Review

1
47 year old non smoking man complains of
a 3 month history of a non productive
cough that is worse at night. He
becomes dyspnic more easily and denies
any blood tinged sputum, weight loss, nasal
congestion or headache he is
normotensive, and his lungs are clear to
auscultation bilaterally except for an
occupational expiratory wheeze on forced
expiration.
►A chest radiograph is read as normal
► What is the most likely diagnosis?
► How would you confirm the diagnosis ?
 2
►A patient with known asthma undergoing
therapy with inhaled corticosteroid and
intermittent short acting β2 –agonists present
with complaints of nocturnal awakenings
secondary to cough and occasional wheezing.
This episodes occurs 3 to 4 times per week . PFT
in the past have shown mild obstructive lung
disease. What is the best next step ?
► A-oral steroids
► B- leukotriene receptors
► C- long acting β2- agonists
► D- theophilline
► E- anti-reflex therapy
 3
►A previously healthy young woman comes in
with a clinical diagnosis of community acquired
pneumonia that has not improved with OPD
treatment.she has diminished breath sounds
and dulness to percussion on the left side of her
chest suggesting a large left sided pleural
effusion which is confirmed by chest
radiography. The effusion likely is caused by
infection in the adjacent lung parenchyma and
may be cause of her failure to improve on
antibiotics

What is the most likely diagnosis?

What is the next step ?
 4
► 39 years old man develops a moderate free-
flowing pleural effusion following a left lower
lobe pneumonia. Thoracocentesis reveals
straw colored fluid with gram positive diplococci
on gram stain PH 6.9,glucose 32mg/dl , and LDH
1890 which of the following is the best next
step.
► A- send the fluid for culture
► B- continue treatment with antibiotics for
pneumococcal infection
► C- tube thoracostomy to drain the effusion
► D- schedule a fallow- up chest X-ray in 2 weeks
to document resolution of the effusion
 5
► 55 years old man with congestive heart failure
develops bilateral pleural effusion. What is the
most likely pleural fluid characteristic if
thoracocentesis is performed ?
► A- pleural fluid LDH 39, LDH ratio 0.2, protein
ratio 0.7
► B- pleural fluid LDH 39, LDH ratio 0.2, protein
ratio 0.1
► C-pleural fluid LDH 599,LDH ratio 0.9. protein
ratio 0.1
► D- pleural fluid LDH 599,LDH ratio 0.9 , protein
ratio 0.7
 6
► 69 years old man complains of gradually
worsening dyspnea and cough over the past 4
weeks 4 weeks and is found to have right sided
pleural effusion which is tapped and grossly
bloody. Which of the following is most likely
diagnosis
► A- parapneumonic effusion
► B- malignancy in the pleural space
► C- rupture of aortic dissection in to the pleural
space
► D- pulmonary embolism with pulmonary
infarction