EMQs in Clinical Medicine.pdf - Peshawar Medical College

Treatment of asthma and COPD – answers 43
be clubbed with coarse inspiratory crackles that can be heard over the
infected areas of lung.
Other causes of bronchiectasis include Kartagener’s syndrome, pertussis
and bronchial obstruction.
E
F
G
A 65-year-old dockyard worker presents with weight loss and shortness
of breath. He is clubbed and cachectic. His chest radiograph
shows pleural calcification and a lobulated pleural mass.
Mesothelioma is a consequence of previous asbestos exposure. The chest
radiograph classically shows a mass with a lobulated margin. Pleural
calcification suggests possible previous exposure to asbestos but, in the
absence of other features, it is benign.
A 40-year-old woman presents with gross clubbing and progressive
shortness of breath. Examination reveals fine end-inspiratory crackles.
Her chest radiograph shows a ground-glass appearance of the lung.
Combination of shortness of breath, clubbing and fine end-inspiratory
crackles suggests cryptogenic fibrosing alveolitis, which usually has an
onset during middle age. Chest radiograph findings include ground-glass
shadowing. As the disease progresses, a ‘honeycomb’ lung may develop.
Fibrosing alveolitis is associated with rheumatoid arthritis, systemic sclerosis
and ulcerative colitis. In these cases it is not referred to as cryptogenic.
A 65-year-old smoker presents with shortness of breath. On the chest
radiograph, eight ribs can be seen anteriorly above the diaphragm on
each side of the chest in the mid-clavicular line.
It is usual to see no more than six ribs anteriorly above the diaphragm
in the mid-clavicular line, in a posteroanterior chest radiograph taken
at full inspiration. The presence of more visible ribs suggests
hyperexpansion which may occur in COPD.
16 Treatment of asthma and COPD
Answers: M K C B H
M
A 7-year-old girl with slight wheeze and shortness of breath despite
inhaled salbutamol.
This patient’s symptoms may respond to inhaled salbutamol if it can be
delivered effectively to the lungs. Use of a spacer improves delivery in
children and patients with poor inhaler technique. In young patients, it
is particularly important to optimize bronchodilator therapy as early
initiation of corticosteroids may lead to growth retardation.
A 22-year-old student with mild asthma that needs treatment for
occasional early morning wheeze.