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حالات سريرية


Dame In Distress |

حالة سريرية

الوصف الكامل Background

A 65-year-old smoker previously diagnosed with ...(?)... presents to the emergency department complaining of worsening cough and sputum production. She reports feeling breathless when climbing the stairs to her first floor walk-up apartment, and has moderate difficulty in providing her history in complete sentences. X-ray of the chest shows hyperinflated lungs with flattened diaphragms, attenuated vascular markings, and a narrow mediastinum.

What agent(s) will provide the greatest relief of symptoms in the emergency department?

(A) Albuterol and ipratropium bromide
(B) Antibiotics
(C) Magnesium sulfate
(D) N-acetylcysteine
(E) Theophylline

سيدة عمرها 65 سنة ( مدخنة سابقة ) مُشخص لها ...(؟)... جاءت إلى قسم الطوارئ مشتكيةً من سعال ازداد سوءاً و منتج للقشع. أخبرت الأطباء بأنها شعرت بانقطاع النفس عند صعودها الدرج إلى شقتها الكائنة في الطابق الاول، كما أنها عانت من صعوبة معتدلة في إعطاء قصتها المرضية بجمل كاملة. الصورة الشعاعية البسيطة تظهر رئتين منتفختين مع حجاب حاجز مسطح، ارتسامات وعائية قليلة، و منصف ضيق.

ما هو الدواء الذي سيؤدي إلى أكبر تخفيف للأعراض في غرفة الطوارئ؟

أ) Albuterol و ipratropium bromide
ب) المضادات الحيوية
ج) سلفات المغنيزيوم
د) N-acetylcysteine
ه) Theophylline

المرجع

Later


ألم صدري شديد مبكي ، بدأ فجأة ، وانتشر للظهر |

حالة سريرية

الوصف الكامل Background
A 55-year-old man presents to the emergency department complaining of sudden-onset tearing chest pain radiating to the back. He denies any history of trauma. Chest radiograph is shown.

What comorbidity is most likely associated with his present condition?

A. Atherosclerosis
B. Churg-Strauss syndrome
C. Hypertension
D. Pericarditis
E. Polycystic kidney disease


Clinical case on pulmonary function tests |

حالة سريرية

الوصف الكامل Background

A 55-year-old man complains of shortness of breath and wheezing. He has now developed worsening dyspnea on exertion. He reports a past history of smoking more than three packs of cigarettes a day for the past 40 years. He has never been intubated but has been admitted in the past for treatment with bronchodilators. On physical examination, he has poor air movement in his lungs. A chest radiograph shows flattening of the diaphragm and an increased anterior-posterior chest diameter. He undergoes pulmonary function testing. Which of the following patterns will be seen on his pulmonary function tests?

A.
Decreased residual volume/total lung capacity RV/TLC

B.
Decreased RV

C.
Normal forced expiratory volume in 1 second/forced vital capacity FEV1/FVC

D.
Reduced FEV1/FVC

E.
Reduced VC and TLC


ما المشترك بينهما؟ |

حالة سريرية

الوصف الكامل Background
Chronic obstructive pulmonary disease is classified as emphysematous or bronchitic depending on the pathologic changes that occur in the lungs. although these two COPD syndromes rarely exist as pure entities, they may be differentiated on the basis of their clinical presentation .

يصنف الداء الرئوي الساد المزمن إلى النفاخ و التهاب قصبات تبعا للتغيرات المرضية في الرئة.على الرغم من أن حدوث أحد هذين النمطين بشكل صرف نادر الحدوث ,إلا أنه يمكن التفريق بينهما اعتمادا على مظهرهما السريري.

كتابة حرة وطرح موضوع النقاش!
Which of the following clinical feature is common to both the emphysematous and bronchitis types of COPD?
1-polycythmeia
2-improved airflow with bronchodilators
3-dyspnea
4-chronic cough
5-hypercapnia

أي المظاهر السريرية التالية شائع في النفاخ و التهاب قصبات سوية؟
1-كثرة الكريات الحمر
2-تحسن الجريان الهوائي باستخدام الموسعات القصبية
3-الزلة التنفسية
4-السعال المزمن
5-فرط CO2الدم


مدخنة بسعال مزمن منتج وتصبغات جلدية زرقاء!!! |

حالة سريرية

الوصف الكامل Background

امرأة في ال60 من عمرها مدخنة بشدة أتت بسعال مزمن ومنتج منذ 3 سنوات متتالية.
بالفحص السريري جلدها مصطبغ بالأزرق ولديها زيادة في الوزن، المريضة شخص لها التهاب قصبات مزمن.

A 60 year old woman with heavy smoking history presents with chronic productive cough that has been present for 3 consecutive years. on physical examination her skin has a bluish tinge and she is overweight. The patient is diagnosed with chronic bronchitis.

كتابة حرة وطرح موضوع النقاش!

Which of the following is the most likely histological finding in this patient’s lungs?
1- Bronchial smooth muscle hypertrophy with proliferation of eosinophils .
2- Diffuse alveolar damage with leakage
3-dilation of air spaces with destruction of alveolar walls
4-hyperplasia of bronchial mucus secreting submucosal glands
5-permanent bronchial dilation caused by chronic infection with bronchi filled with mucus and neutrophils

ما هو الموجود النسيجي الأكثر احتمالا في رئتيها؟
1.تضخم في العضلات الملساء القصبية وكثرة الإيوزينيات.
2-تحطم سنخي منتثر مع ارتشاح سائل غني بالبروتين إلى المسافات السنخية
3-توسع المساحات الرئوية مع تحطم جدر الأسناخ
4-فرط تنسج الغدد القصبية تحت المخاطية المفرزة للمخاط
5-توسع قصبي دائم بسبب الانتان المزمن مع امتلاء القصبات بالمخاط والعدلات.


مريض يسعل و لونه أحمر!! |

حالة سريرية

الوصف الكامل Background
a 60year old man ,a heavy smoker presents for advise to stop smoking .on physical examination he is thin and has a ruddy complexion .he has a productive cough and a barrel shaped chest,he sits leaning forward with his lips pursed to facilitate his breathing. a diagnosis of emphysema is made

.

أتى إلى عيادتك رجل في ال60 من عمره, مدخن بشدة , يريد الحصول على استشارة طبية للتوقف عن التدخين .
بالفحص السريري وجدت ان المريض نحيف ,جلده محمر,لديه سعال منتج ,و صدر على شكل برميل,ويجلس منحنيا للأمام زامّا شفتيه لتسهيل التنفس.
تم وضع تشخيص نفاخ رئوي .

كتابة حرة وطرح موضوع النقاش!
which of the following is the most likely histologic finding in his lungs?
1-bronchial smooth muscle hypertrophy with proliferation of eosinophils
2-diffuse alveolar damage with leakage of protein rich fluid into the alveolar spaces
3-dilation of air spaces with destruction of alveolar walls
4-hyperplasia of bronchial mucus secreting submucosal glands
5-permanent bronchial dilation caused by chronic infection with bronchi filled with mucus and neutrophils

ما هو الموجود النسيجي الأكثر احتمالا في رئتيه؟
1-تضخم العضلات الملساء القصبية مع كثرة في الأيوزينيات
2-تحطم سنخي منتثر مع ارتشاح سائل غني بالبروتين إلى المسافات السنخية
3-توسع المساحات الرئوية مع تحطم جدر الأسناخ
4-فرط تنسج الغدد القصبية تحت المخاطية المفرزة للمخاط
5-توسع قصبي دائم بسبب الانتان المزمن مع امتلاء القصبات بالمخاط والعدلات.


حالة اسعافية |

حالة سريرية

كتابة حرة وطرح موضوع النقاش!

أحضر رجل 24 سنة الى الاسعاف بعد سقوطه من على السلم .تبين أن الرجل يعاني من صعوبة بالتنفس وزرقة .لم يمكن اصغاء الاصوات التنفسية بالساحة الرئوية اليمنى وكانت تبدي طبلية بالقرع ما الخطوة الأولى بتدبير المريض ؟
1- خزع حلقي درقي
2- تفجير صدر بأنبوب
3- ادخال انبوب انفي معدي
4- اجراء صورة شعاعية بسيطة


ذات رئة .... |

حالة سريرية

الوصف الكامل Background
A 74-year-old woman, who has been followed for the past 25 years for chronic obstructive pulmonary disease (COPD) presents complaining of 48 hours of temperatures to 38.6 C (101.4 F) and worsening shortness of breath. She has a chronic productive cough, which has become more copious. On physical examination, she has rhonchi and increased fremitus in the posterior mid-lung field. A Gram's stain reveals many epithelial cells and multiple gram-positive and gram-negative organisms; no neutrophils are seen. Which of the following is the most likely organism causing the symptoms?
A. Escherichia coli
B. Haemophilus influenzae
C. Klebsiella pneumoniae
D. Mycobacterium tuberculosis
E. Mycoplasma pneumonia

ذات رئة 2 |

حالة سريرية

كتابة حرة وطرح موضوع النقاش!
A previously healthy 25-year-old music teacher develops fever and a
rash
over her face and chest. The rash is itchy and on exam involves multiple
papules and vesicles in varying stages of development. One week later
she complains of cough and is found to have an infiltrate on x-ray. [i]The
most likely etiology of the infection is

a. Streptococcus pneumoniae
b. Mycoplasma pneumoniae
c. Pneumocystis carinii
d. Varicella virus

توصيل صدرية 2 .. |

حالة سريرية

كتابة حرة وطرح موضوع النقاش!
For each clinical situation, select the arterial blood gas and pH values with
which it is most likely to be associated.
a. pH 7.50, PO2 75, PCO2 28
b. pH 7.15, PO2 78, PCO2 92
c. pH 7.06, PO2 36, PCO2 95
d. pH 7.06, PO2 108, PCO2 13
e. pH 7.39, PO2 48, PCO2 54
1. A 30-year-old obese female bus driver develops sudden pleuritic leftsided
c2. A 60-year-old heavy smoker has severe chronic bronchitis and
peripheral edema and cyanosis. (CHOOSE 1 SET OF VALUES)
3. A 22-year-old drug-addicted man is brought to the emergency
room by friends who were unable to awaken him. (CHOOSE 1 SET OF
VALUES)
4. A 62-year-old man who has chronic bronchitis and chest pain is given
oxygen via mask in the ambulance en route to the hospital and becomes
lethargic in the emergency room. (CHOOSE 1 SET OF VALUES)
56. A 20-year-old man with diabetes mellitus comes to the emergency
room with diffuse abdominal pain, tachypnea, and fever. (CHOOSE 1
SET OF VALUES)hest pain and dyspnea. (CHOOSE 1 SET OF VALUES

توصيل صدرية .. |

حالة سريرية

كتابة حرة وطرح موضوع النقاش!
a. Asthma
b. Rheumatoid arthritis
c. A1 antitrypsin deficiency
d. Cystic fibrosis
e. Sarcoidosis
1. Low levels of glucose in pleural effusions (SELECT 1 DISEASE)
2. Bronchiectasis and severe hemoptysis as frequent complications of
clinical course (SELECT 1 DISEASE)
3. Presence of the mucoid strain of Pseudomonas aeruginosa (SELECT 1
DISEASE)
4. Development of severe liver disease that is usually associated with,
but may be independent of, lung disease (SELECT 1 DISEASE)
5. Development of symptoms after ingestion of tartrazine yellow or
aspirin (SELECT 1 DISEASE)

سعال مع قشع مزمن .. |

حالة سريرية

كتابة حرة وطرح موضوع النقاش!
A 60-year-old male has had a chronic cough for over 5 years with clear
sputum production
. He has smoked one pack of cigarettes per day for 20
years and continues to do so. X-ray of the chest shows hyperinflation without
infiltrates
. Arterial blood gases show a pH of 7.38, PCO2 of 40 mmHg,
and PO2 of 65 mmHg. Spirometry shows an FEV1/FVC of 65%. The most
important treatment modality for this patient is

a. Oral corticosteroids
b. Home oxygen
c. Broad-spectrum antibiotics
d. Smoking cessation program

زلة تنفسية مترقية .. |

حالة سريرية

كتابة حرة وطرح موضوع النقاش!
A 35-year-old female complains of slowly progressive dyspnea. Her
history is otherwise unremarkable, and there is no cough, sputum production,
pleuritic chest pain, or thrombophlebitis. She has taken appetite suppressants
at different times. On physical exam, there is jugular venous
distention, a palpable right ventricular lift, and a loud P2 heart sound
. Chest
x-ray shows clear lung fields. ECG shows right axis deviation. A perfusion
lung scan is normal with no segmental deficits. The most likely diagnosis in
this patient is

a. Primary pulmonary hypertension
b. Recurrent pulmonary emboli
c. Cardiac shunt
d. Interstitial lung disease

سهلة بس من باب التكرار بيعلم الغزال ;cool ; |

حالة سريرية

الوصف الكامل Background
Five days after a total hip replacement, a 72-
year-old woman
becomes acutely short of
breath, diaphoretic, and hypotensive
. Both
lung fields are clear to auscultation and percussion,
but examination of the neck reveals
mild jugular venous distension with prominent
A waves
. Heart sounds are normal. An
ECG shows sinus tachycardia and minor
nonspecific ST-T wave changes
. 1-What is the
most likely diagnosis?

(A) aspiration pneumonia
(B) acute myocardial infarction
(C) aortic dissection
(D) pulmonary embolism
(E) pericarditis

2. What is the most appropriate treatment for
the patient described above?

(A) clindamycin
(B) streptokinase
(C) urgent cardiac surgery
(D) heparin
(E) indomethacin


COPD |

حالة سريرية

الوصف الكامل Background
A 63-year-old man with chronic bronchitis
presents to the emergency department with
worsening shortness of breath. He is dyspneic,
his respiratory rate is 32/min, and he
has peripheral cyanosis. A chest examination
reveals increased anteroposterior diameter
and scattered rhonchi, but no wheezes or evidence
of consolidation. His ABG determinations
on room air are pH of 7.36, arterial oxygen
pressure (PaO2) of 40 mm Hg, and PaCO2
of 47 mm Hg. He is given oxygen by face
mask while awaiting a chest x-ray. His respiratory
rate falls to 12/min, but his ABGs on
oxygen are now pH of 7.31, PaO2 of 62 mm
Hg, and PaCO2 of 58 mm Hg. What should
the next step be?

(A) Repeat the ABG.
(B) Initiate mechanical ventilation.
(C) Obtain a chest x-ray.
(D) Check the oxygen delivery system.
(E) Decrease the fraction of inspired oxygen
(FIO2).

ذات رئة .. |

حالة سريرية

الوصف الكامل Background
A 60-year-old man presents with a nonproductive
cough for a week and generalized
malaise. He also has noted some abdominal
pain associated with diarrhea
for the past
few days. His temperature is 101.5°F, and
clinical exam is unremarkable. A chest x-ray
shows a left lower lobe infiltrate. His urinalysis
shows 50 red blood cells (RBCs), and his
BUN (30) and creatinine (1.6) are both mildly
elevated. In light of the extrapulmonary
symptoms and signs, which of the following
is the most likely cause of his pneumonia?

(A) Pseudomonas aeruginosa
(B) Staphylococcus aureus
(C) Hemophilus influenzae
(D) Streptococcus pneumoniae
(E) Legionella

pulmonary embolism2 |

حالة سريرية

كتابة حرة وطرح موضوع النقاش!

2 - You are taking care of a 32 year-old woman for pulmonary embolism. After two miscarriages, about 10 years ago, she was diagnosed with lupus anticoagulant syndrome. She's adequately anticoagulated, asymptomatic and you think it's time to discharge her home. She asks you for how long she's going to take the warfarin and your answer is:

a - 1 week

b - between 3 and 6 months

c - at least 6 months

d - at least 12 months

e - indefinely

f - she's going to receive Aspirin daily only


pulmonary embolism1 |

حالة سريرية

كتابة حرة وطرح موضوع النقاش!

1 - You are taking care of a 42 year-old man who came to the hospital with a pulmonary embolism suspicion, after an airplane trip from China to USA. He's a smoker (2 packs per day for 20 years), has hypercholesterolemia and his father died on an MI at 62 years old. The V/Q test defined the diagnosis as PE. You started him on heparin, added warfarin after 24 h and reached the ideal level of anticoagulation. Upon discharge, you are going to keep him anticoagulated for:

a - 1 week

b - between 3 and 6 months

c - at least 6 months

d - at least 12 months

e - indefinely

f - he's going to receive Aspirin daily only


صل هؤلاء المرضى التنفسيين مع العامل الممرض المحتمل |

حالة سريرية

الوصف الكامل Background
For each of the following patients with a respiratory
illness, select the most likely pathogen
.

(A) adenovirus
(B) Bordetella pertussis
(C) Chlamydia trachomatis
(D) coxsackievirus
(E) Epstein–Barr virus
(F) Hemophilus influenzae
(G) herpes simplex 1
(H) Moraxella catarrhalis
(I) Mycoplasma pneumoniae
(J) parainfluenza virus
(K) respiratory syncytial virus
(L) rotavirus
(M) Staphylococcus aureus
(N) Streptococcus agalactiae (group B)
(O) Streptococcus pneumoniae
(P) Streptococcus pyogenes (group A)

صل هؤلاء المرضى التنفسيين مع العامل الممرض المحتمل :

-ادينو فيروس
-بورتديلا الشاهوقية
-الكلاميديا التراخومية
-كوكساكي
-ابشتين بار
-المستدميات الدموية
-الحلأ البسيط 1
-الموراكسيلا
-بارا انفلونزا
-الفيروسات المخلوية التنفسية
-الروتا فيروس
-العنقوديات المذهبة
-العقديات b
-العقديات الرئوية
-العقديات المقيحة a

1. A 3-month-old infant with wheezing and history
of 3 days of cough, congestion, and rhinorrhea

وليد 3 أشهر مع وزيز وقصة سعال من 3 أيام واحتقان و نز أنفي

2. A 9-year-old with gradual onset of fever,
malaise, and worsening cough over 5 days
and rales in the area of the right upper lobe

طفل 9 سنوات مع حرارة وتعب و متدرج وسعال ساء خلال 5 أيام وخراخر بالفص الأيمن العلوي

3. A 3-month-old infant with history of eye
drainage at 2 weeks of age who now has
insidious onset of staccato cough and is
afebrile, with bilateral rales on exam

وليد 3 أشهر مع مفرزات عينية بعمر اسبوعين و الأن سعال متقطع مخاتل و الوليد ليس لديه حرارة وخراخر مزدوجة بالفحص

4. A 6-month-old with history of 2 weeks of
congestion and rhinorrhea, who now has
worsening paroxysms of coughing

طفل 6 أشهر مع قصة احتقان وسيلان أنف من اسبوعين و الان نوبات سعال متدهورة

5. A 2-year-old with 2 days of rhinorrhea and
cough, now with hoarseness and a barky
cough

طفل 2 سنة مع سيلان أنف و سعال من يومين و الأن بحة سعال نباحي


Pulmonary 5 |

حالة سريرية

الوصف الكامل Background
A 55-year-old man is evaluated in the emergency department for severe dyspnea and right-sided chest pain. His medical history includes anaphylaxis after a (normal) coronary angiogram last year.

On physical examination, the temperature is 38.1 °C (101.6 °F), blood pressure 110/70 mm Hg, heart rate 115/min, and respiration rate 24/min. Portable anteroposterior chest radiograph is normal.

Measurement of arterial blood gases with the patient breathing room air shows a PO2 of 60 mm Hg, PCO2 of 35 mm Hg, and pH of 7.44; with the patient breathing 100% oxygen by a nonrebreather face mask, the results are PO2 of 150 mm Hg, PCO2 of 35 mm Hg, and pH of 7.44.

كتابة حرة وطرح موضوع النقاش!
Which of the following is the most appropriate next step in the evaluation of this patient?

A. Ultrasound of the left pleural space
B. Ventilation/perfusion scanning
C. Echocardiogram with air contrast injection
D. Azithromycin therapy
E. Noncontrast helical CT scanning


Pulmonary 4 |

حالة سريرية

الوصف الكامل Background
A 46-year-old man is evaluated in the emergency department with a 1-day history of progressive dyspnea and nonproductive cough. He does not have hemoptysis, chest pain, or leg discomfort, and no personal or family history of cancer or clotting episodes. He had outpatient ophthalmologic surgery under local anesthesia last week. His medical history includes mild asthma and impaired glucose tolerance, which is controlled by diet. His only medication is a topical optic analgesic.

On physical examination, he is dyspneic and appears anxious; the temperature is 37.6 °C (99.8 °F), blood pressure 150/89 mm Hg, heart rate 110/min, and respiration rate 24/min. Cardiac examination discloses tachycardia without murmurs of gallops or evidence of jugular venous distention. Examination of the lungs discloses faint bilateral expiratory wheezes, without rhonchi or rales; the hemi-diaphragms descend normally during inhalation. The abdomen is normal. Extremities are not swollen, nonedematous, nontender, and not cyanotic.

Chest radiograph is normal; electrocardiogram shows tachycardia. Measurement of arterial blood gases with the patient breathing room air show PO2 93 mm Hg, PCO2 36 mm Hg, and pH 7.45. The D-dimer level is 200 mg/dL (normal <250 mg/dL).

كتابة حرة وطرح موضوع النقاش!
Which of the following would most effectively determine the clinical likelihood of this patient's having a pulmonary embolism?

A. Obtaining the report of the patient's ophthalmologic surgery
B. Measuring hemoglobin A1C
C. Determining the effect of bronchodilators on the patient's signs and symptoms
D. Repeating D-dimer after one therapeutic dose of low-molecular-weight heparin


Pulmonary 3 |

حالة سريرية

الوصف الكامل Background
A 75-year-old man with 80-pack-year smoking history is evaluated for a 3-month history of night sweats, weight loss, and progressive shortness of breath. He has a dull ache in his left chest. He has an occasional cough with mucoid sputum production. He is dyspneic with minimal exertion.

On physical examination, his temperature is 36.8 °C (98.2 °F), pulse rate is 112/min, respiration rate is 26/min, and systolic blood pressure is 96 mm Hg. The trachea is shifted to the right. He has dullness to percussion and decreased breath sounds on examination of the left hemithorax. The abdomen is scaphoid with no organomegaly. There is no peripheral edema.

Laboratory tests show a leukocyte count of 6800/μL (6.8 × 109/L). Metabolic panel and liver and renal functions are normal. The serum protein is 5.0 g/dL (50 g/L), and the serum lactate dehydrogenase (LDH) is 188 U/L. Chest radiograph shows complete opacification of the left hemithorax with mediastinal shift to the right. Pleural fluid laboratory tests show the following:

Laboratory Studies:

Cell count :

Erythrocytes : 150,000/μL (150 × 109/L);
leukocyte count : 980/μL (0.98 × 109/L) with 20% neutrophils, 55% lymphocytes, 10% mesothelial, and 15% eosinophils.
Total protein : 4.5 mg/dL (45 g/L)
Lactate dehydrogenase : 1200 U/L
Glucose : 45 mg/dL (2.5 mmol/L)
pH : 7.2

Pleural fluid Gram stain is negative; cytology is pending.

كتابة حرة وطرح موضوع النقاش!
Which of the following is the most likely diagnosis?

A. Transudative pleural effusion
B. Malignant pleural effusion
C. Parapneumonic effusion
D. Rheumatoid pleural effusion
E. Pleural effusion associated with esophageal rupture


Pulmonary 2 |

حالة سريرية

الوصف الكامل Background
A 28-year-old woman is evaluated for persistent cough. She has never smoked and travels to Mexico to vacation yearly. Physical examination is normal. Plain chest radiograph shows mild interstitial abnormalities with associated hilar and mediastinal fullness. Pulmonary physiology reveals normal spirometry (FVC, FEV1, and FEV1/FVC ratio) and a normal DLCO. A PPD is negative.
كتابة حرة وطرح موضوع النقاش!
Which additional findings in this patient would warrant oral corticosteroid therapy?

A. Bilateral anterior uveitis
B. Hypercalcemia
C. Tender red nodules over the anterior shins
D. Abnormal liver function tests


Pulomnary 1 |

حالة سريرية

الوصف الكامل Background
A 50-year-old woman is evaluated for a 6-week history of dry cough, exertional dyspnea, and low-grade fever of 37.8 to 38.3 °C (100 to 101 °F). Five weeks ago a chest radiograph showed a focal right lower lung zone infiltrate. She did not improve with a course of azithromycin followed by a course of levofloxacin over the past 3 weeks. Lately she has been coughing up clear, scanty phlegm that reveals leukocytes with no specific bacteria seen on Gram's stain. Her physical examination is unremarkable. Apart from a mildly elevated leukocyte count (14,800/μL) with normal differential, her routine blood counts and chemistry profile are within normal range. Serologic studies (antinuclear antibody, rheumatoid factor, and antineutrophil cytoplasmic antibody) are all negative.

Laboratory Studies:

Forced vital capacity (FVC) : 60% of predicted
Forced expiratory volume in 1 sec (FEV1) : 62% of predicted
Total lung capacity : 55% of predicted
DLCO : 42% of predicted

Current chest radiograph reveals an enlarging right lower lung zone infiltrate. HRCT shows right basilar consolidative and ground glass opacities.

كتابة حرة وطرح موضوع النقاش!
Which of the following is the most likely diagnosis?

A. Respiratory bronchiolitis-associated interstitial lung disease.
B. Wegener's granulomatosis.
C. Cryptogenic organizing pneumonia.
D. Sarcoidosis.
E. Hypersensitivity pneumonitis.


bronchoalveolar lavage |

حالة سريرية

الوصف الكامل Background

You have four patients with similar clinical problems who require further evaluation. All of them have presented with cough and progressive dyspnea. Initial workup did not reveal any diagnosis. Their chest x-rays reveal diffuse pulmonary infiltrates. You, and your attending physician, are planning to perform bronchoscopy with bronchoalveolar lavage on these patients. In which of the following patients, this procedure will most likely yield a diagnosis?

A.35-year-old female suspected of sarcoidosis
B.50-year-old male working in an asbestos industry
C. 35-year-old HIV patient with CD4 count of 150
D. 37-year-old female with positive rheumatoid factor


lung cancer case |

حالة سريرية

الوصف الكامل Background

-مريض عمره53 سنة حضر بقصة زلة تنفسية مترقيةخلال4 شهورونقص شهية وفقد وزن ,المريض لديه قصة قرحة عفجية مزمنة وبعض الانزعاج الشرسوفي ويتناول الranitidineمن فترة لأخرى ونفى تناول الكحول والتدخين.
المريض يعمل عامل تمديدات صحية "سباك" وهو يزاول هذا العمل من 30 سنة وينفى أي تعرض للحيوانات
بالفحص يوجد خراخر قاعدية وCXRأظهرت لويحات جنبية متعددة ثنايئة الجانب بالإضافة إلى كتلة في محيط الرئة اليمنى,تم إجراء خزعة موجهة ب.ctما هي الخباثة الأكثر احتمالا ؟
1-نقائل سرطان معدة
2-نقائل سرطان كولون
3-نقائل سرطان بنكرياس
4-سرطانة قصبية
5-ميزوتيلوما بريتوانية
6-ميزوتيلوما جنبية


COPD 2 |

حالة سريرية

الوصف الكامل Background
A 72-year-old man is evaluated for progressive dyspnea on exertion and a morning cough productive of thick white sputum. The patient is a life-long cigarette smoker and was diagnosed with chronic obstructive pulmonary disease 4 years ago; he has had two unscheduled office visits in the past 6 months for bronchitis.

On physical examination, he is thin (BMI 20), his chest is hyperinflated, breath sounds are diminished, he has 1+ ankle edema. Spirometry shows an FEV1 35% of predicted which improves 5% with albuterol. Lung volume measurement shows a total lung capacity of 140 % and residual volume of 130%; the DLCO is 55% of predicted.

رجل عمره 72 سنة قدم بشكوى زلة تنفسية مترقية على الجهد مع سعال صباحي منتج لقشع ثخين أبيض. المريض مدخن طيلة حياته ومشخص بمرض تنفسي ساد مزمن منذ 4 سنوات. قام المريض بزيارتين سابقتين للعيادة غير مخطط لهما خلال الـ 6 أشهر الماضية من أجل التهاب القصبات.
بالفحص السريري. المريض نحيل ( BMI = 20), صدره مفرط الانتفاخ, أصواته التنفسية منخفضة, ولديه وذمة في الكاحل من الدرجة الأولى. أظهر مقياس التنفس FEV1 = 35% مع تحسن بمقدار 5% باستخدام الألبوتيرول. قياس الحجوم الرئوية أظهر: السعة الكلية للرئة 140%, الحجم المتبقي: 130%, وDLCO = 55%.

كتابة حرة وطرح موضوع النقاش!
Which of the following is the most appropriate therapy for this patient?

A. Albuterol, tiotropium, and inhaled corticosteroids.
B. Ipratropium bromide and tiotropium.
C. Albuterol/ipratropium bromide inhaler, a long-acting β-agonist, and oral corticosteroids.
D. Ipratropium bromide and montelukast.

أي مما يلي هو العلاج الأكثر ملاءمة للمريض؟
1. ألبوتيرول, تيوتروبيوم, وستيروئيات استنشاقاً.
2. بروميدات الابرتروبيوم و التيوتروبيوم.
3. البوتيرول/ بروميد الايبراتروبيوم استنشاقاً, مشابهات بيتا طويلة الأمد, وستيروئيدات فموية.
4. بروميد الايبراتروبيوم و والمونتيلوكاست.


COPD 1 |

حالة سريرية

الوصف الكامل Background
A 55-year-old woman is evaluated for ankle edema of 4 weeks' duration, along with fatigue, chest congestion, and a morning cough productive of yellow sputum. She has been a life-long smoker of about one-half to one pack of cigarettes a day. On physical examination, the patient is obese (BMI 33), blood pressure is 140/100 mm Hg, heart rate is 80/min; she has wheezing and 1+ ankle edema. Chest radiograph shows border-line cardiomegaly and enlarged pulmonary arteries. The FEV1 is 1.5 L (60% of predicted); measurement of arterial blood gases shows a PO2 of 60 mm Hg, PCO2 of 48 mm Hg, and pH of 7.38. Echocardiography suggests mild pulmonary hypertension. The patient is offered various smoking cessations programs.

سيدة عمرها 55 سنة تم تقييمها من أجل وذمة في الكاحل منذ 4 أسابيع, مترافقة مع ضعف, احتقان صدري, وسعال صباحي منتج لقشع أصفر. المريضة مدخنة طيلة حياتها بمقدار من نصف إلى علبة واحدة يومياً. بالفحص السريري, المريضة بدينة (BMI = 33), الضغط : 140/100, النبض: 80/د, لديها وزيز مع وذمة كاحل من الدرجة الأولى. أظهرت صورة الصدر ضخامة قلبية واضحة الحدود مع توسع في الشرايين الرئوية. FEV1 = 1.5 ليتر (60%), أظهرت قياسات الغازات الشريانية : PO2 = 60 مم ز, PCO2 = 48 مم ز, PH = 7.38. أظهر الايكو القلبي وجود ارتفاع توتر رئوي خفيف. وتم عرض عدة برامج لوقف التدخين عند المريضة.

كتابة حرة وطرح موضوع النقاش!
Which of the following would be most appropriate in the evaluation of this patient?
A. Right heart catheterization.
B. A therapeutic trial of bronchodilators, oral corticosteroids, and antibiotics.
C. Measurement of B-type natriuretic peptide.
D. A formal sleep study.

أي مما يلي هو الأجراء الأكثر ملاءمة لتقييم المريضة؟
1. قثطرة القلب الأيمن.
2. معالجة تجريبية بموسعات القصبات, الستيروئيدات الفموية, والصادات.
3. قياس مستويات الببتيد المدر للصوديوم نمط B.
4. دراسة منهجية للنوم.


ربو مستمر متوسط ؟؟؟؟ |

حالة سريرية

الوصف الكامل Background
Which of the following medication grouping is most appropriate for a patient older than 5 years with moderate persistent asthma ?
1- none
2- a daily low dose inhaled corticosteroid
3- a daily medium dose of inhaled corticosteroid and a long acting inhaled b2 agonist
4- a daily medium dose of inhaled corticosteroid and theophylline
5- a daily medium dose of inhaled corticosteroid and nedocromil

أي من الأدوية التالية الأنسب لمريض أكبر من 5 سنوات من العمر لديه ربو مستمر متوسط الشدة ؟
1- ستيروئيد انشاقي منخفض الجرعة يوميا
2- ستيروئيد انشاقي متوسط الجرعة يوميا و مشابهات بيتا2 طويلة الامد
3- ستيروئيد انشاقي متوسط الجرعة يوميا وتيوفللين
4- ستيروئيد انشاقي متوسط الجرعة يوميا و نيدوكروميل
5- لا شيء مما سبق
Eye-wink Eye-wink Eye-wink Eye-wink


مريض يعاني من وزيز، ضيق صدر، ضيق نفس..A pt complaining of wheezing, chest tightness, shortness of breath |

حالة سريرية

الشكوى الرئيسية CC
Mr.C is a 32-year-old man with occasional wheezing.

زارك اليوم في عيادتك السيد "س" ذو الـ32 عاماً شاكياً من وزيز يعاني منه بين الحين والآخر.

القصة المرضية HPI
Mr.C has been having symptoms for 1-2 years. His symptoms have always been so mild that he has never sought care. Over the last month, he has been more symptomatic with wheezing, chest tightness, and shortness of breath. Usually he complains only of chest tightness and dyspnea. Only when his symptoms are at thier worst he hears wheezing. He notes that he often goes days without any symptoms. His symptoms are worse with exercise (e.g. when he jogs) and worse at night. He also reports that his symptoms are worse when he has a cold, and when he is around dogs and cats.

يعاني السيد "س" منذ حوالي السنة إلى سنتين، لكن أعراضه كانت دوماً معتدلة الشدة لذلك لم يطلب علاجاً. خلال الشهر الماضي أصبحت أعراضه أكثر وضوحاً وعانى من الوزيز، ضيق الصدر، ضيق نفس. غالباً معاناته كانت بسبب ضيق الصدر والزلة التنفسية (ضيق النفس)، وفقط عندما كانت تسوء حالته كان يسمع الوزيز. يذكر لك المريض بأن هناك أياماً لا يعاني فيها من أي عرض.
لاحظ السيد "س" بأن أعراضه تسوء عندما يمارس الرياضة (مثلاً عندما يهرول)، وفي الليل، عندما يصاب بالزكام، وعندما يتواجد في أماكن يتواجد فيها كلاب أو قطط.

السوابق المرضية الشخصية PMH
On further history, Mr. C reports that he had asthma as a child and was treated for years with theophylline. He was without symptoms until he moved 2 years ago.

بطرحك المزيد من الأسئلة أخبرك المريض بأنه كان في صغره مصاباً بالربو وعولج بالتيوفللين لعدة سنوات. ولم يعاني المريض من أي أعراض حتى غير مكان سكنه قبل عامين.

الوضع الصحي والاجتماعي SH
Mr.C doesn't smoke cigarettes.

لا يدخن السيد "س" السجائر.

الفحص السريري Clinical Exam
On physical exam he appears well. His vital signs are BP 120/76 mm Hg, RR 14 /min, pulse 72 bpm, temperature 36.9 C. His lung exam is normal without wheezes or prolonged expiratory phase. His peak flow is 87% of predicted.

بالفحص السريري وجدت أن المريض يبدو بحال عانة جيدة. علاماته الحيوية هي: الضغط الدموي 120/76 ملم زئبق، سرعة التنفس 14 مرة/د، النبض 72 ضربة في الدقيقة، درجة الحرارة 36.9 مئوية. فحص رئتيه كان طبيعياً دون وزيز أو تطاول زفير. بقياس الجريان الأعظمي لديه وجد بأنه يساوي 87% من القيمة المتوقعة.

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