occult malignancy
	1 hour baby, respiratory distress symptoms, however he has intercostal retraction and clear breath sounds, X-ray: fluid in the interlobar fissures	Transient tachypnea of newborn ( delayed resorption and clearance of alveolar fluid) Rx: supportive
	COPD decreased vital capacity cause ?	Progressive expiratory airflow limitation( air trapping)
	6 months of dry cough and worsening dyspnea, late expiratory crackles, digital clubbing, no accompanying etiology , what is the abnormality???	Increased alveolar-arterial gradient ( interstitial lung disease) due to idiopathic fibrosis
	Front (Term)	Laryngeal edema ( fixed upper airway obstruction) due to food allergies Rx: epinephrine, corticosteroids, antihistamines
	Front (Term)	Back (Definition)
	60, pulmonary symptoms, decreased FEV1/FVC, DLCO is normal????	COPD ( chronic bronchitis) لا تنخدع بمهنة المريض، خلي تركيزك عالفحص الصدري Ps: if DLCO decreased ( emphysema)
	Left sided chest discomfort, history of accident 2 months ago , X-ray : mediastinal deviation , next ??	CT of chest and abdomen ( to role out diaphragm rupture)
	38, progressive SOB, cough with mucoid for 6 months, no wheezing, no other symptoms, X-ray: bilateral basilar lucency, next ??	Serum alpha-1 antitrypsin deficiency.
	Silicosis symptoms ( stone worker) with TB symptoms With kidney symptoms, upper airway involved ( trachea) ???	Granulomatosis with polyangiitis Dx: ANCA , biopsy Rx: corticosteroids, methotrexate, cyclophosphamide
	Immigrant, hemoptysis, with cough and foamy sputum, IV fluids and oxygen is portable X-ray: dense opacity in upper right lobe , next ??	Respiratory isolation ( TB high suspicion) , if continue bleeding put him on lateral position and do bronchoscopy to Dx and Rx.
	Fresh frozen plasma indicated if the INR is	> 1.5
	Pulmonary symptoms, with right arm pain	Superior pulmonary sulcus tumor ( pancoast tumors)
	Asthma exacerbation treated with albuterol and IV methylprednisolone, the next day she developed high leukocytosis with bands form ??	Medication effect ( steroids)
	Mediastinum tumors according to location	Anterior: thymoma Posterior: neurogenic tumors, esophageal leiomyoma Middle: bronchogenic cysts, trachea, lymphoma,
	Left sided chest discomfort, history of accident 2 months ago , X-ray : mediastinal deviation , next ??	CT of chest and abdomen ( to role out diaphragm rupture)
	HIV, noncompliant with treatment, pulmonary symptoms( PCP), given abx and 5 L normal saline, after 2 days he developed hyponatremia with confusion???	SIADH which happens in euvolemia state
	Pneumonia symptoms on the left side , the oxygen saturation is normal when lying on right side, but it decreased when lying of the left side ( affected side ) , why ??	Intrapulmonary shunting ( right to left) of blood due to gravity
	6th rib fracture, base atelectasis , best essential Rx??	Pain control to maintain adequate ventilation
	Immigrant, Persistent cough, dyspnea for 3 months, E: crackles, enlarged cardiac silhouette with vascular congestion, left main bronchus is elevated, irregular rhythm on ECG ??	Mitral stenosis caused by rheumatic heart disease
	8, chronic smoker, have progressive SOB and wheezing for 2 days, E: using accessory muscle in breathing, normal vital, auscultation: decreased???	Chronic obstructive pulmonary disease exacerbation.
	Accident, Respiratory distress, bilateral coarse breath sounds, X-ray: multiple ribs fractures ?	Flail chest
	Sleep apnea treatment	Weight reduction, avoid sleep in supine .
	Recurrent sinusitis and otitis despite antibiotics, joint and back pain, urinary symptoms???	Granulomatosis with polyangiitis Dx: ANCA( quantitive serum autoantibodies
	Compensation of respiratory acidosis ???	Renal bicarbonate retention ( metabolic alkalosis)
	Newborn, preterm, delivered at 28 weeks, has central cyanosis, bilateral breath sounds are diminished , grunting,flaring, retraction, X-ray: diffuse reticular granular opacities bilaterally ??	Respiratory distress syndrome Rx: early continuous positive air pressure
	6 months of dry cough and worsening dyspnea, late expiratory crackles, digital clubbing, no accompanying etiology , what is the abnormality???	Increased alveolar-arterial gradient ( interstitial lung disease) due to idiopathic fibrosis
	Front (Term)	Laryngeal edema ( fixed upper airway obstruction) due to food allergies Rx: epinephrine, corticosteroids, antihistamines
	Front (Term)	Back (Definition)
	Child, difficulty breathing development, rhinorrhea, congestion dry cough ( barking dog ), stridor at rest, Rx ???	Racemic epinephrine ( croup) Ps: if no stridor ( humidified air )
	Accident, Respiratory distress, bilateral coarse breath sounds, X-ray: multiple ribs fractures ?	Flail chest
	Management of ARDS treated with mechanical ventilation complications	Low tidal volume ventilation which leads to decreased overdistending alveoli ( improves mortality)
	63, cough , wheezing, yellow sputum, lost weight, smoking history, prominent fingers clubbing that wasn’t 6 months ago, why the digital clubbing ??	Occult malignancy
	1 hour baby, respiratory distress symptoms, however he has intercostal retraction and clear breath sounds, X-ray: fluid in the interlobar fissures	Transient tachypnea of newborn ( delayed resorption and clearance of alveolar fluid) Rx: supportive
	COPD decreased vital capacity cause ?	Progressive expiratory airflow limitation( air trapping)
	6 months of dry cough and worsening dyspnea, late expiratory crackles, digital clubbing, no accompanying etiology , what is the abnormality???	Increased alveolar-arterial gradient ( interstitial lung disease) due to idiopathic fibrosis
	Front (Term)	Laryngeal edema ( fixed upper airway obstruction) due to food allergies Rx: epinephrine, corticosteroids, antihistamines
	Front (Term)	Back (Definition)
	60, pulmonary symptoms, decreased FEV1/FVC, DLCO is normal????	COPD ( chronic bronchitis) لا تنخدع بمهنة المريض، خلي تركيزك عالفحص الصدري Ps: if DLCO decreased ( emphysema)
	Left sided chest discomfort, history of accident 2 months ago , X-ray : mediastinal deviation , next ??	CT of chest and abdomen ( to role out diaphragm rupture)
	38, progressive SOB, cough with mucoid for 6 months, no wheezing, no other symptoms, X-ray: bilateral basilar lucency, next ??	Serum alpha-1 antitrypsin deficiency.
	Silicosis symptoms ( stone worker) with TB symptoms With kidney symptoms, upper airway involved ( trachea) ???	Granulomatosis with polyangiitis Dx: ANCA , biopsy Rx: corticosteroids, methotrexate, cyclophosphamide
	Immigrant, hemoptysis, with cough and foamy sputum, IV fluids and oxygen is portable X-ray: dense opacity in upper right lobe , next ??	Respiratory isolation ( TB high suspicion) , if continue bleeding put him on lateral position and do bronchoscopy to Dx and Rx.
	Fresh frozen plasma indicated if the INR is	> 1.5
	Pulmonary symptoms, with right arm pain	Superior pulmonary sulcus tumor ( pancoast tumors)
	50, fatigue, sleep during day,, doesn’t sleep well at night, morning headache , smoking history, BMI 36 , next??	Nocturnal polysomnography ( the gold standard for OSA)
	Asthma exacerbation treated with albuterol and IV methylprednisolone, the next day she developed high leukocytosis with bands form ??	Medication effect ( steroids)
	Left sided chest discomfort, history of accident 2 months ago , X-ray : mediastinal deviation , next ??	CT of chest and abdomen ( to role out diaphragm rupture)
	19, has asthma-like symptoms after Twice a week workout sessions???	Exercise induced bronchoconstriction Rx: inhaled albuterol 10 minutes before exercise Ps: if she exercise daily then she should use inhaled corticosteroids.
	HIV, noncompliant with treatment, pulmonary symptoms( PCP), given abx and 5 L normal saline, after 2 days he developed hyponatremia with confusion???	SIADH which happens in euvolemia state
	Pneumonia symptoms on the left side , the oxygen saturation is normal when lying on right side, but it decreased when lying of the left side ( affected side ) , why ??	Intrapulmonary shunting ( right to left) of blood due to gravity
	6th rib fracture, base atelectasis , best essential Rx??	Pain control to maintain adequate ventilation
	Immigrant, Persistent cough, dyspnea for 3 months, E: crackles, enlarged cardiac silhouette with vascular congestion, left main bronchus is elevated, irregular rhythm on ECG ??	Mitral stenosis caused by rheumatic heart disease
	8, chronic smoker, have progressive SOB and wheezing for 2 days, E: using accessory muscle in breathing, normal vital, auscultation: decreased???	Chronic obstructive pulmonary disease exacerbation.
	Accident, Respiratory distress, bilateral coarse breath sounds, X-ray: multiple ribs fractures ?	Flail chest
	Sleep apnea treatment	Weight reduction, avoid sleep in supine .
	Recurrent sinusitis and otitis despite antibiotics, joint and back pain, urinary symptoms???	Granulomatosis with polyangiitis Dx: ANCA( quantitive serum autoantibodies
	Compensation of respiratory acidosis ???	Renal bicarbonate retention ( metabolic alkalosis)
	Newborn, preterm, delivered at 28 weeks, has central cyanosis, bilateral breath sounds are diminished , grunting,flaring, retraction, X-ray: diffuse reticular granular opacities bilaterally ??	Respiratory distress syndrome Rx: early continuous positive air pressure
	6 months of dry cough and worsening dyspnea, late expiratory crackles, digital clubbing, no accompanying etiology , what is the abnormality???	Increased alveolar-arterial gradient ( interstitial lung disease) due to idiopathic fibrosis
	Front (Term)	Laryngeal edema ( fixed upper airway obstruction) due to food allergies Rx: epinephrine, corticosteroids, antihistamines
	Front (Term)	Back (Definition)
	Child, difficulty breathing development, rhinorrhea, congestion dry cough ( barking dog ), stridor at rest, Rx ???	Racemic epinephrine ( croup) Ps: if no stridor ( humidified air )
	Accident, Respiratory distress, bilateral coarse breath sounds, X-ray: multiple ribs fractures ?	Flail chest
	Management of ARDS treated with mechanical ventilation complications	Low tidal volume ventilation which leads to decreased overdistending alveoli ( improves mortality)
	63, cough , wheezing, yellow sputum, lost weight, smoking history, prominent fingers clubbing that wasn’t 6 months ago, why the digital clubbing ??	Occult malignancy
	1 hour baby, respiratory distress symptoms, however he has intercostal retraction and clear breath sounds, X-ray: fluid in the interlobar fissures	Transient tachypnea of newborn ( delayed resorption and clearance of alveolar fluid) Rx: supportive
	COPD decreased vital capacity cause ?	Progressive expiratory airflow limitation( air trapping)
	6 months of dry cough and worsening dyspnea, late expiratory crackles, digital clubbing, no accompanying etiology , what is the abnormality???	Increased alveolar-arterial gradient ( interstitial lung disease) due to idiopathic fibrosis
	Front (Term)	Laryngeal edema ( fixed upper airway obstruction) due to food allergies Rx: epinephrine, corticosteroids, antihistamines
	Front (Term)	Back (Definition)
	60, pulmonary symptoms, decreased FEV1/FVC, DLCO is normal????	COPD ( chronic bronchitis) لا تنخدع بمهنة المريض، خلي تركيزك عالفحص الصدري Ps: if DLCO decreased ( emphysema)
	Left sided chest discomfort, history of accident 2 months ago , X-ray : mediastinal deviation , next ??	CT of chest and abdomen ( to role out diaphragm rupture)
	38, progressive SOB, cough with mucoid for 6 months, no wheezing, no other symptoms, X-ray: bilateral basilar lucency, next ??	Serum alpha-1 antitrypsin deficiency.
	Silicosis symptoms ( stone worker) with TB symptoms With kidney symptoms, upper airway involved ( trachea) ???	Granulomatosis with polyangiitis Dx: ANCA , biopsy Rx: corticosteroids, methotrexate, cyclophosphamide
	Immigrant, hemoptysis, with cough and foamy sputum, IV fluids and oxygen is portable X-ray: dense opacity in upper right lobe , next ??	Respiratory isolation ( TB high suspicion) , if continue bleeding put him on lateral position and do bronchoscopy to Dx and Rx.
	Fresh frozen plasma indicated if the INR is	> 1.5
	Pulmonary symptoms, with right arm pain	Superior pulmonary sulcus tumor ( pancoast tumors)
	50, fatigue, sleep during day,, doesn’t sleep well at night, morning headache , smoking history, BMI 36 , next??	Nocturnal polysomnography ( the gold standard for OSA)
	Asthma exacerbation treated with albuterol and IV methylprednisolone, the next day she developed high leukocytosis with bands form ??	Medication effect ( steroids)
	Left sided chest discomfort, history of accident 2 months ago , X-ray : mediastinal deviation , next ??	CT of chest and abdomen ( to role out diaphragm rupture)
	19, has asthma-like symptoms after Twice a week workout sessions???	Exercise induced bronchoconstriction Rx: inhaled albuterol 10 minutes before exercise Ps: if she exercise daily then she should use inhaled corticosteroids.
	HIV, noncompliant with treatment, pulmonary symptoms( PCP), given abx and 5 L normal saline, after 2 days he developed hyponatremia with confusion???	SIADH which happens in euvolemia state
	Pneumonia symptoms on the left side , the oxygen saturation is normal when lying on right side, but it decreased when lying of the left side ( affected side ) , why ??	Intrapulmonary shunting ( right to left) of blood due to gravity
	6th rib fracture, base atelectasis , best essential Rx??	Pain control to maintain adequate ventilation
	3- weeks of hacking, nonproductive cough , sensation of dripping into back of his neck, no other symptoms, next ?	Oral antihistamine first generation ( upper airway cough syndrome)
	Flattering diaphragm in COPD leads to ??	Increase work of breathing
	Elasticity and compliance in COPD	Decreased elasticity Increased compliance
	Infant, doesn’t gain weight, loose oily bowel movement, has pulmonary symptoms, had pneumonia month ago, small boy, what other findings???	Absence of bilateral vas deferens ( male infertility ) by cystic fibrosis Dx: elevation sweat chloride Rx: airway clearance, broad spectrum abx ( staph, pseudo)
	Pulmonary right sided symptoms, Pleural effusion: glucose < 60, pH< 7.2 , LDH 620 ??	Pneumonia with complicated( exudate) parapneumonic effusion Rx: abx and drainage
	34, hemoptysis, sudden right- sided chest pain with dyspnea, pain increase with deep breathing, history of HIV, heroin, cellulitis, CD4 is 350, tachycardia???	Pulmonary thromboembolism
	35, fell on stairs, having pain in shoulder, X-ray: reveals normal shoulder and 1.5 cm lesion in the right lung , next ?	Ask for previous X-ray for comparison ( absence of growth over 2-3 years rules out malignancy) if previous X-ray not available do CT
	Pulmonary function test in chronic lung disease	Back (Definition)
	56, progressive exertional dyspnea,no Pulmonary symptoms, insulation and plumbing worker, digital clubbing, bibasilar crackles, the PFTs finding ??	Decreased diffusion lung capacity( asbestosis) Dx: pleural plaques on imaging
	60, undergoing surgery, he vomited during intubation, after 4 hours postoperative he becomes tachypnea and hypoxia, bilateral crackles??	Inflammatory reaction to aspirated gastric acid (pneumonitis ) Rx: supportive Ps: aspiration pneumonia: infection after days, fever, Rx ( antibiotics)
	Flattering diaphragm in COPD leads to ??	Increase work of breathing
	24, evaluation of PFTs due to dyspnea, low back pain improves with activity, FEV1/FVC 95%, Vital capacity is decreased???	Chest wall motion restriction due to ankylosing spondylitis
	Ct scan of solitary nodule management	Benign: serial CT scans Intermediate suspicious of malignancy: biopsy or PET scan High suspicious for malignancy: surgical excision
	Fat embolism characteristics	Respiratory distress, neurological abnormalities, petechial rash
	Accident, symptoms...etc, Po2 was 81, after giving fluids the PO2 becomes 75, bilateral diffuse rales in both lungs??	Pulmonary contusion
	65, lung nodule irregular without calcification , smoking history, 2-cm, in the right lower lobe , Best next step ??	Surgical excision ( high suspicious malignancy)
	Solitary pulmonary nodule on routine chest X-ray chart page 534	Back (Definition)
	Causes of hypoxemia page 571	571
	Complications of positive pressure ventilation for ARDS	Alveolar damage, pneumothorax, hypotension
	ARDS Patient, after giving positive pressure ventilation developed SOB , hypotension, tachycardia, tracheal deviation, unilateral breath sound absence??	Pneumothorax
	Postpartum cesarean sudden onset of severe dyspnea and right sided chest pain , moderate respiratory distress, ECG sinus tachy , next ??	IV heparin ( not CT angiogram because the patient is moderate distress and there is not contraindications for anticoagulant) after heparin do the CT ..
	COPD acute exacerbation management ( severe and moderate) ??	Oxygen, inhaled bronchodilator, systemic corticosteroids, Abx( if > 2 symptoms), oseltamivir( if influenza), NPPV( if ventilatory failure, tracheal intubation NPPV: noninvasive positive pressure ventilation
	COPD, sudden severe dyspnea and right sided chest pain, E: no tracheal deviation, tactile fremitus and breath sounds are decreased in right side , wheezing in left, why ??	Rupture of an apical alveolar bleb( secondary spontaneous pneumothorax )
	34, hemoptysis, sudden right- sided chest pain with dyspnea, pain increase with deep breathing, history of HIV, heroin, cellulitis, CD4 is 350, tachycardia???	Pulmonary thromboembolism
	Accident, Hypotension, tachycardia, tachypnea, trachea shifted to right, on left absent breath sound and dullness???	Hemothorax
	Pulmonary function test in chronic lung disease	Back (Definition)
	68, Navy worker, progressive dyspnea dry cough for a year, fine crackles ?	Idiopathic Pulmonary fibrosis due to restrictive profile ( decreased DLCO and TLC, normal FEV1/FVC )
	40, exertional dyspnea for 6 months, decreased breath sounds, mild LFTs elevated, his father died from cirrhosis ???	Alpha-1 antitrypsin deficiency
	3- weeks of hacking, nonproductive cough , sensation of dripping into back of his neck, no other symptoms, next ?	Oral antihistamine first generation ( upper airway cough syndrome)
	Flattering diaphragm in COPD leads to ??	Increase work of breathing
	Elasticity and compliance in COPD	Decreased elasticity Increased compliance
	Infant, doesn’t gain weight, loose oily bowel movement, has pulmonary symptoms, had pneumonia month ago, small boy, what other findings???	Absence of bilateral vas deferens ( male infertility ) by cystic fibrosis Dx: elevation sweat chloride Rx: airway clearance, broad spectrum abx ( staph, pseudo)
	Pulmonary right sided symptoms, Pleural effusion: glucose < 60, pH< 7.2 , LDH 620 ??	Pneumonia with complicated( exudate) parapneumonic effusion Rx: abx and drainage
	34, hemoptysis, sudden right- sided chest pain with dyspnea, pain increase with deep breathing, history of HIV, heroin, cellulitis, CD4 is 350, tachycardia???	Pulmonary thromboembolism
	35, fell on stairs, having pain in shoulder, X-ray: reveals normal shoulder and 1.5 cm lesion in the right lung , next ?	Ask for previous X-ray for comparison ( absence of growth over 2-3 years rules out malignancy) if previous X-ray not available do CT
	Pulmonary function test in chronic lung disease	Back (Definition)
	56, progressive exertional dyspnea,no Pulmonary symptoms, insulation and plumbing worker, digital clubbing, bibasilar crackles, the PFTs finding ??	Decreased diffusion lung capacity( asbestosis) Dx: pleural plaques on imaging
	60, undergoing surgery, he vomited during intubation, after 4 hours postoperative he becomes tachypnea and hypoxia, bilateral crackles??	Inflammatory reaction to aspirated gastric acid (pneumonitis ) Rx: supportive Ps: aspiration pneumonia: infection after days, fever, Rx ( antibiotics)
	Flattering diaphragm in COPD leads to ??	Increase work of breathing
	24, evaluation of PFTs due to dyspnea, low back pain improves with activity, FEV1/FVC 95%, Vital capacity is decreased???	Chest wall motion restriction due to ankylosing spondylitis
	Ct scan of solitary nodule management	Benign: serial CT scans Intermediate suspicious of malignancy: biopsy or PET scan High suspicious for malignancy: surgical excision
	Fat embolism characteristics	Respiratory distress, neurological abnormalities, petechial rash
	Accident, symptoms...etc, Po2 was 81, after giving fluids the PO2 becomes 75, bilateral diffuse rales in both lungs??	Pulmonary contusion
	65, lung nodule irregular without calcification , smoking history, 2-cm, in the right lower lobe , Best next step ??	Surgical excision ( high suspicious malignancy)
	Solitary pulmonary nodule on routine chest X-ray chart page 534	Back (Definition)
	Causes of hypoxemia page 571	571
	Complications of positive pressure ventilation for ARDS	Alveolar damage, pneumothorax, hypotension
	ARDS Patient, after giving positive pressure ventilation developed SOB , hypotension, tachycardia, tracheal deviation, unilateral breath sound absence??	Pneumothorax
	اللهم نجحني	اللهم اجعلني من المتفوقين يا الله
	Postpartum cesarean sudden onset of severe dyspnea and right sided chest pain , moderate respiratory distress, ECG sinus tachy , next ??	IV heparin ( not CT angiogram because the patient is moderate distress and there is not contraindications for anticoagulant) after heparin do the CT ..
	COPD acute exacerbation management ( severe and moderate) ??	Oxygen, inhaled bronchodilator, systemic corticosteroids, Abx( if > 2 symptoms), oseltamivir( if influenza), NPPV( if ventilatory failure, tracheal intubation NPPV: noninvasive positive pressure ventilation
	COPD, sudden severe dyspnea and right sided chest pain, E: no tracheal deviation, tactile fremitus and breath sounds are decreased in right side , wheezing in left, why ??	Rupture of an apical alveolar bleb( secondary spontaneous pneumothorax )
	34, hemoptysis, sudden right- sided chest pain with dyspnea, pain increase with deep breathing, history of HIV, heroin, cellulitis, CD4 is 350, tachycardia???	Pulmonary thromboembolism
	Accident, Hypotension, tachycardia, tachypnea, trachea shifted to right, on left absent breath sound and dullness???	Hemothorax
	Pulmonary function test in chronic lung disease	Back (Definition)
	68, Navy worker, progressive dyspnea dry cough for a year, fine crackles ?	Idiopathic Pulmonary fibrosis due to restrictive profile ( decreased DLCO and TLC, normal FEV1/FVC )
	40, exertional dyspnea for 6 months, decreased breath sounds, mild LFTs elevated, his father died from cirrhosis ???	Alpha-1 antitrypsin deficiency
	3- weeks of hacking, nonproductive cough , sensation of dripping into back of his neck, no other symptoms, next ?	Oral antihistamine first generation ( upper airway cough syndrome)
	Flattering diaphragm in COPD leads to ??	Increase work of breathing
	Elasticity and compliance in COPD	Decreased elasticity Increased compliance
	Infant, doesn’t gain weight, loose oily bowel movement, has pulmonary symptoms, had pneumonia month ago, small boy, what other findings???	Absence of bilateral vas deferens ( male infertility ) by cystic fibrosis Dx: elevation sweat chloride Rx: airway clearance, broad spectrum abx ( staph, pseudo)
	Pulmonary right sided symptoms, Pleural effusion: glucose < 60, pH< 7.2 , LDH 620 ??	Pneumonia with complicated( exudate) parapneumonic effusion Rx: abx and drainage
	22, 188cm, BMI 19, sudden dyspnea while watching tv, the dyspnea gradual improves but still the sharp pain with deep inspiration, X-ray: small right apical pneumothorax , Rx?	Supplement oxygen ( primary spontaneous pneumothorax) Dx: visceral pleural line on X-ray Ps:: If Large and stable patient: ( needle thoracostomy) If unstable: tube thoracostomy
	35, fell on stairs, having pain in shoulder, X-ray: reveals normal shoulder and 1.5 cm lesion in the right lung , next ?	Ask for previous X-ray for comparison ( absence of growth over 2-3 years rules out malignancy) if previous X-ray not available do CT
	Solitary pulmonary nodule on routine chest X-ray chart page 534	Back (Definition)
	56, progressive exertional dyspnea,no Pulmonary symptoms, insulation and plumbing worker, digital clubbing, bibasilar crackles, the PFTs finding ??	Decreased diffusion lung capacity( asbestosis) Dx: pleural plaques on imaging
	60, undergoing surgery, he vomited during intubation, after 4 hours postoperative he becomes tachypnea and hypoxia, bilateral crackles??	Inflammatory reaction to aspirated gastric acid (pneumonitis ) Rx: supportive Ps: aspiration pneumonia: infection after days, fever, Rx ( antibiotics)
	Solitary nodule round with sharp borders 1cm, previous 3 years X-ray was normal, next?	CT of the chest
	24, evaluation of PFTs due to dyspnea, low back pain improves with activity, FEV1/FVC 95%, Vital capacity is decreased???	Chest wall motion restriction due to ankylosing spondylitis
	Ct scan of solitary nodule management	Benign: serial CT scans Intermediate suspicious of malignancy: biopsy or PET scan High suspicious for malignancy: surgical excision
	Fat embolism characteristics	Respiratory distress, neurological abnormalities, petechial rash
	Accident, symptoms...etc, Po2 was 81, after giving fluids the PO2 becomes 75, bilateral diffuse rales in both lungs??	Pulmonary contusion
	65, lung nodule irregular without calcification , smoking history, 2-cm, in the right lower lobe , Best next step ??	Surgical excision ( high suspicious malignancy)
	53, several days of SOB, productive cough, uses heroin IV, fever, oxygen saturation is 89%, extensive white plaques on oral mucosa, bilateral crackles, mechanism of hypoxemia ??	Ventilation/ perfusion mismatch ( right to left intrapulmonary shunt) due to pneumonia ( mostly PCP)
	Causes of hypoxemia page 571	571
	Complications of positive pressure ventilation for ARDS	Alveolar damage, pneumothorax, hypotension
	ARDS Patient, after giving positive pressure ventilation developed SOB , hypotension, tachycardia, tracheal deviation, unilateral breath sound absence??	Pneumothorax
	اللهم نجحني	اللهم اجعلني من المتفوقين يا الله
	Postpartum cesarean sudden onset of severe dyspnea and right sided chest pain , moderate respiratory distress, ECG sinus tachy , next ??	IV heparin ( not CT angiogram because the patient is moderate distress and there is not contraindications for anticoagulant) after heparin do the CT ..
	COPD acute exacerbation management ( severe and moderate) ??	Oxygen, inhaled bronchodilator, systemic corticosteroids, Abx( if > 2 symptoms), oseltamivir( if influenza), NPPV( if ventilatory failure, tracheal intubation NPPV: noninvasive positive pressure ventilation
	COPD, sudden severe dyspnea and right sided chest pain, E: no tracheal deviation, tactile fremitus and breath sounds are decreased in right side , wheezing in left, why ??	Rupture of an apical alveolar bleb( secondary spontaneous pneumothorax )
	34, hemoptysis, sudden right- sided chest pain with dyspnea, pain increase with deep breathing, history of HIV, heroin, cellulitis, CD4 is 350, tachycardia???	Pulmonary thromboembolism
	Accident, Hypotension, tachycardia, tachypnea, trachea shifted to right, on left absent breath sound and dullness???	Hemothorax
	Pulmonary function test in chronic lung disease	Back (Definition)
	68, Navy worker, progressive dyspnea dry cough for a year, fine crackles ?	Idiopathic Pulmonary fibrosis due to restrictive profile ( decreased DLCO and TLC, normal FEV1/FVC )
	40, exertional dyspnea for 6 months, decreased breath sounds, mild LFTs elevated, his father died from cirrhosis ???	Alpha-1 antitrypsin deficiency
	54, chronic cough and blood sputum, weight loss, fatigue, X-ray: hilar mass in left lung, hypercalcemia ????	Squamous cell carcinoma
	Paraneoplastic syndromes in small cell carcinoma of lung ??	ACTH, SIADH
	Child, same cystic fibrosis symptoms ( recurrent infections), point of maximal impulse is on right chest ???	Kartagener syndrome ( primary ciliary dyskinesia) Dx: low nasal nitric acid
	Asthma exacerbation, given inhaled albuterol and systemic steroids intubated, after 6 hours the attack is gone and she can’t rise her arms above head , tremor, next??	Serum electrolytes ( albuterol causes hypokalemia)
	13 day, clear runny nose, cough , E: bilateral wheezing and crackles, complication??	Apnea ( bronchiolitis caused by respiratory syncytial virus) Rx: supportive Prevention: palivizumab
	Child, Situs inversus, recurrent sinusitis, bronchiectasis ??	Kartagener syndrome
	Postoperative day, oxygen saturation 89%, respiratory acidosis???	Alveolar hypoventilation
	Normal A-a gradient ( PAO2-PaO2)	< 15 If > 30 it’s considered elevated
	33, repeated episodes of generalized symptoms with pulmonary symptoms for 6 months, comes suddenly and last several days, she breeds budgerigars, serology: antibodies to the bird antigen, Rx?	Avoid exposure to birds ( hypersensitivity pneumonitis )
	36, dyspnea on exertion, lungs are clear, X-ray: prominent pulmonary arteries, enlarged right heart??	Primary Pulmonary hypertension
	COPD exacerbation, treated with oxygen, IV antibiotics, ...etc, but she still dyspneic and use accessory muscles, she still alert , next ??	Start noninvasive positive pressure ventilation ( decreased mortality), if failed do mechanical ventilation
	55, recurrent pneumonia in last 4 months, and now also , smoking, leukocytosis, fever previous and current X-ray reveal consolidation in right lower lung( same place ) next?	CT scan to role out malignancy ( localized airway obstruction)
	COPD exacerbation, treated with oxygen, IV antibiotics, ...etc, but she still dyspneic and use accessory muscles, she still alert , next ??	Start noninvasive positive pressure ventilation ( decreased mortality), if failed do mechanical ventilation
	Asthma patient taking albuterol, he has 3-4 night symptoms in month, next step ?	Add corticosteroids
	Child, same cystic fibrosis symptoms ( recurrent infections), point of maximal impulse is on right chest ???	Kartagener syndrome ( primary ciliary dyskinesia) Dx: low nasal nitric acid
	Asthma exacerbation, given inhaled albuterol and systemic steroids intubated, after 6 hours the attack is gone and she can’t rise her arms above head , tremor, next??	Serum electrolytes ( albuterol causes hypokalemia)
	13 day, clear runny nose, cough , E: bilateral wheezing and crackles, complication??	Apnea ( bronchiolitis caused by respiratory syncytial virus) Rx: supportive Prevention: palivizumab
	يا رحمن يا رحيم ، يا غفور يا كريم	اكتبني من الناجحين المتفوقين في الامتحان يا الله
	Child, Situs inversus, recurrent sinusitis, bronchiectasis ??	Kartagener syndrome
	Postoperative day, oxygen saturation 89%, respiratory acidosis???	Alveolar hypoventilation
	Normal A-a gradient ( PAO2-PaO2)	< 15 If > 30 it’s considered elevated
	33, repeated episodes of generalized symptoms with pulmonary symptoms for 6 months, comes suddenly and last several days, she breeds budgerigars, serology: antibodies to the bird antigen, Rx?	Avoid exposure to birds ( hypersensitivity pneumonitis )
	COPD exacerbation, treated with oxygen, IV antibiotics, ...etc, but she still dyspneic and use accessory muscles, she still alert , next ??	Start noninvasive positive pressure ventilation ( decreased mortality), if failed do mechanical ventilation
	Asthma exacerbation, pH: 7.43, PaO2: 65, PaCO2: 40, which indicator of patient getting worse ??	Normal PaCO2 ( because in asthma exacerbation usually respiratory alkalosis developed, which means the PaCO2 must be low ) Ps: if PaCO2 is normal or elevated in asthma exacerbation it’s mean respiratory failure
	55, recurrent pneumonia in last 4 months, and now also , smoking, leukocytosis, fever previous and current X-ray reveal consolidation in right lower lung( same place ) next?	CT scan to role out malignancy ( localized airway obstruction)
	COPD exacerbation, treated with oxygen, IV antibiotics, ...etc, but she still dyspneic and use accessory muscles, she still alert , next ??	Start noninvasive positive pressure ventilation ( decreased mortality), if failed do mechanical ventilation
	Asthma patient taking albuterol, he has 3-4 night symptoms in month, next step ?	Add corticosteroids
	Child, same cystic fibrosis symptoms ( recurrent infections), point of maximal impulse is on right chest ???	Kartagener syndrome ( primary ciliary dyskinesia) Dx: low nasal nitric acid
	Asthma exacerbation, given inhaled albuterol and systemic steroids intubated, after 6 hours the attack is gone and she can’t rise her arms above head , tremor, next??	Serum electrolytes ( albuterol causes hypokalemia)
	13 day, clear runny nose, cough , E: bilateral wheezing and crackles, complication??	Apnea ( bronchiolitis caused by respiratory syncytial virus) Rx: supportive Prevention: palivizumab
	يا رحمن يا رحيم ، يا غفور يا كريم	اكتبني من الناجحين المتفوقين في الامتحان يا الله
	Child, Situs inversus, recurrent sinusitis, bronchiectasis ??	Kartagener syndrome
	Postoperative day, oxygen saturation 89%, respiratory acidosis???	Alveolar hypoventilation
	Normal A-a gradient ( PAO2-PaO2)	< 15 If > 30 it’s considered elevated
	33, repeated episodes of generalized symptoms with pulmonary symptoms for 6 months, comes suddenly and last several days, she breeds budgerigars, serology: antibodies to the bird antigen, Rx?	Avoid exposure to birds ( hypersensitivity pneumonitis )
	COPD exacerbation, treated with oxygen, IV antibiotics, ...etc, but she still dyspneic and use accessory muscles, she still alert , next ??	Start noninvasive positive pressure ventilation ( decreased mortality), if failed do mechanical ventilation
	Asthma exacerbation, pH: 7.43, PaO2: 65, PaCO2: 40, which indicator of patient getting worse ??	Normal PaCO2 ( because in asthma exacerbation usually respiratory alkalosis developed, which means the PaCO2 must be low ) Ps: if PaCO2 is normal or elevated in asthma exacerbation it’s mean respiratory failure
	55, recurrent pneumonia in last 4 months, and now also , smoking, leukocytosis, fever previous and current X-ray reveal consolidation in right lower lung( same place ) next?	CT scan to role out malignancy ( localized airway obstruction)
	COPD exacerbation, treated with oxygen, IV antibiotics, ...etc, but she still dyspneic and use accessory muscles, she still alert , next ??	Start noninvasive positive pressure ventilation ( decreased mortality), if failed do mechanical ventilation
	Asthma patient taking albuterol, he has 3-4 night symptoms in month, next step ?	Add corticosteroids
	Respiratory distress syndrome in infant risk factor??	Prematurity, maternal DM
	24, worsening productive cough with tenacious sputum, fever, SOB for a week, hemoptysis, had these symptoms before improving with abx but never gone , E: Upper lung fields crackles, digital clubbing, cause ??	Defective chloride channel ( Bronchiectasis caused by CF) Dx: High resolution CT
	31, SOB, anxiety, no others symptoms, the symptoms resolved after one hour, next ?	D-dimer ( if normal: reassurance, if elevated follow up)
	38, dry cough , malaise, bilateral hilar adenopathy ??	Sarcoidosis ( noncaseating granulomatous inflammation)
	Mechanical ventilation, FiO2 is 70%, PaO2: 54, PaCO2: 30, next ?	Increase PEEP to maintain the oxygenation( ps: u can also increase the FiO2 but when it’s < 60)
	69, SOB, cough, Edema, faint heart sound, JVD: 11, decreased breath sounds, hepatomegaly and ascites, X-ray: enlargement of central pulmonary arteries????	Cor pulmonale ( isolated right heart failure due to pulmonary hypertension)
	The indication for initiation long term home oxygen therapy?	Oxygen saturation < 88
	Indications for long term oxygen therapy	1. PaO2< 55 or SaO2 < 88 2. (PaO2 < 59 or SaO2< 89) with hematocrit > 55
	53, 2 episodes of hemoptysis, history of 2 years morning cough producing white sputum, smoker, construction?	Chronic bronchitis
	55, fever, SOB, productive cough, foul smelling sputum, history of acute pancreatitis, Bar fight, E: missing teeth, dense lower lobe infiltrate??	Aspiration pneumonia due to alcoholism
	12, bee sting, developed full body hives, difficulty breathing, vomiting, history of moderate persistent asthma, after giving im epinephrine she got better, after 10 minutes the symptoms returned, next ?	Im epinephrine ( as needed) for anaphylaxis Prevention: venom immunotherapy
	Newborn in respiratory distress syndrome, BP 70/40, nasal flaring, grunting, absent breath sound on the left, scaphoid abdomen, next ??	Endotracheal intubation ( congenital diaphragmatic hernia), then gastric tube to decompress the bowel
	Postoperative cough and some sputum, E: decreased breath sounds at right lung base without wheezing or prolonged expiration, arterial blood gases will be ???	Decreased PCO2 and PO2, increased pH ( respiratory alkalosis due to atelectasis) Rx and preoperative prevention: breathing exercise
	42, difficulty breathing and wheezing, history of persistent nasal blockage, had angina 6 months ago which taking medications ( aspirin,atovarsatin ..etc) , why the respiratory symptoms???	Pseudoallergic drug reaction ( aspirin respiratory disease) Rx: stop NSAIDs, use leukotriene receptor antagonists( montelukast)
	Postoperative, so many symptoms ( hypotension, leukocytosis, Fever...etc) , next step?	IV normal saline 0.9%( for hypertension caused by septic shock) , then vasopressors( dopamine)
	Shoulder pain, hand pain with chronic pulmonary symptoms , horner syndrome, next ??	chest X-ray ( Superior pulmonary sulcus tumors of lung)
	COPD increased survival interventions??	Long-term supplemental oxygen ( for significant hypoxemia ) Ps: significant hypoxemia( 1. PaO2< 55 or SaO2< 88, 2. If none there and hematocrit > 55
	Right upper lobe perfusion defect with good ventilation, the GFR is 20 ( < 30 ), Rx?	Unfractionated heparin ( due to renal insufficiency)
	Patient on mechanical ventilation, FiO2 is 80%, PaO2 is 105, PaCo2 is 37 , next ??	Decrease fraction of inspiration oxygen below 60% (FiO2 < 60%) to prevent oxygen toxicity
	Asthma patient, progressive asthma symptoms, no dyspnea , her throat is sore and hoarseness that resolves during the day , next ?	Add omeprazole ( comorbid GERD causing asthma exacerbation)
	Respiratory distress syndrome in infant risk factor??	Prematurity, maternal DM
	24, worsening productive cough with tenacious sputum, fever, SOB for a week, hemoptysis, had these symptoms before improving with abx but never gone , E: Upper lung fields crackles, digital clubbing, cause ??	Defective chloride channel ( Bronchiectasis caused by CF) Dx: High resolution CT
	31, SOB, anxiety, no others symptoms, the symptoms resolved after one hour, next ?	D-dimer ( if normal: reassurance, if elevated follow up)
	38, dry cough , malaise, bilateral hilar adenopathy ??	Sarcoidosis ( noncaseating granulomatous inflammation)
	Mechanical ventilation, FiO2 is 70%, PaO2: 54, PaCO2: 30, next ?	Increase PEEP to maintain the oxygenation( ps: u can also increase the FiO2 but when it’s < 60)
	69, SOB, cough, Edema, faint heart sound, JVD: 11, decreased breath sounds, hepatomegaly and ascites, X-ray: enlargement of central pulmonary arteries????	Cor pulmonale ( isolated right heart failure due to pulmonary hypertension)
	The indication for initiation long term home oxygen therapy?	Oxygen saturation < 88
	Indications for long term oxygen therapy	1. PaO2< 55 or SaO2 < 88 2. (PaO2 < 59 or SaO2< 89) with hematocrit > 55
	53, 2 episodes of hemoptysis, history of 2 years morning cough producing white sputum, smoker, construction?	Chronic bronchitis
	55, fever, SOB, productive cough, foul smelling sputum, history of acute pancreatitis, Bar fight, E: missing teeth, dense lower lobe infiltrate??	Aspiration pneumonia due to alcoholism
	12, bee sting, developed full body hives, difficulty breathing, vomiting, history of moderate persistent asthma, after giving im epinephrine she got better, after 10 minutes the symptoms returned, next ?	Im epinephrine ( as needed) for anaphylaxis Prevention: venom immunotherapy
	Newborn in respiratory distress syndrome, BP 70/40, nasal flaring, grunting, absent breath sound on the left, scaphoid abdomen, next ??	Endotracheal intubation ( congenital diaphragmatic hernia), then gastric tube to decompress the bowel
	Collision, pulse oximetry 88, no tracheal deviation, several chest wall bruises, right chest moves inward during inspiration, decreased breath sounds??	Rib fractures( > 3 ) leading to flail chest Rx: pain control, oxygen
	Asthma patient, difficulty in breathing one hour ago, had antibiotic earlier this morning for upper respiratory infection, hypotension, E: urticarial rash over the body, next ??	Im epinephrine ( anaphylaxis due to allergy to antibiotics)
	COPD exacerbation management	Bronchodilators( B-agonist and anticholinergic) and Systemic glucocorticoids ( methylprednisolone) , oxygen...
	53, plumber, smoking history, 4 months of progressive dyspnea, weight loss, E: bilateral pleural plaques, 6 cm cavity mass in right lower lung ??	Bronchogenic carcinoma ( asbestos exposure)
	Collision, unresponsive, BP is 70/30, no tracheal deviation, extremities are cold, tachycardia, what also ??	Small left ventricle with ejection fraction of 75%
	Cough with blood tinged sputum, history of malaise congestion sore throat 10 days ago, no other findings, X-ray normal, scattered bilateral wheezing and crackles clear with cough , next ??	Symptomatic treatment only ( acute bronchitis caused by upper respiratory viral infection ), don’t use abx
	ACEi using, chronic nonproductive cough ??	Side effect by increasing levels of kinins, substance P, prostaglandins, thromboxane
	History of cancer, unconscious, severe hypotension, elevated pulmonary artery and right atrial pressure, normal PCWP ????	Pulmonary embolism If PCWP is elevated the cause will be left ventricle dysfunction
	Elevated PCWP means?	Left ventricle dysfunction
	66, exertional dyspnea for 2 years, recurrent cough productive of whitish sputum, E: scattered expiratory wheezing, Rx??	Muscarinic antagonist ( COPD)
	Postoperative cough and some sputum, E: decreased breath sounds at right lung base without wheezing or prolonged expiration, arterial blood gases will be ???	Decreased PCO2 and PO2, increased pH ( respiratory alkalosis due to atelectasis) Rx and preoperative prevention: breathing exercise
	37, transplant, cough with bright blood, fever, pleuritic pain, E: right upper lobe dense infiltrate grown in size, CT: several nodular lesions with surrounding ground-glass( halo sign) opacities ??	Invasive aspergillosis Rx: voriconazole and caspofungin
	54, fatigue, cough with blood for few months , weight loss , immigrant treated for TB 10 years ago ??	Chronic pulmonary aspergillosis Dx: IgG aspergillus serology
	COPD exacerbation, oxygen saturation 91%, given medications with high facial mask oxygen,he developed seizure why ??	Carbon dioxide retention ( due to supplemental oxygen causing V/Q mismatch)
	PE Patient with obesity on further evaluation what the arterial blood gas gradient??	High alveolar-arterial gradient
	COPD exacerbation acid-base status??	Respiratory acidosis , widespread wheezing
	66, SOB, history of hypertension, stenting , E: decreased breath sounds at bases, bilateral crackles, occasional wheezes, respiratory alkalosis, ???	CHF
	Transudate vs exudate effusion	Transudate: decreased oncotic pressures, elevated hydrostatic Exudate: increased permeability, disruption to lymphatic outflow
	Exudate criteria	Protein ( pleural/ serum) > 5 or LDH( pleural/serum) > 0.6 or Pleural LDH > two thirds upper limit of normal serum LDH
	54, fatigue, cough with blood for few months , weight loss , immigrant treated for TB 10 years ago ??	Chronic pulmonary aspergillosis Dx: IgG aspergillus serology
	42, difficulty breathing and wheezing, history of persistent nasal blockage, had angina 6 months ago which taking medications ( aspirin,atovarsatin ..etc) , why the respiratory symptoms???	Pseudoallergic drug reaction ( aspirin respiratory disease) Rx: stop NSAIDs, use leukotriene receptor antagonists( montelukast)
	Postoperative, so many symptoms ( hypotension, leukocytosis, Fever...etc) , next step?	IV normal saline 0.9%( for hypertension caused by septic shock) , then vasopressors( dopamine)
	Shoulder pain, hand pain with chronic pulmonary symptoms , horner syndrome, next ??	chest X-ray ( Superior pulmonary sulcus tumors of lung)
	COPD increased survival interventions??	Long-term supplemental oxygen ( for significant hypoxemia ) Ps: significant hypoxemia( 1. PaO2< 55 or SaO2< 88, 2. If none there and hematocrit > 55
	Right upper lobe perfusion defect with good ventilation, the GFR is 20 ( < 30 ), Rx?	Unfractionated heparin ( due to renal insufficiency)
	Patient on mechanical ventilation, FiO2 is 80%, PaO2 is 105, PaCo2 is 37 , next ??	Decrease fraction of inspiration oxygen below 60% (FiO2 < 60%) to prevent oxygen toxicity
	Asthma patient, progressive asthma symptoms, no dyspnea , her throat is sore and hoarseness that resolves during the day , next ?	Add omeprazole ( comorbid GERD causing asthma exacerbation)
	Respiratory distress syndrome in infant risk factor??	Prematurity, maternal DM
	24, worsening productive cough with tenacious sputum, fever, SOB for a week, hemoptysis, had these symptoms before improving with abx but never gone , E: Upper lung fields crackles, digital clubbing, cause ??	Defective chloride channel ( Bronchiectasis caused by CF) Dx: High resolution CT
	31, SOB, anxiety, no others symptoms, the symptoms resolved after one hour, next ?	D-dimer ( if normal: reassurance, if elevated follow up)
	38, dry cough , malaise, bilateral hilar adenopathy ??	Sarcoidosis ( noncaseating granulomatous inflammation)
	Mechanical ventilation, FiO2 is 70%, PaO2: 54, PaCO2: 30, next ?	Increase PEEP to maintain the oxygenation( ps: u can also increase the FiO2 but when it’s < 60)
	69, SOB, cough, Edema, faint heart sound, JVD: 11, decreased breath sounds, hepatomegaly and ascites, X-ray: enlargement of central pulmonary arteries????	Cor pulmonale ( isolated right heart failure due to pulmonary hypertension)
	The indication for initiation long term home oxygen therapy?	Oxygen saturation < 88
	Indications for long term oxygen therapy	1. PaO2< 55 or SaO2 < 88 2. (PaO2 < 59 or SaO2< 89) with hematocrit > 55
	53, 2 episodes of hemoptysis, history of 2 years morning cough producing white sputum, smoker, construction?	Chronic bronchitis
	55, fever, SOB, productive cough, foul smelling sputum, history of acute pancreatitis, Bar fight, E: missing teeth, dense lower lobe infiltrate??	Aspiration pneumonia due to alcoholism
	12, bee sting, developed full body hives, difficulty breathing, vomiting, history of moderate persistent asthma, after giving im epinephrine she got better, after 10 minutes the symptoms returned, next ?	Im epinephrine ( as needed) for anaphylaxis Prevention: venom immunotherapy
	Newborn in respiratory distress syndrome, BP 70/40, nasal flaring, grunting, absent breath sound on the left, scaphoid abdomen, next ??	Endotracheal intubation ( congenital diaphragmatic hernia), then gastric tube to decompress the bowel
	Collision, pulse oximetry 88, no tracheal deviation, several chest wall bruises, right chest moves inward during inspiration, decreased breath sounds??	Rib fractures( > 3 ) leading to flail chest Rx: pain control, oxygen
	Asthma patient, difficulty in breathing one hour ago, had antibiotic earlier this morning for upper respiratory infection, hypotension, E: urticarial rash over the body, next ??	Im epinephrine ( anaphylaxis due to allergy to antibiotics)
	COPD exacerbation management	Bronchodilators( B-agonist and anticholinergic) and Systemic glucocorticoids ( methylprednisolone) , oxygen...
	53, plumber, smoking history, 4 months of progressive dyspnea, weight loss, E: bilateral pleural plaques, 6 cm cavity mass in right lower lung ??	Bronchogenic carcinoma ( asbestos exposure)
	Collision, unresponsive, BP is 70/30, no tracheal deviation, extremities are cold, tachycardia, what also ??	Small left ventricle with ejection fraction of 75%
	Cough with blood tinged sputum, history of malaise congestion sore throat 10 days ago, no other findings, X-ray normal, scattered bilateral wheezing and crackles clear with cough , next ??	Symptomatic treatment only ( acute bronchitis caused by upper respiratory viral infection ), don’t use abx
	ACEi using, chronic nonproductive cough ??	Side effect by increasing levels of kinins, substance P, prostaglandins, thromboxane
	History of cancer, unconscious, severe hypotension, elevated pulmonary artery and right atrial pressure, normal PCWP ????	Pulmonary embolism If PCWP is elevated the cause will be left ventricle dysfunction
	Elevated PCWP means?	Left ventricle dysfunction
	66, exertional dyspnea for 2 years, recurrent cough productive of whitish sputum, E: scattered expiratory wheezing, Rx??	Muscarinic antagonist ( COPD)
	Postoperative cough and some sputum, E: decreased breath sounds at right lung base without wheezing or prolonged expiration, arterial blood gases will be ???	Decreased PCO2 and PO2, increased pH ( respiratory alkalosis due to atelectasis) Rx and preoperative prevention: breathing exercise
	37, transplant, cough with bright blood, fever, pleuritic pain, E: right upper lobe dense infiltrate grown in size, CT: several nodular lesions with surrounding ground-glass( halo sign) opacities ??	Invasive aspergillosis Rx: voriconazole and caspofungin
	54, fatigue, cough with blood for few months , weight loss , immigrant treated for TB 10 years ago ??	Chronic pulmonary aspergillosis Dx: IgG aspergillus serology
	COPD exacerbation, oxygen saturation 91%, given medications with high facial mask oxygen,he developed seizure why ??	Carbon dioxide retention ( due to supplemental oxygen causing V/Q mismatch)
	PE Patient with obesity on further evaluation what the arterial blood gas gradient??	High alveolar-arterial gradient
	COPD exacerbation acid-base status??	Respiratory acidosis , widespread wheezing
	66, SOB, history of hypertension, stenting , E: decreased breath sounds at bases, bilateral crackles, occasional wheezes, respiratory alkalosis, ???	CHF
	Transudate vs exudate effusion	Transudate: decreased oncotic pressures, elevated hydrostatic Exudate: increased permeability, disruption to lymphatic outflow
	Exudate criteria	Protein ( pleural/ serum) > 5 or LDH( pleural/serum) > 0.6 or Pleural LDH > two thirds upper limit of normal serum LDH
	54, fatigue, cough with blood for few months , weight loss , immigrant treated for TB 10 years ago ??	Chronic pulmonary aspergillosis Dx: IgG aspergillus serology
	اللهم اني توكلت عليك يا قدير	فلا تردني خائباً يا الله و نجحني في الامتحان
	42, difficulty breathing and wheezing, history of persistent nasal blockage, had angina 6 months ago which taking medications ( aspirin,atovarsatin ..etc) , why the respiratory symptoms???	Pseudoallergic drug reaction ( aspirin respiratory disease) Rx: stop NSAIDs, use leukotriene receptor antagonists( montelukast)
	Postoperative, so many symptoms ( hypotension, leukocytosis, Fever...etc) , next step?	IV normal saline 0.9%( for hypertension caused by septic shock) , then vasopressors( dopamine)
	Shoulder pain, hand pain with chronic pulmonary symptoms , horner syndrome, next ??	chest X-ray ( Superior pulmonary sulcus tumors of lung)
	COPD increased survival interventions??	Long-term supplemental oxygen ( for significant hypoxemia ) Ps: significant hypoxemia( 1. PaO2< 55 or SaO2< 88, 2. If none there and hematocrit > 55
	Right upper lobe perfusion defect with good ventilation, the GFR is 20 ( < 30 ), Rx?	Unfractionated heparin ( due to renal insufficiency)
	Patient on mechanical ventilation, FiO2 is 80%, PaO2 is 105, PaCo2 is 37 , next ??	Decrease fraction of inspiration oxygen below 60% (FiO2 < 60%) to prevent oxygen toxicity
	Asthma patient, progressive asthma symptoms, no dyspnea , her throat is sore and hoarseness that resolves during the day , next ?	Add omeprazole ( comorbid GERD causing asthma exacerbation)
	Respiratory distress syndrome in infant risk factor??	Prematurity, maternal DM
	24, worsening productive cough with tenacious sputum, fever, SOB for a week, hemoptysis, had these symptoms before improving with abx but never gone , E: Upper lung fields crackles, digital clubbing, cause ??	Defective chloride channel ( Bronchiectasis caused by CF) Dx: High resolution CT
	31, SOB, anxiety, no others symptoms, the symptoms resolved after one hour, next ?	D-dimer ( if normal: reassurance, if elevated follow up)
	38, dry cough , malaise, bilateral hilar adenopathy ??	Sarcoidosis ( noncaseating granulomatous inflammation)
	Mechanical ventilation, FiO2 is 70%, PaO2: 54, PaCO2: 30, next ?	Increase PEEP to maintain the oxygenation( ps: u can also increase the FiO2 but when it’s < 60)
	69, SOB, cough, Edema, faint heart sound, JVD: 11, decreased breath sounds, hepatomegaly and ascites, X-ray: enlargement of central pulmonary arteries????	Cor pulmonale ( isolated right heart failure due to pulmonary hypertension)
	The indication for initiation long term home oxygen therapy?	Oxygen saturation < 88
	Indications for long term oxygen therapy	1. PaO2< 55 or SaO2 < 88 2. (PaO2 < 59 or SaO2< 89) with hematocrit > 55
	53, 2 episodes of hemoptysis, history of 2 years morning cough producing white sputum, smoker, construction?	Chronic bronchitis
	55, fever, SOB, productive cough, foul smelling sputum, history of acute pancreatitis, Bar fight, E: missing teeth, dense lower lobe infiltrate??	Aspiration pneumonia due to alcoholism
	12, bee sting, developed full body hives, difficulty breathing, vomiting, history of moderate persistent asthma, after giving im epinephrine she got better, after 10 minutes the symptoms returned, next ?	Im epinephrine ( as needed) for anaphylaxis Prevention: venom immunotherapy
	Newborn in respiratory distress syndrome, BP 70/40, nasal flaring, grunting, absent breath sound on the left, scaphoid abdomen, next ??	Endotracheal intubation ( congenital diaphragmatic hernia), then gastric tube to decompress the bowel
	Collision, pulse oximetry 88, no tracheal deviation, several chest wall bruises, right chest moves inward during inspiration, decreased breath sounds??	Rib fractures( > 3 ) leading to flail chest Rx: pain control, oxygen
	Asthma patient, difficulty in breathing one hour ago, had antibiotic earlier this morning for upper respiratory infection, hypotension, E: urticarial rash over the body, next ??	Im epinephrine ( anaphylaxis due to allergy to antibiotics)
	COPD exacerbation management	Bronchodilators( B-agonist and anticholinergic) and Systemic glucocorticoids ( methylprednisolone) , oxygen...
	53, plumber, smoking history, 4 months of progressive dyspnea, weight loss, E: bilateral pleural plaques, 6 cm cavity mass in right lower lung ??	Bronchogenic carcinoma ( asbestos exposure)
	Collision, unresponsive, BP is 70/30, no tracheal deviation, extremities are cold, tachycardia, what also ??	Small left ventricle with ejection fraction of 75%
	Cough with blood tinged sputum, history of malaise congestion sore throat 10 days ago, no other findings, X-ray normal, scattered bilateral wheezing and crackles clear with cough , next ??	Symptomatic treatment only ( acute bronchitis caused by upper respiratory viral infection ), don’t use abx
	ACEi using, chronic nonproductive cough ??	Side effect by increasing levels of kinins, substance P, prostaglandins, thromboxane
	History of cancer, unconscious, severe hypotension, elevated pulmonary artery and right atrial pressure, normal PCWP ????	Pulmonary embolism If PCWP is elevated the cause will be left ventricle dysfunction
	Elevated PCWP means?	Left ventricle dysfunction
	66, exertional dyspnea for 2 years, recurrent cough productive of whitish sputum, E: scattered expiratory wheezing, Rx??	Muscarinic antagonist ( COPD)
	Postoperative cough and some sputum, E: decreased breath sounds at right lung base without wheezing or prolonged expiration, arterial blood gases will be ???	Decreased PCO2 and PO2, increased pH ( respiratory alkalosis due to atelectasis) Rx and preoperative prevention: breathing exercise
	37, transplant, cough with bright blood, fever, pleuritic pain, E: right upper lobe dense infiltrate grown in size, CT: several nodular lesions with surrounding ground-glass( halo sign) opacities ??	Invasive aspergillosis Rx: voriconazole and caspofungin
	54, fatigue, cough with blood for few months , weight loss , immigrant treated for TB 10 years ago ??	Chronic pulmonary aspergillosis Dx: IgG aspergillus serology
	COPD exacerbation, oxygen saturation 91%, given medications with high facial mask oxygen,he developed seizure why ??	Carbon dioxide retention ( due to supplemental oxygen causing V/Q mismatch)
	PE Patient with obesity on further evaluation what the arterial blood gas gradient??	High alveolar-arterial gradient
	COPD exacerbation acid-base status??	Respiratory acidosis , widespread wheezing
	66, SOB, history of hypertension, stenting , E: decreased breath sounds at bases, bilateral crackles, occasional wheezes, respiratory alkalosis, ???	CHF
	Transudate vs exudate effusion	Transudate: decreased oncotic pressures, elevated hydrostatic Exudate: increased permeability, disruption to lymphatic outflow
	Exudate criteria	Protein ( pleural/ serum) > 5 or LDH( pleural/serum) > 0.6 or Pleural LDH > two thirds upper limit of normal serum LDH
	54, fatigue, cough with blood for few months , weight loss , immigrant treated for TB 10 years ago ??	Chronic pulmonary aspergillosis Dx: IgG aspergillus serology
	اللهم اني توكلت عليك يا قدير	فلا تردني خائباً يا الله و نجحني في الامتحان
	42, difficulty breathing and wheezing, history of persistent nasal blockage, had angina 6 months ago which taking medications ( aspirin,atovarsatin ..etc) , why the respiratory symptoms???	Pseudoallergic drug reaction ( aspirin respiratory disease) Rx: stop NSAIDs, use leukotriene receptor antagonists( montelukast)
	Postoperative, so many symptoms ( hypotension, leukocytosis, Fever...etc) , next step?	IV normal saline 0.9%( for hypertension caused by septic shock) , then vasopressors( dopamine)
	Shoulder pain, hand pain with chronic pulmonary symptoms , horner syndrome, next ??	chest X-ray ( Superior pulmonary sulcus tumors of lung)
	COPD increased survival interventions??	Long-term supplemental oxygen ( for significant hypoxemia ) Ps: significant hypoxemia( 1. PaO2< 55 or SaO2< 88, 2. If none there and hematocrit > 55
	Right upper lobe perfusion defect with good ventilation, the GFR is 20 ( < 30 ), Rx?	Unfractionated heparin ( due to renal insufficiency)
	Patient on mechanical ventilation, FiO2 is 80%, PaO2 is 105, PaCo2 is 37 , next ??	Decrease fraction of inspiration oxygen below 60% (FiO2 < 60%) to prevent oxygen toxicity
	Asthma patient, progressive asthma symptoms, no dyspnea , her throat is sore and hoarseness that resolves during the day , next ?	Add omeprazole ( comorbid GERD causing asthma exacerbation)
	36, 4 months of cough, white sputum, worsen at night, history of GERD, normal breath sound, split second heart sound with inspiration, next ?	PFTs to check bronchodilator response ( asthma)
	The most effective way to differentiate asthma from COPD	Spirometry before and after administration of bronchodilator
	Asthma vs COPD Rx	Asthma: albuterol and inhaled corticosteroids COPD: albuterol and long- acting anticholinergic inhaler
	53, suddenly collapsed and lost consciousness for 3 minutes, left sided chest pain, no seizure, E: hypotension, tachycardia, oximetry 80%, tachypnea, jugular venous pressure 13, which other finding ??	Right heart dysfunction due to massive PE
	36, 4 months of cough, white sputum, worsen at night, history of GERD, normal breath sound, split second heart sound with inspiration, next ?	PFTs to check bronchodilator response ( asthma)
	The most effective way to differentiate asthma from COPD	Spirometry before and after administration of bronchodilator
	Asthma vs COPD Rx	Asthma: albuterol and inhaled corticosteroids COPD: albuterol and long- acting anticholinergic inhaler
	53, suddenly collapsed and lost consciousness for 3 minutes, left sided chest pain, no seizure, E: hypotension, tachycardia, oximetry 80%, tachypnea, jugular venous pressure 13, which other finding ??	Right heart dysfunction due to massive PE
	72, passing while getting out of bed, no seizure, no chest pain, no SOB, history of watery diarrhea 2-3 days, BP is 120/70 while supine and 98/50 while standing, which laboratory value indicator of this condition	Decreased urine sodium due to activating of aldosterone ( due to hypovolemia )
	الحمد لله على الختام اللهم ذكرني ما قرأت في الامتحان	و أرشدني إلى الاجابة الصحيحة يا رب اللهم إني توكلت عليك

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