PULMONOLOGY

1. A 68 year old gentlemen retired bureaucrat who is

heavy smoker has chronic productive cough for past 8
years his exertional dyspnea has been increasing for the
past three years. When he is brought to the hospital he is
drowsy, has cyanosis, flapping tremors, pitting edema,
the JVP is raised up to 6cm and the liver is enlarged and
tender. His pulse is 130/minutes , irregularly irreugularly
irregular and BP 100/60 mmHg respiratory rate is 30
bpm. He is using accessory muscles of respiration , has
an audible wheeze and bilateral crackles.
a. What is your comprehensive Dx of all his
manifestation?(COPD)
b. What further investigation will help you plan his
management?
c. What immediate treatment will you carry out for
this patient.
2. A 45 year old lady who was treated as a case of
pulmonary TB about two years back presented with
history of productive cough with copious foul smelling
sputum for last 6 month there was also history of massive
hemoptysis 3 month ago O/E she was clubbed and was
having bilateral crepts, her sputum for AFB was negative
.
a. Give most probable DX?(Bronchiectasis)
b. Name one important possible investigation with
possible result.
c. How will you treat this case?
3. 35 year old Mr jawad presented in emergency dpt with
severe SOB. He can’t explain his history due to severity
 of dyspnea. His mother reports that he had experienced
same problem last year and was given some treatment
which he didn’t took. He had fever sore throat and flu in
past one week. You have found wheeze on both
inspiration and expiration. There is mild cyanosis. His
temperature is 100f pulse is 100/min and BP 110/70
(2017,19
a. Give Dx?( acute exacerbation of asthma)
b. Give investigation.
c. Treatment.
4. 55 year old gentleman presented with Hx of fever cough
chest pain and SOB for last 4-5 days O/E his pulse was
120/min respiratory was 19/min and temperature was
102 F chest examination showed bronchial breathing
with increased vocal resonance in right lowe chest
a. Name two most imp organism involved in this case?
(pneumonia)
b. Investigations?
c. How will you assess severity of disease?
5. A middle aged male presented with SOB low grade fever
and cough. O/E he was pale with respiratory rate of
26/breath per minutes. Examination of chest reveal
absence of breath sound upto right mid zone along with
reduced chest movements on the same side.
a. Give Dx(right side lobar oneumonia)
b. List four investigations
c. What are the causes of diseases
6. A 13 year old girl brought to you with history of fever
chest pain and mild cough for last two weeks she
become SOB while climbing stairs examination reveal
decreased chest movements on left side. Trachea is
 deviated to right there are absent breath sound with stony
dull percussion note on left side of chest.
a. Give DX and five causes
b. Investigation
c. Management
7. 40 year old man presented with one month history of
productive cough and night sweats he lost 6kg weight
during two month and on examination he is underweight
febrile and is pale his CXR shows opacities . ESR is
50mm fall at end of 1st hour
a. Give Dx
b. Investigation
c. Treatment
Farhan-59