Respiratory disease

14 Respiratory disease



Questions




Question 1


As a third-year medical student in Russia I am researching ‘the role of proteolytic enzymes and their inhibitors in lung pathology’. Can you explain how proteolytic enzymes function in the normal lung?



Question 2


Bronchiectasis is given as one of the causes of bronchial breath sounds. This is difficult to comprehend. Could you explain the mechanism of bronchial breath sounds more clearly?



Question 3


I have been taught to examine vocal resonance by asking the patient to say ‘ninety-nine’ while auscultating. I listen for a louder ‘ninety-nine’ over an area of consolidation and more quiet sounds with effusion. Is this right?



Question 4


What role does bupropion play in giving up smoking?



Question 5


The clinical signs and symptoms of rhinitis are very similar to those of the common cold (influenza). How do I differentiate between the two?



Question 6


What is the advantage of the drugs des-loratidine and levo-cetirizine over their parent compounds? Are they safe in pregnancy and lactation?



Question 7


What are the differences between acute bronchitis and pneumonia? Are both diseases caused by infection?



Question 8



1. If a patient with chronic bronchitis develops obstructive jaundice and Escherichia coli biliary sepsis, should the routine administration of oral steroids (e.g. prednisolone) be suspended until liver function improves?

2. Are there any adverse reactions that preclude the concurrent use of steroids while the patient is treated with IV ciprofloxacin, gentamicin, metronidazole and cefuroxime?


Question 9


Robbins Basic Pathology mentions that in patients with chronic obstructive pulmonary disease (COPD), the forced ventilation capacity (FVC) is either normal or slightly increased! I just can’t justify that. I mean it should decrease. And this is exactly what is mentioned in your book. I couldn’t contact the authors of that book so I decided to ask you whether there is actually a situation in which the FVC in COPD patients might increase?



Question 10


Is there any obstructive pulmonary condition in which there might be an increase in FVC? If so by what mechanism?



Question 11


I am confused whether clubbing is a feature of chronic obstructive pulmonary disease (COPD) or not – you have mentioned that it is not a feature of COPD but some books do say that clubbing is a clinical feature of COPD.



Question 12


A 70-year-old man with chronic obstructive pulmonary disease (COPD) and a past history of myocardial infarction with a left ventricular ejection fraction (LVEF) of 25% is dyspnoeic on slight exertion such as walking, bathing. He is not orthopnoeic and claims to have no paroxysmal nocturnal dyspnoea (PND). He has no wheezing or productive cough and his blood pressure is normal. He has had three episodes of ventricular tachycardia (VT) and has been on amiodarone for the past year. What is the best way to determine the exact cause of dyspnoea in this case?



Question 13


In bronchiectasis, what is the reason for using a bronchodilator if the airways are already dilated?



Question 14


Why is it that asthmatics having a severe attack can be seen clawing their hands?



Question 15


Practical use of steroids:


• Which form of regimen is better (alternate-day, daily or in pulse form)?

• What should be the dose (once daily or three times daily or {2/3} in the morning)?

• For how long, especially when to give short courses as in asthmatics, when we don’t need to taper it down?


Question 16


In pregnancy, what is the recommended treatment for bronchial asthma? Is the use of the long-acting beta-adrenergic agonist Seretide, the corticosteroid Symbicort and leucotriene receptor antagonists (LTRAs) recommended?



Question 17


In asthma patients, which is the safest analgesic to use?



Question 18


Is the use of nebulized heparin in the treatment of asthmatic attacks recommended?



Question 19


I would like to ask you about pneumonia and its classifications in particular; what are they?



Question 20


What are the pathological differences in typical and atypical pneumonia?



Question 21


Why, sometimes in cases of aspiration pneumonia, would the level of lymphocytes drop below normal range while the level of white blood cells (WBC) and neutrophils are above normal range?



Question 22


Should steroids be used in the treatment of a standard case of pneumonia in a young child?



Question 23


I want to know more about the epidemiology and pathophysiology of this severe acute respiratory syndrome (SARS) scare and what advances have been made in its therapy.



Question 24


What symptoms will confirm, without doubt, a diagnosis of tuberculosis?



Question 25


Please could you tell me the skin-prick test result for non-infected and non-immune tuberculosis carriers?



Question 26


Please can you help me find the answer to whether the purified protein derivative (PPD) in the tuberculin skin test develops memory T lymphocytes? If so, would it not be confusing with the way BCG vaccine works?



Question 27


In diseases that have night sweats as a symptom (e.g. tuberculosis, infective endocarditis), what causes the sweats to occur only at night and not consistently during the day as well?



Question 28


An asymptomatic patient, whose tuberculous pleural effusion has subsided after a year’s treatment of anti-TB, is left with a small loculated effusion, apparent on ultrasound and chest X-ray. Should this be aspirated?



Question 29


I want to know what are the exact indications for using steroids in patients with tuberculous pleural effusions/ascites?



Question 30


Should prednisolone be added to the anti-tuberculosis therapy in all cases of massive tuberculous effusion? Does the quick absorption help prevent fibrosis?



Question 31


In the case of antituberculous treatment toxicity, how high should the serum glutamic pyruvate transaminase (SGPT) rise before we should stop treatment?



Question 32


After starting antituberculous treatment, when is the fever expected to subside and the erythrocyte sedimentation rate (ESR) to return to normal?



Question 33


What are the indications of steroids in the treatment of tuberculosis?



Question 34


I am a final-year medical student in India, where tuberculosis in all forms is one of the most common diseases with which we deal. I read that you feel there is no indication for steroids in tuberculosis. Is it not reasonable to give steroids with antitubercular therapy (ATT) in a patient with tuberculous pericarditis, meningitis, peritonitis and ocular manifestations due to tuberculosis, in order to reduce the damage caused by inflammation and fibrosis? If not, what suitable alternatives, other than steroids, would you recommend to reduce damage from postinflammatory fibrosis?



Question 35


What dosage of steroids and duration of treatment should be given to patients with idiopathic pulmonary fibrosis? What are the new drugs, their recommended dosage and duration of treatment?



Question 36


What is the poor prognostic factor in cryptogenic fibrosis: fibrosis or concomitant connective tissue disorder?



Question 37


Are wheezes present in extrinsic allergic alveolitis?



Question 38


Is the measurement of chest expansion with a tape a useful physical examination to indicate the severity of emphysema?



Question 39


In asbestos-related pleural disease (pleural plaques and mesothelioma), how do asbestos fibres get to the pleural space?



Question 40


How do you differentiate clinically between thickened pleura and pleural effusion?



Question 41


What is the difference between transudate and exudate?



Question 42


I wish to ask about Meigs’ syndrome. I know that it is an association of pleural effusion, ascites and benign ovarian tumours or fibromas. Is the effusion transudate or exudate?



Question 43


I have read that patients with cystic fibrosis should not meet each other socially. Why is this?



Question 44


I have a young patient with bilateral hilar lymphadenopathy but no other manifestations of sarcoidosis. How can I make a diagnosis?



Question 45


We have read in your book that continuous oxygen therapy at home reduces mortality in chronic obstructive pulmonary disease (COPD). I am concerned that my patient might develop acute respiratory failure.



Question 46


I have a patient with asthma who is on long-term inhaled corticosteroids. She is very concerned about long-term steroid therapy. Could I replace the steroids with a long-acting beta2 agonist?



Question 47


What is the role of leukotriene-modifying agents in asthma?



Question 48


Is it true that the Mantoux test is no longer used?



Question 49


Is there a screening test that is useful for the diagnosis of lung cancer?



Question 50


For how long should treatment be continued for cervical lymphadenopathy and abdominal tuberculosis? What role, if any, do steroids play in the treatment of these conditions?

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Dec 4, 2016 | Posted by in GENERAL & FAMILY MEDICINE | Comments Off on Respiratory disease

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