MDcooper
Forum Guru
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30 years old male
history of recurrent pneumonias and chronic cough
Presenting complaint is foul smelling purulent,blood tinged sputum,which is worse in the morning and on lying down.
Physical Exam shows clubbing of fingers
Chest exam shows wet inspiratory rales at lung bases posteriorly.
A.What is the diagnosis?
2.The most commonly involved area is likely to be the
A. apical segment of the upper lobe
B. posterior basal segments of the lower lobes
C. lingula
D. right middle lobe
E. superior segments of the lower lobes
3. The most important procedure necessary to define the extent of the disease would be
A. computed tomography
B. bronchoscopy
c. bronchography
D. open thoracotomy
E. gastric washings
4.Therapy for this disease might include
A. antibiotics and postural drainage
B. steroids
C. radiotherapy
D. aerosols
E. niazid
What is the most likely precursor of the disease?
Edited by MDcooper on 06/08/06 - 06:46 AM
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| achilles
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it is most likely a lung abscess.
most likely area- superior segment of the lower lobe ??
CT scan
antibiotics and postural drainage.
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| powerranger
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achilles is right.....
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| cyra
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Could it be bronchiectasis with a superimposed infection?(the history of recurrent pneumonias and chronic cough made me think of that.Also clubbing would more likely be seen with bronchiectasis than a lung abcess)
Involving posterior basal segments of lower lobes.
Diagnostic test....CT
T/M....antibiotics and postural drainage.
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| MDcooper
Forum Guru
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DD includes both abscess and bronchiactesis.The most common cause of hemoptysis is bronchiactasis.clubbing and wet rales will be there.sputum will have characteristic three layered pattern.Chronic cough and weight loss present.The answer is bronchaictasis.The answer with me says that it is diagnosed through bronchography(wierd as I know it is diagnosed through CT).Treatment is antibiotics and common location is basal post part of lower lobes.any comments as how to diagnose and find the extent of involvement?
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| cyra
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Its CT scan definitely.
From emedicine:
"CT scanning (see Image 4), particularly HRCT scanning of the chest, has replaced bronchography as the defining modality of bronchiectasis."
Heres the link...scroll down to imaging studies.
http://www.emedicine.com/med/topic246.htm
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| MDcooper
Forum Guru
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that is what I think too.
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