Case 1

A 26-year-old male patient who is a car mechanic goes to the emergency room because of a sudden pain in his left chest. had no respiratory disease in the past. no difficulty breathing, normal signs of survival. when you arrive, the patient has had a chest X-ray (Figure 4.1).

Figure 4.1

a Describe the abnormality on the film (Figure 4.1) and give a diagnosis

b What clinical symptoms do you expect to have during your exam to aid in diagnosis? [2]

c Treat you to this patient in the emergency room. [4]

d After your treatment, you decide to release the patient. What would you recommend this patient?

Case 2

The 59-year-old male patient went to the emergency room because he had a productive cough and had difficulty breathing for 3 days. he can still walk half a kilometer every day without getting tired. He doesn’t have any symptoms of lung disease, but he shows you his last pulmonary sign:

FVC 2.7 L (bt 5.0 L)

FEV1 1.5 L (bt 4.0 L)

He was awake, even though he had difficulty breathing. you observed respiration rates 30l / p and sp02 82% with room air. your arterial blood gas test results below

pH 7.29

pCO2 8.6 kPa

pO2 6.8 kPa

HCO3 – 30.9 mEq / L

BE + 4.1

a Based on respiratory sign and clinical symptoms, what is the possible diagnosis in this patient? Give your reason.

b Analysis of the injury of arterial blood gas. c gave your 4 initial treatment of the case.

d Repeat blood gas after 30 minutes to see the acidosis worse. What you will do?

Case 3

24-year-old female patient, 16 weeks pregnant, went to the emergency room because of chest pain and her trigger. history of asthma. She said she had stopped the reliever sprays since she was 4 weeks pregnant, for fear of harming the fetus. at pulse 95, HA 110 / 70mmHg, breathing 26l / p, sp02 94% with room air and initial peak flow 200 L / min.

a List 3 symptoms in an acute attack

b How would you treat this patient initially? (drug name, dose and route of administration)?

c What are the four indications for pulmonary radiography in this patient during an asthma attack?

d What characteristics of the patient are used to calculate peak expiratory flow rate (PEFR)?

e What will you do next if the patient does not respond to initial management?

Case 4

55-year-old female patient examined because of difficulty breathing. XQ had large left pleural effusion, patient was very short of breath, temperature 37.8 ° C, pulse 110 bpm, blood pressure 110/80 mmHg, sp02 88% in room air and breathing 26 breaths / min.

a Bringing 3 initial treatments to this patient makes the patient more comfortable.

b What clinical signs do you look for when examining your chest to distinguish pleural effusion from coagulation?

c 4 possible types of fluid in pleural effusion

d You decide to pull the fluid and get the red fluid and send it for testing

Test results about

Protein 29 g / L (serum protein 54 g / L)

Glucose 3.2 mmol / L

pH 7.3

LDH 167 u / L (serum LDH 205 u / L)

Amylase 97 u / dL

Is this seepage or exudate? why?

e make your differential diagnosis based on your opinion (d )

Case 5

A 65-year-old male patient with a history of drug addiction was taken to the emergency room by his wife. He coughed up sputum three times in the past week, bloody, although breathing normally, seems to have worsened over the past few days. Chest X-ray below (Figure 4.2).

a Describe 2 abnormalities on XQ film (Figure 4.2) and diagnosis?

b Include the 3 symptoms and localized signs you are looking for at the examination to support the diagnosis of primary pulmonary K

c In addition to malignancy, 2 common causes of blood cough in adults

d If the x-ray of the patient is normal and he is not having difficulty breathing, how would you treat the patient with hemoptysis who rarely goes to the emergency room.

Case 6

29-year-old male patient admitted to the emergency room because of irritability, coughing sputum and fever with night sweats for 3 weeks. The patient looked thin, dressed in rags, and appeared homeless. signs of birth tone are okay even though sp02 94%. If you suspect TB, you should allow the patient to breathe through a mask and in an isolated room

a What are the 3 signs on the CXR that do you suspect tuberculosis (TB) in this patient?

b What else would you do if you suspect TB in this patient? [1]

c Pulmonary tissue 4 signs of mycobacterium infection. [4]

d List 4 of the risk factors for TB and you will ask this patient

e List the 4 drugs you take on the “4 drugs” TB regimen and the side effects of each drug to advise patients.

Case 7

47-year-old female patient entered the emergency room due to acute dyspnea and left chest pain. pulse 112 bpm, blood pressure 115/75 mmHg, breathing 22 / min and sp02 94%. She did not smoke, only used thyroxine to treat hypothyroidism. healthy history, but 1 course of warfarin was used for deep vein thrombosis. Her blood gases are below in the room air:

pH 7.38

pCO2 2.6 kPa

pO2 10.4 kPa

HCO3– 23.4 mEq / L

BE –1.7

a Calculate Alveolar-arterial (Aa) gradient based on blood gas. based on your results assess this patient’s condition

b Put 3 possible abnormalities on radiograph related to pulmonary embolism (PE).

c In addition to venous thromboembolism, there are four major risk factors for PE

d What would you ask if in doubt PE? [1]

e How did you handle this case? [2]

Case 8

A 39-year-old female patient entered the emergency room for 4 days with green sputum cough and pleural left chest pain. She only takes birth control pills. she has a penicillin allergy. she remained awake, pulse 104 bpm, blood pressure 105/55 mmHg, breathing 24 / min, 37.7 ° C. Chest X-ray below (Figure 4.3).

a Description of abnormality on the film (Figure 4.3). [2]

b Identify 3 pathogens most likely to cause community acquired pneumonia. [3]

c The patient is awake. blood test below:

WCC 15.2 × 109 / L

Neutrophils 14.6 × 109 / L

N + 129 mmol / L

K + 4.7 mmol / L

Urea 6.4 mmol / L

Creatinine 78 μmol / L

CRP 267 mg / L

What is the CURB65 score and 30-day risk of death? [4]

d You let the hospital discharge patient prescribe erythromycin more orally. What effects of erythromycin would you warn patients about and what special advice would you give to patients who need to take erythromycin? [3]

e What would you recommend for the patient when he is discharged from the hospital? [2]

Case 1

a Visibility of the left lung and loss of identifiers indicates the presence of gas between the left lung and chest wall (Figure 4.1). The British Thoracic Society (BTS) 20104 pleural disease guidelines divide the size of pneumothorax into large and small depending on the size of the air coronary is larger or less than 2cm between the lung and chest wall. The 2cm air rim is equivalent to about 50% loss of lung capacity, equivalent to large tkmp

b Affected lateral dyspnea occurs in large tkmp during echoing, vocal loss and possible decrease in thoracic dilatation. In the patient has no prior lung disease, this is primary tkmp (PSP). Most large PSPs have to use needles (14−16G) to remove the gas during the first treatment, then take XQ again in the first hour for reassessment. If aspiration fails, use fine needle (<14 Fr) to drain and be hospitalized. if the lung is then restored to normal, the patient may be discharged from the hospital and have a respiratory specialist examination in 2-4 weeks.4 d patients discharged after pneumothorax treatment will be advised

● Get in hospital immediately if symptoms (difficulty breathing or pleural pain) recur

● Avoid traveling in an airplane until the lungs are swollen evenly

● Avoid diving underwater

● Stop smoking (a risk factor for recurrence of tkmp).

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