Anwser,s 4
-
Upload
anas-sohle -
Category
Health & Medicine
-
view
322 -
download
3
description
Transcript of Anwser,s 4
Wednesday, April 12, 2023
Anwser,sDr :ANAS SAHLE
1. Chest xr cases.2. Chest clinical case.
3. Chest ct cases.4. MRCP exam.
:http://www.facebook.com/dranas224
chest xr casesDr :anas sahle
http://www.facebook.com/dranas224
Cxr -7
• Compare between tow view\PA\LATERAL:• DIAGNOSIS IS:
Wednesday, April 12, 2023
DISCUSSION
Mass density is seen in the lateral view, but not in the PA view.
• This suggests a chest wall or external problem.• In film below mass in the axilla is projecting as
a mass in the chest.
CXR -8
Wednesday, April 12, 2023
Non-anatomical Lines
• The linear shadows do not correspond to any anatomical structure.
• Consider the following: • Pleural fibrosis• Extra-thoracic density• Bleb wall• Lung fibrosis
• This example represents pleural fibrosis.
CXR-9
Wednesday, April 12, 2023
Inlet to Outlet Shadow
• In-homogeneous cardiac density: Right half more dense than left
• Density crossing midline (right black arrow).• Right sided inlet to outlet shadow• Right para spinal line (left black arrow).• This is a case of achalasia cardia.
CXR-10
Wednesday, April 12, 2023
One Diaphragm (in lateral view)• You should be able to detect both diaphragms in
the lateral view. • If one is missing, it indicates that there is a
problem in that hemithorax. • By identifying which diaphragm is missing, you can
locate the side of the problem. • Naturally it is easy to identify the problem from
the PA view.
Which lung is resected?• Note that you can see only one diaphragm in the
film on the left. • The film below is pre-pneumonectomy, where you
can identify both diaphragms.• The visible diaphragm has a stomach bubble
underneath, indicating that it is on the left. • Hence, right lung pneumonectomy has occurred.
Wednesday, April 12, 2023
chest clinical casesPersistent Dyspnea Despite
Maximal Medical Therapy in COPD
Submitted byBrian P. Mieczkowski, DOFellowDivision of Pulmonary, Allergy, Critical Care and Sleep MedicineThe Ohio State University Medical CenterColumbus, OhioMichael E. Ezzie, MDAssistant Professor of Internal MedicineDivision of Pulmonary, Allergy, Critical Care and Sleep MedicineThe Ohio State University Medical CenterColumbus, Ohio
http://www.thoracic.org/index.php
Wednesday, April 12, 2023
History• A 64-year-old woman with a history of smoking presented with progressive shortness of breath with
exertion. • The patient smoked one to two packs of cigarettes per day for forty-two years and quit smoking one
year ago. • She had increasing dyspnea on exertion over the past few years that accelerated over the last year. • She reported she could now only walk short distances before sitting down to catch her breath. • Her family doctor started her on bronchodilators a few years ago.• She had improvement at the time, but now feels very limited. • She had several episodes of increased dyspnea, wheezing, and productive cough over the past two
years. • These exacerbations were treated as an outpatient with oral corticosteroids and antibiotics. • Two years ago, she participated in a four week course of pulmonary rehab which resulted in
improvement in her dyspnea. • She denied chest pain or palpitations with breathing symptoms. • She reported no shortness of breath at rest, except when talking for more than a few minutes. • She had no emergency department visits and had not required mechanical ventilator support for
breathing. • She had no nocturnal symptoms of wheezing or shortness of breath, but did have occasional wheezing
during the day along with a dry cough. • The patient was interested in discussing additional therapies for her lung disease.
Wednesday, April 12, 2023
CONTIN-• Her past medical history was significant for smoking, depression,
arthritis, hypertension, hyperlipidemia, and squamous cell carcinoma of the skin on the leg that was removed.
• Her current medications included amlodipine, sertraline, aspirin, tiotropium, albuterol, salmeterol/fluticasone, and simvastatin.
• The patient reported that her father had chronic obstructive pulmonary disease (COPD). There was no other family history of lung disease.
• The patient had been married for forty-five years and had two children. • She was a former smoker of one to two packs per day for forty-two
years. She denied alcohol or drug use. • She reported no significant occupational exposures.• A review of systems was pertinent for fatigue and occasional heartburn.
Wednesday, April 12, 2023
Physical Exam• On examination, the patient’s weight was 118 pounds with a body mass
index (BMI) of 20.3. • Her blood pressure was 120/70 mmHg with a pulse of 96 beats per minute. • Her oxygen saturation was 91% breathing ambient air. • Her general appearance was thin, and notable for a pleasant female who
was alert and oriented in no acute distress.• Her oropharynx was clear without exudate and neck exam revealed no
lymphadenopathy. • Her lung exam had diminished breath sounds bilaterally with comfortable
respirations and an appreciably long expiratory phase. No wheezes, rhonchi or rales were noted.
• Cardiac exam was normal rate with a regular rhythm. • Abdomen was thin, soft and nontender.• extremities showed no evidence of clubbing or edema.
Wednesday, April 12, 2023
Diagnostic studies• Pulmonary Function Tests:• (FEV1): 0.84 L (34% predicted) • (FVC): 2.46 L (56% predicted) • FEV1/FVC: 0.34 • Total lung capacity (TLC): 138% of predicted • Residual volume (RV): 227% of predicted • Diffusing Capacity of Carbon Monoxide (DLCO): 31% of predicted • 6-minute walk distance: She walked 900 feet and desaturated to
91%. • Cardiopulmonary exercise testing: Her power output was 20 watts.• Arterial blood gas: Baseline measurement of pCO2 was 37 and pO2 was
72. • The carboxyhemoglobin level was 0.
Wednesday, April 12, 2023
CXR
Wednesday, April 12, 2023
CT
Wednesday, April 12, 2023
Lung Perfusion Scan
Demonstrating her right upper lobe with 3.6% of total perfusion, her left upper lobe with 5% of total perfusion, her right middle lobe 13.6% of the total, her right lower lobe 26.3% of the total, and her left lower lobe 25.8% with left middle area 25.7%.
Wednesday, April 12, 2023
Question 1• Based on our current understanding of gender differences in
COPD, which of the following might be expected in this female patient compared to a male with an equivalent degree of airflow obstruction?
A. She has more evidence of emphysema on her chest CT than her male counterpart.
B. She has a greater bronchodilator response than her male counterpart.
C. She has a greater number of cigarette pack-years with the same disease as her male counterpart.
D. She would have greater improvement in her FEV1 one year after smoking cessation than her male counterpart.
E. She is older than her male counterpart with equivalent disease.
Wednesday, April 12, 2023
DISCUSSION• Chronic Obstructive Pulmonary Disease (COPD) is defined as airflow limitation that is not fully
reversible and is progressive with an associated abnormal inflammatory response of the lung to noxious stimuli.
• COPD is diagnosed by spirometry, with a forced expiratory volume in one second (FEV1) to forced vital capacity (FVC) ratio of less than 0.7 and is classified by the degree of loss of FEV1.
• The leading cause of COPD in the United States is cigarette smoking and the number of women dying from COPD is now equal to or surpassing the number of men.
• There is an increased understanding of gender differences in COPD development and progression.
• Women tend to develop COPD at an earlier age and generally have less pack-years of smoking compared to men with similar FEV1 values.
• Chest CT scans of female patients have less evidence of emphysema and histological examinations demonstrate thicker airways and narrower lumens when compared to men with equivalent levels of obstruction.
• Even with this phenotypic difference, there has been no data to suggest that women have a greater response to bronchodilators.
• Given the increased risk of smoking-induced lung impairment, women may benefit from smoking cessation more than men.
• The Lung Health Study found women had 2.5 times greater percentage improvement in FEV1 compared to men one year after smoking cessation.
Wednesday, April 12, 2023
Question 2• Which of the following indices used to
evaluate severity and mortality in COPD includes the numbers of exacerbations in the evaluation of the patient?
• A.DOSE • B.BODE • C.ADO • D.Both A and B are correct
Wednesday, April 12, 2023
DISCUSSION• Multiple indices have been developed to predict outcomes in COPD. • The BODE index described additional parameters to improve upon the FEV1-based mortality
prediction in patients with COPD. • It has also been validated to predict hospitalizations. • The BODE index includes: BMI, degree of obstruction, symptoms of dyspnea, and exercise
tolerance based on a six minute walk test. • The DOSE index, in addition to functional status, includes the frequency of exacerbation in its
prediction for hospitalization, respiratory failure and subsequent exacerbations over the next year.
• The components include dyspnea symptoms, degree of obstruction, smoking status, and exacerbation frequency.
• The ADO index was designed to simplify and improve the all-cause mortality prediction of the BODE index and found age to be an important factor.
• It includes age, dyspnea symptoms, and degree of obstruction. • The COPD prognostic index (CPI) is another index that uses exacerbation history to help
predict future exacerbations, hospitalizations, and mortality. • The CPI was developed from pooled data of 12 randomized controlled trials. • The components include age, gender, degree of obstruction, quality of life, BMI, frequency of
exacerbations, and history of cardiovascular disease.
Wednesday, April 12, 2023
Question 3• Of the following therapies for COPD, which potential benefits would
you expect to see in our patient?• A. Supplemental oxygen will improve her life expectancy by five
years. • B. Tiotropium will decrease her annual exacerbation rate, but may
increase her cardiac mortality. • C. The combination of salmeterol (long-acting beta agonist) and
fluticasone (inhaled corticosteroid) will improve mortality related to COPD.
• D. Pulmonary Rehabilitation will improve her quality of life, but will increase her healthcare utilization.
• E. Lung volume reduction surgery will improve her quality of life, dead space ventilation and long term mortality.
Wednesday, April 12, 2023
DISCUSSION• The patient does have moderately low oxygen levels on her six minute walk test to 91%,
but there is no data to suggest she would have a 5 year mortality benefit from supplement oxygen.
• Patients with very low oxygen levels at rest (paO2 less than 55 mmHg) had improved survival in early studies of home oxygen use (10, 11).
• The ongoing Long-term Oxygen Treatment Trial (LOTT) (Clinicaltrials.gov identifier NCT00692198) is assessing the effect of supplement oxygen in COPD patients with moderate hypoxemia.
• The TORCH trial evaluated the effectiveness of a long acting beta agonist (LABA) with and without an inhaled corticosteroid (ICS).
• The combination was most effective at improving lung function and quality of life as well as decreasing the time to the next exacerbation (12).
• The study did not however, demonstrate a statistically significant mortality benefit in regard to death from COPD with the use of a LABA with ICS.
• The INSPIRE trial reported that both tiotropium and a LABA with ICS were equally effective at decreasing the annual exacerbation rate.
• Similar to other trials with inhaled corticosteroids, INSPIRE did show an increased risk of pneumonia in the ICS treatment group (13).
Wednesday, April 12, 2023
CONTIN-• The GOLD guidelines currently suggest adding an ICS in symptomatic
patients with an FEV1 less than 50% who also have frequent exacerbations (1).
• Based on retrospective data showing ipratropium may increase adverse cardiac events, there was a concern with a class effect with tiotropium.
• The UPLIFT trial found fewer cardiac events and a decreased cardiac mortality in the tiotropium treatment group (14).
• Pulmonary rehabilitation has been shown to improve exercise tolerance, quality of life, and decrease healthcare utilization, but studies have not been powered to assess the effect on mortality (15).
• Lung volume reduction surgery (LVRS) has been shown to improve dyspnea scores, dead space ventilation, exercise tolerance, and quality of life.
• In select patients, including our patient, LVRS may improve long-term mortality as well (16-18).
Wednesday, April 12, 2023
Question 4• What patient population has the greatest mortality
risk from LVRS?• A. Patients with homogeneous emphysema and a
low exercise capacity • B. Patients with upper lobe predominate
emphysema and low exercise capacity • C. Patients with homogenous emphysema and high
exercise capacity • D. Patients with upper lobe predominant
emphysema and high exercise capacity
Wednesday, April 12, 2023
DISCUSSION• Lung Volume Reduction Surgery (LVRS) is done by performing a wedge resection of emphysematous
lung tissue in select patients with COPD that are poorly controlled despite maximal medical therapy. • LVRS is thought to improve a patient’s functional status by increasing the elastic recoil and expiratory
airflow by restoring the outward circumferential pull on small airways. • In addition, it is thought to help improve the strength and efficiency of the diaphragm by decreasing
the radius of its curvature. • The National Emphysema Treatment Trial (NETT) showed that LVRS improved dyspnea symptom
scoring, minute ventilation with exercise, and maximal exercise capacity (16). • A group of patients with an FEV1 less than 20% predicted and a diffusion capacity of less than 20%
predicted were found to have a 30-day mortality rate of 16%. • These patients were termed high risk and were eliminated from further analysis (19). • Among the remaining non-high risk patients, mortality at 30-days was increased (2.2% in the LVRS
group versus 0.2% in the maximal medical therapy group), but long term mortality at two years was similar.
• A subgroup analysis divided patients into groups based on location of emphysema and high versus low exercise capacity defined by a cut off of 40 watts in men and 25 watts in women.
• At 24 months, the subgroup of upper lobe predominate emphysema and low exercise capacity had improved survival, while the subgroup of patients with homogeneous emphysema and a high exercise tolerance had decreased survival.
• The other two groups did not show survival benefit or an increased risk of death.
Wednesday, April 12, 2023
Question 5• Which of the following changes to the patient’s history
would exclude her from Lung Volume Reduction Surgery (LVRS)?
• A. A post-rehabilitation six-minute walk test of 150 meters • B. A room air partial pressure of oxygen of 48 mmHg • C. A diffusing capacity of inhaled carbon monoxide (DLCO)
that is 30% predicted • D. A total lung capacity of 100% predicted. • E. A requirement of 30 mg of prednisone a day to control
symptoms
Wednesday, April 12, 2023
DISCUSSION• Patients that have COPD with severe obstruction and upper lobe predominate emphysema with poor
control despite maximal medical therapy can be considered for LVRS. • To better stratify which patients will benefit from LVRS, further evaluation of their physiology and
functional status is needed. • This evaluation should include a full set of pulmonary function testing, a six minute walk, a
cardiopulmonary exercise test, an ABG, and an echocardiogram. • The Centers for Medicare and Medicaid Services (CMS) require that a patient have an FEV1 less than 45%
predicted and if over 75 years of age, the FEV1 must be greater than 15% predicted. • If the FEV1 is less than 20% predicted, the DLCO must be greater than 20% predicted. • The patient must also be stable on less than 20 mg of prednisone a day. • A minimal total lung capacity of 100% predicted and a residual volume of 150% predicted are needed to
qualify. • There is evidence that a higher RV to TLC ratio yields greater improvement in post-operative FVC. • Participation in a minimal 6-week pre-operative pulmonary rehabilitation program is required and a post-
rehabilitation six minute walk of greater than 140 meters is needed to be considered for LVRS. • An arterial partial pressure of oxygen of 45 mmHg or greater and a partial pressure of carbon dioxide less
than 60 mmHg are also requirements from CMS. • If a patient has an ejection fraction of less than 45% then evaluation and approval by a cardiologist is
required. • Other factors that may exclude a patient from LVRS include: active smoking, severe cachexia or obesity,
comorbid lung or pulmonary vascular disease, and prior thoracic surgery.
Wednesday, April 12, 2023
Question 6• What is the most common complication seven
days out from LVRS?• A. Persistent chest tube air leak • B. Pneumonia • C. Renal failure • D. Arrhythmias
Wednesday, April 12, 2023
DISCUSSION• The most common post-operative complications from LVRS are persistent air
leaks, cardiac arrhythmias, pneumonia, and respiratory failure requiring sustained mechanical ventilation or re-intubation.
• NETT found that air leaks occurred in 90% of patients with a median duration of seven days and 12% of patients had an air leak for greater than thirty days.
• Cardiac arrhythmias were the next most common complication with 23% of patients developing an arrhythmia within the first thirty days.
• Pneumonia develops in approximately 18% of patients in the post-operative period.
• Renal failure is not a common complication after LVRS surgery (16). • A recent review of patients that underwent LVRS based on the NETT criteria had
prolonged air leak (greater than 7 days) as the most common complication, occurring in 43% of patients (17).
• Persistent air leaks often lead to a protracted time that the patient needs a chest tube, longer hospitalizations, and may require further surgical intervention to repair the bronchopleural fistula.
Wednesday, April 12, 2023
chest ct cases-3Dr :anas sahle
http://www.facebook.com/dranas224
HRCT-1
HRCT-1
• What is the major abnormality in this case?• a) Linear opacities• b) Nodules• c) Consolidation• d) Ground-glass opacity
Note: The vessels are very prominent in this case because the computer was set to optimize
visualization of the subtle major abnormality.
HRCT-2
HRCT-2
• 2. What is the distribution of the abnormalities?
• a) Bronchovascular.• c) Centrilobular.• d) Pleural.
Note: D = dome of diaphragm
HRCT-3
HRCT-3
• Find an area of ground-glass opacity in the right lung.
• Find 2 pleural nodules in the right lung.• Find a nodule at the end of a vessel in the
right lung.• Find 3 centrilobular nodules in the right lung.
HRCT-3
HRCT-4
HRCT-4
• Find a pleural nodule in the right lung.• Find 2 nodules along the major fissure of the
right lung.*Identification of fissure:
Vessels from upper and lower lobes branch and taper toward the fissure and are absent at the fissure.
HRCT-4
Histologic Features
• Find two arteries obstructed by a cellular mass with central hemorrhagic necrosis.
• Find the small subpleural hemorrhagic infarct caused by the arterial obstruction.
Histologic FeaturesThese two vessels would appear on HRCT as nodules at ends of vessels.
Note that on HRCT, some of the subpleural nodules in these cases may represent infarcts.
Histologic Features
• Find and outline the cellular mass within the vessel.
• What is the nature of the cellular masses in this picture and in the one above?
• Find and outline the cellular mass within the vessel.
• What is the nature of the cellular masses in this picture and in the one above?
• Hematogenous metastatic neoplasm, which may be confined to the vessel or may spread into the surrounding lung
Diagnosis:
Hematogenous metastatic tumor
Summary
• diagnostic features of numerous hematogenous metastatic nodules on HRCT:–Usually random distribution –Often smooth, well-defined –Varying size common
random nodules
• Differential diagnosis of on HRCT:– hematogenous metastasis (particularly from thyroid,
kidney, and breast) and – miliary infections.
Langerhans' cell histiocytosis, sarcoidosis, and silicosis are common causes of nodules, but such nodules are rarely diffuse and haphazard.
• Random nodules occur along the pleura and fissures, in a centrilobular location, and in the bronchovascular region.
• The bronchovascular nodules in the case of random nodules are seen at the ends of small arteries and not in the proximal bronchovascular interstitium.
• Nodules in lymphangitic tumor and sarcoidosis are frequently seen in the central bronchovascular interstitium.
Wednesday, April 12, 2023
04/12/202355
MRCP EXAMRespiratory
04/12/202356
Q1•The following are recognised associations
with pulmonary hypertension:•A- An apgar of 3 at 5 minutes
•B- Meconium aspiration•C- Hyaline membrane disease
•D- Hypo-glycaemia•E- Oligo-hydraminos
04/12/202357
A1 •The following are recognised associations
with pulmonary hypertension:•A- An apgar of 3 at 5 minutes (true)
•B- Meconium aspiration (true)•C- Hyaline membrane disease (true)
•D- Hypo-glycaemia (true)•E- Oligo-hydraminos (true)
Wednesday, April 12, 2023
Q2•The following are recognised causes of
pulmonary eosinophilia:•A- Asthma
•B- Loeffler's Syndrome•C- Hookworm infestation•D- Aspergillus fumigatus
•E- Schistosomiasis
Wednesday, April 12, 2023
A2 •The following are recognised causes of
pulmonary eosinophilia:•A- Asthma (True)
•B- Loeffler's Syndrome (True)•C- Hookworm infestation (True)•D- Aspergillus fumigatus (True)
•E- Schistosomiasis(false)
Wednesday, April 12, 2023
Q3The following are recognised treatments for complications of cystic fibrosis:
A- DNAase to assist in reinflating collapsed lung segments .
B- Rectal pull-through and anastamosis for rectal prolapse .C- Pancreatic transplant for diabetes mellitus .
D- Nebulised tobramycin for pseudomonas colonisation of the lower respiratory tract.E- Hypotonic saline drinks for hypernatraemic dehydration.
Wednesday, April 12, 2023
A3 The following are recognised treatments for complications of cystic fibrosis:
A- DNAase to assist in re-inflating collapsed lung segments (false) .
B- Rectal pull-through and anastamosis for rectal prolapse (false) .C- Pancreatic transplant for diabetes mellitus (false) .
D- Nebulised tobramycin for pseudomonas colonisation of the lower respiratory tract (true).E- Hypotonic saline drinks for hypernatraemic dehydration (false).
Wednesday, April 12, 2023
Q4Regarding the sweat test:A- Sweating is enhanced by application of atropine .
B- The filter paper is left on for a total of about 4 hours .
C- At least 25mg of sweat is necessary for a reliable result .
D- More than 60mmol/L of chloride in sweat is diagnostic of cystic fibrosis .
E- False/positive results may be encountered in children with nephrotic syndrome.
Wednesday, April 12, 2023
A4 Regarding the sweat test:
A- Sweating is enhanced by application of atropine (false) .
B- The filter paper is left on for a total of about 4 hours (false) .
C- At least 25mg of sweat is necessary for a reliable result (false) .
D- More than 60mmol/L of chloride in sweat is diagnostic of cystic fibrosis (true) .
E- False/positive results may be encountered in children with nephrotic syndrome (false).
Wednesday, April 12, 2023
Q5Diffusion capacity of carbon monoxide:A- Is a specific measure of lung perfusion .
B- Depends on the thickness of the alveolar wall .
C- Depends on the surface area available for gas exchange .D- Is increased in cigarette smokers .E- Is increased in emphysema.
Wednesday, April 12, 2023
A5 Diffusion capacity of carbon monoxide:
A- Is a specific measure of lung perfusion (false) .
B- Depends on the thickness of the alveolar wall (true) .
C- Depends on the surface area available for gas exchange (true) .D- Is increased in cigarette smokers (false) .E- Is increased in emphysema (false).
Wednesday, April 12, 2023
Q6The following respiratory symptoms may be exacerbated by gastro-oesophageal
reflux:A- Asthma
B- Central apnoea
C- Obstructive apnoea
D- Stridor
E- Wheeze
Wednesday, April 12, 2023
A6 The following respiratory symptoms may be exacerbated by gastro-oesophageal
reflux:A- Asthma (true)
B- Central apnoea (true)
C- Obstructive apnoea (true)
D- Stridor (true)
E- Wheeze (true)
Wednesday, April 12, 2023
Q7In lung perfusion scanning:
A- Emphysema and pulmonary embolism give similar appearances .B- Iodine sensitivity is a contraindication .C- Is always abnormal in Scimitar Syndrome .
D- May show decreased upper lobe perfusion in mitral stenosis .
E- Shows decreased perfusion in McLeod's Syndrome.
Wednesday, April 12, 2023
A7 In lung perfusion scanning:
A- Emphysema and pulmonary embolism give similar appearances (false) . B- Iodine sensitivity is a contraindication (false) .
C- Is always abnormal in Scimitar Syndrome (true) .
D- May show decreased upper lobe perfusion in mitral stenosis (false) .
E- Shows decreased perfusion in McLeod's Syndrome (true).
Wednesday, April 12, 2023
Q8In cystic fibrosis:A- The sweat chloride is higher than the sodium .
B- The secretions are viscid because water cannot be actively transported form the respiratory epithelial cell.
C- The amino acid at position 508 of the CTRE gene acts as a regulator of the chloride channel.
D- The DeltaF508 mutation explains most of the inter-racial differences in the incidence of cystic fibrosis.
E- The CFTR traverses the cell membrane 7 times, and is arranged in ring formation.
Wednesday, April 12, 2023
A8 In cystic fibrosis:A- The sweat chloride is higher than the sodium (true) .
B- The secretions are viscid because water cannot be actively transported form the respiratory epithelial cell (false).
C- The amino acid at position 508 of the CTRE gene acts as a regulator of the chloride channel (true).
D- The DeltaF508 mutation explains most of the inter-racial differences in the incidence of cystic fibrosis (true).
E- The CFTR traverses the cell membrane 7 times, and is arranged in ring formation (true).
Wednesday, April 12, 2023
Q9Pneumocystis carinii:A- Predisposes to pneumothorax .
B- Can cause pneumonia with very few signs on chest x-ray .C- Is an obligate intracellular organism .D- May cause extrapulmonary infection .
E- Is usually diagnosed by finding a rising titre of neutralising antibodies.
Wednesday, April 12, 2023
A9 Pneumocystis carinii:A- Predisposes to pneumothorax (true) .
B- Can cause pneumonia with very few signs on chest x-ray(false) .C- Is an obligate intracellular organism(false) .
D- May cause extra-pulmonary infection (true) .
E- Is usually diagnosed by finding a rising titre of neutralising antibodies(false).
Wednesday, April 12, 2023
Q10Recognised complications of bronchoscopy include:
A- Haemorrhage
B- Pneumothorax
C- Segmental collapse
D- Hypoxic ischaemic encephalopathy
E- Empyema
Wednesday, April 12, 2023
A10 Recognised complications of bronchoscopy include:
A- Haemorrhage (true)
B- Pneumothorax (true)
C- Segmental collapse (true)D- Hypoxic ischaemic encephalopathy(false)
E- Empyema (true)
Wednesday, April 12, 2023