Lobar pneumonia is often due to Streptococcus. pneumoniae. Amoxicillin is the drug of choice for treating pneumonia.

Cigarette smoking is the most important risk factor for COPD, and smoking cessation is, in most cases, the most effective way of preventing the onset and progression of COPD.

Side effects of anti tubercular drugs-

• INH: peripheral neuritis and hepatitis. [Add ( B6 pyridoxine ) for peripheral neuritis].
• Ethambutol: optic neuritis
• Rifampicin: orange discoloration of urine & tears
• Streptomycin: causes ototoxicity & nephrotoxicity.

INH: peripheral neuritis and hepatitis. [Add B6 pyridoxine for peripheral neuritis].

Isoniazid [INH], a common TB medication can interfere with vitamin B6 metabolism, leading to a deficiency. Vitamin B6 is crucial for nerve function, so without enough, nerve damage can occur, causing symptoms like numbness or tingling.

During an asthma attack, the airway becomes narrow, making breathing difficult and causing SOB. Even if X-rays and blood tests look normal, asthama can still cause this. Hyperventilation can lead to an increased pH.

Streptococcus pneumonia is the most common cause of community-acquired pneumonia.

Incorrect options-

• Haemophilus influenzae causes pneumonia but less often than streptococcus.
• Mycoplasma causes very mild form of pneumonia.
• Klebsiella is more common in sick and immunocompromised patients.

Viral pharyngitis due to EBV presented with enlarged tonsil with exudates and petechiae on soft palate and enlargement of the uvula and sometimes present with tender splenomegaly.

Streptomycin causes ototoxicity & nephrotoxicity.

Acute chest syndrome is the non-infectious vaso-occlusive crisis of pulmonary vasculature presented with chest pain, fever, tachypnea, and hypoxemia.

Spasmodic croup: recurrent sudden upper airway obstruction which presents as stridor and cough. Approximately 50% of children have atopic disease.

Asthma stepwise therapy: in step 2 add ICS to control asthma.

Corticosteroids help to reduce inflammation in your airways, making it easier to breathe.

Chyene-stokes respiration: rapid deep breathing phase followed by a period of apnea, present with heart failure, stroke, and brain trauma, also can be with sleep or high altitude.

Incorrect option-

• Abdominal breathing and normal breathing don't follow this pattern.
• Kusmmaul’s breathing is defined as rapid and deep breathing, present with metabolic acidosis particularly in diabetic ketoacidosis.

If you have had RF before, there's a 50% chance of getting it again after a strep throat infection.

Parainfluenza viruses are the main cause of croup, which leads to barking cough and noisy breathing in young children.

Streptococcus pneumoniae commonly causes pneumonia. A sore throat followed by cough and fever might mean the infection has spread to the lungs.

Incorrect options-

• Staph aureus is less likely to cause pneumonia after sore throat.
• H.influenzae can cause pneumonia but less commonly than streptococcus pneumoniae
• Parainfluenza causes croup.

For mild intermittent asthma, a quick relief inhaler like albuterol is the go-to solution to open airways during attacks.

Adenocarcinoma is usually located peripherally, so the upper part location is the correct option.

Other options are incorrect because-

• The most common tumor in females is breast tumors.
• Small cell carcinoma spreads faster, not squamous cell.

According to various guideline committees, the standard duration of therapy for drug-susceptible TB, regardless of HIV status, should be six months;

this includes two months of isoniazid (INH), a rifamycin (eg, rifampin or rifabutin), pyrazinamide, and ethambutol followed by isoniazid and a rifamycin for four additional months.

• When to prolong therapy — The duration of TB therapy is longer in specific clinical situations, regardless of HIV status: For those patients with cavitary disease and positive sputum cultures after two months of treatment, the duration of isoniazid and rifampin treatment should be extended by three months for a total of nine months of treatment.
• For patients with bone, joint, or CNS disease, many experts recommend 9 to 12 months of therapy.
• For all other patients with extrapulmonary disease, the recommended treatment is two months of four-drug therapy followed by four months of isoniazid and rifampicin.
• The duration of therapy is also generally longer in patients with drug-resistant TB.
• HIV-infected patients with MDR TB should be treated for 24 months after the conversion of sputum culture to negative. After the cessation of therapy, patients should be examined every four months for an additional 24 months to monitor for evidence of relapse.

A nasopharyngeal tube helps to keep the airway open in a responsive patient with multiple injuries, allowing them to breathe better.

Incorrect options-

• Oxygen supply is important for breathing but doesn't secure the airway.
• Ventilator is used in patient's who can't breathe on their own, not for responsive ones.
• Tracheostomy is a surgical procedure used for severe cases, not for responsive patients.

Croup causes a barking cough and noisy breathing, often worse at night, and is common in children with conditions like eczema.

Beta-2 agonist relax airway muscles, making it easier to breathe, and are go-to quick-relief inhalers for asthama attack.

 Non-caseating granuloma supports the diagnosis of sarcoidosis.

Incorrect options-

• Pneumoconiosis is an occupational & restrictive lung disease caused by the inhalation of dust, depending on the dust type the disease is given its name, in cotton case it is called ' Byssinosis'.Bilateral hilar lymphadenopathy present in both Sarcoidosis & Pneumoconiosis.
• Berylliosis and amyloidosis don't have the following findings.

Consult oncologist for radiation therapy ± chemotherapy because SVC syndrome symptoms and hoarseness suggest unrespectable lesion.

This patient is at high risk of pneumonia and flu complications. Waiting 4 weeks lets the body recover fully before getting vaccinated, which can cause mild side effects.

The classic radiographic findings of evenly distributed diffuse small 2–3-mm nodules, with a slight lower lobe predominance, are seen in 85% of cases of miliary TB.

A pneumothorax is when air leaks into the space around the lungs, causing them to collapse. This leads to sudden chest pain, difficulty breathing, and signs like decreased tactile fremitus and chest movement on one side, along with specific X-ray findings.

Salicylate ingestion causes metabolic acidosis (from lactate, ketones) + respiratory alkalosis due to stimulation of CNS respiratory centers.

Salbutamol quickly relaxes airway muscles, making it easier to breathe. Nebulized salbutamol delivers it directly to the lungs for fast relief during an asthma attack.

Incorrect options-

• IV aminophylline takes longer to act, so its not the first choice.
• Pleural aspiration is used to drain fluid around lungs not for asthma attacks.
• Heimlich maneuver is used in choking not asthma.

By asthma stepwise management guidelines if the patient is on Ventolin and the asthma is still not controlled (partially controlled 3 attacks per week) then add LABA which will help in preventing attacks by keeping the airways relaxed.

For COPD patients, oxygen is only given when blood oxygen levels drop below 88%, as this ensures they get the support they need without overloading their system.

A lung abscess is a pocket of pus caused by infection. Symptoms like fever, foul-smelling sputum, and a fluid-filled cavity on X-ray strongly suggest the diagnosis.

 Buffered charcoal yeast extract (BCYE) agar is a selective growth medium used to culture or grow certain bacteria, particularly the Gram-negative species Legionella pneumophila

The patients symptoms, like numbness and tingling, could be due to an electrolyte imbalance, especially if they have had vomiting and diarrhea.

Incorrect options-

• Breathe in bag is a method used for hyperventilation.
• Giving glucose treats hypoglycemia not electrolyte imbalance
• Reassurance will not alone be sufficient.

The primary respiratory infections in early phase (non-immunocompromised phase) include those caused by pathogens common to the general public. The predominant organisms are Streptococcus pneumonia, Haemophilus influenza, and community-acquired respiratory viruses.

In ARDS, high oxygen levels are sometimes used to help support breathing. However prolonged use of  high levels of oxygen can cause oxygen toxicity.  This damage can make blood vessels leak and may lead to hemothorax.

The respiratory drive is normally largely initiated by PaCO2 but in chronic obstructive pulmonary disease (COPD) hypoxia can be a strong driving force and so if the hypoxia is corrected then the respiratory drive will be reduced. There will also be a loss of physiological hypoxic vasoconstriction.

INH is the go to medication for preventing TB. It works by stopping the bacteria from growing and spreading.

A chest tube is the best way to drain excess fluid from around the lungs, helping them expand properly again.

 The most common causes of chronic cough are-

• Postnasal drip
• Asthma
• Acid reflux from the stomach.

  ---

  These three causes are responsible for up to 90 percent of all cases of chronic cough.

The symptoms of fever, night sweats, bloody sputum, and weight loss- along with a positive PPD test and apex lung infiltrate on X-ray, are classic signs of reactivated TB.

Incorrect options-

• Sarcoidosis may present with fever, weight loss but doesn't cause sputum and positive PPD.
• Adenocarcinoma/Lung cancer can mimic TB but doesn't have positive PPD test.

In tension pneumothorax, trapped air in the pleural space builds pressure and pushes the mediastinum, and trachea away from the affected side.

• All other options are a late sign.

Breath-holding spells are the occurrence of episodic apnea in children, possibly associated with loss of consciousness, and changes in postural tone.

Breath-holding spells occur in approximately 5% of the population with equal distribution between males and females. They are most common in children between 6 and 18 months and usually not present after 5 years of age. They are unusual before 6 months of age. A positive family history can be elicited in 25% of cases.

• They may be confused with a seizure disorder. They are sometimes observed in response to frustration during the disciplinary conflict.

Cefuroxime is a 2nd generation cephalosporin used in respiratory infections “H. influenza and M. catarrhalis” whcih commonly causes pneumonia in COPD patients.

After surgery, patients are at increased risk of DVT. A DVT can dislodge and travel to the lungs causing pulmonary embolism.

• Classic signs include SOB, hypotension, and unilateral leg swelling.

Incorrect options-

• Hypovolemic shock will have a history of significant blood loss.
• Septic shock would have history of fever and other signs of infection.
• MI unilateral leg swelling isn't a feature of heart attack.

INH is the standard preventive therapy for close contacts of active TB patients. It reduces the risk of developing active TB after exposure.

Klebsiella pneumoniae is a major cause of bacterial pneumonia, especially in hospitalized or immunocompromised patients. It often leads to severe symptoms like fever, cough, and difficulty breathing.

The history of positive PPD test, apical infiltration, and hemoptysis are classic signs of old, inactive TB. A previously positive PPD test reflects prior TB exposure, while apical changes on X-ray support the diagnosis.

The first priority in trauma management is ensuring a clear airway to prevent  obstruction. Trauma can also cause blood, vomit, or broken teeth to block the airway, so clearing it is critical for effective breathing.

These are the basic investigations for TB patient

• CXR
• PPD
• AFB “Ziehl Neelsen stain”

.

Azithromycin is the first-line treatment for CAP. It's effective against common pathogens like Streptococcus pneumoniae and Mycoplasma pneumoniae.

Incorrect options-

• Ciprofloxacin is used for specific bacteria like pesudomonas.
• Gentamycin is not used for CAP due to toxicity concerns.
• Tetracycline is rarely used in adults for CAP.

Atelectasis, or partial collapse of lung, is a common cause of fever shortly after surgery. Pain and shallow breathing post-surgery can lead to poor lung expansion, causing this condition.

• Postoperative atelectasis generally occurs within 48 hours.

LMWHs, like enoxaparin, are the gold standard for DVT prevention after surgery beacause they're highly effective, safe, and easy to administer subcutaneously without frequent monitoring.

Incorrect options-

• Warfarin has delayed effect and requires regular monitoring.
• Aspirin is less effective than LMWH for post-op DVT prevention.
• Unfractioned heparin is effective but inconvenient .

Nigh time cough and shortness of breath are hallmark asthma symptoms. The history of rash and allergic rhinitis indicates an atopic predisposition, commonly linked to asthma.

Albuterol, a short-acting beta-agonist, is the first-line treatment. It relaxes airway muscles quicly, relieving bronchospasm and easing breathing during an acute asthma episode.

Inhaled corticosteroids are the most effective for long-term asthma control. They reduce airway inflammation, preventing frequent and severe attacks.

Symptoms of nicotine withdrawal generally start within 2 - 3 hours after the last tobacco use, and will peak about 2 - 3 days later.

• Wheezing and chest complaints in babies less than 1 year old - Bronchiolitis.

More than One year old - ARDS.

A V/Q mismatch occurs when the balance between ventilation and perfusion is disrupted. This is a common cause of hypoxemia, seen in conditions like asthma, pulmonary embolism, or pneumonia, where certain lung areas get airflow but lack adequate blood flow or vice versa.

Incorrect options-

• Hypoventilation reduces overall oxygen intake but isn't the primary mechanism compared to V/Q.
• Improper alveolar diffusion causes hypoxemia in diseases like pulmonary fibrosis, but is less common than V/Q mismatch.
• Elevated 2,3-DPG enhances oxygen release from hemoglbin, typically improving oxygen delivery, not causing hypoxemia.

Inhaled corticosteroids like betamethasone can slightly affect growth in children by mildly supressing the hypothalamic-pituitary-adrenal axis. While this effect is usually minimal and temporary, regular monitoring is recommended to ensure the child's growth stays within the normal range.

ARDS etiologies:

• Direct injury: pneumonia, inhalation injury, aspiration, lung contusion, and near drowning.
• Indirect injury: sepsis, pancreatitis, shock, trauma/multiple fractures, DIC, and transfusion.

•  All patients with interstitial lung diseases develop exertional dyspnea and non-productive cough.
• The examination revealed typical coarse crackles and evidence of pulmonary hypertension.
• PFTs show evidence of restrictive pattern (decreased volumes).

 The most common causes of an air bronchogram are consolidations of various origins.

• Widespread air bronchograms are seen in hyaline membrane disease but its not always typical.
• Air bronchograms are also seen in atelectatic lobes on chest radiographs when the airway is patent, notably when atelectasis is caused by pleural effusion, pneumothorax, or bronchiectasis.

Cryptic tonsilitis involves the formation of pockets or crypts in the tonsils that can trap food, bacteria, and debris. These trapped substances can harden into tonsililoliths, causing halitosis and the appearance of seed like structures.

Incorrect options-

• Tonsillitis may cause bad breath but it usually presents with symptoms like throat pain, fever, and red, swollen tonsils, not seed like structures.
• Croup is a viral condition with a barking cough and stridor, unrelated to tonsils or halitosis.
• Pharyngitis is the infalmmation of pharynx, often causing sore throat and redness, but not associated with tonsil stones or cryptic structures.

 A typical arterial gas during an acute uncomplicated asthma attack reveals normal PaO2, low PaCO2, and respiratory alkalosis.

• Hypoxemia in a PaO2 range of 60 to 80 mm Hg frequently is found even in moderately severe asthma. However; a PaO< 60 mm Hg may indicate severe disease.

  ---

  Hypoxemia is due to ventilation-perfusion mismatching, whereas low PaCO2 is a result of hyperventilation. A progressive increase in PaCO2 is an early warning sign of severe airway obstruction in a child with respiratory muscle fatigue.

Pulmonary angiography is the gold standard for diagnosing pulmonary embolism. It involves injecting contrast dye into the pulmonary arteries and directly visualizing blood clots. It's highly accurate but invasive, so it's typically used when other tests are inconclusive. 

 The most common side effects are-

• Cardiac arrhythmia,
• Anxiety,
• Tremors,
• Tachycardia & seizures.

  ---

  [Always monitor ECG]

 Clinical features of Bronchiectasis are recurrent pneumonia because of the dilated bronchi so there’s a reduction in the ability the clearance secretions and pathogens from the airways. The sputum is copious, could have foul smell and the patients would have clubbing.

Incorrect options-

• A lung abscess also causes clubbing and foul-smelling sputum but its not a typical feature.
• COPD has frequent infective exacerbations but doesn’t cause clubbing.
• Pneumonia is an acute process and no clubbing occurs.

It is commonly associated with Mycoplasma pneumonia. Cold agglutinins are antibodies that cause red blood cells to clump together at low tempratures. This finding is a key diagnostic clue for mycoplasma infections.

A chest tube is the most appropriate treatment for pneumothorax caused by trauma. It drains air or fluid from the chest cavity, allowing the lung to re-expand. This is the standard care for significant pneumothorax.

The right lung has two pulmonary veins which carry oxygenated blood from the lungs back to the left atrium of the heart.

Symptoms and signs of tension pneumothorax may include the following:

• Chest pain 
• Dyspnea
• Anxiety
• Acute epigastric pain (a rare finding)
• Fatigue Respiratory distress (considered a universal finding) or respiratory arrest
• Unilaterally decreased or absent lung sounds (a common finding; but decreased air entry may be absent even in an advanced state of the disease)
• Adventitious lung sounds (crackles, wheeze; an ipsilateral finding)
• Lung sounds transmitted from the non-affected hemithorax are minimal with auscultation at the midaxillary line
• Tachypnea
• Hyperexpansion of the chest wall Increasing resistance to providing adequate ventilation assistance.
• Tachycardia (a common finding)
• Hypotension (should be considered as an inconsistently present finding; while hypotension is typically considered a key sign of a tension pneumothorax, studies suggest that hypotension can be delayed until its appearance immediately precedes cardiovascular collapse).
• Pulsus paradoxus & Jugular venous distension

Sodium gluconate isn't a standard treatment for severe bronchial asthma. It mainly adresses calcium deficiencies and is rarely used in asthma care.

Small cavities on chest X-ray are a hallmark of miliary TB, caused by lung damage from TB bacteria.

These are the first choice for quick relief of asthma symptoms like wheezing and breathlessness. They relax airway muscles, easing breathing.

This combination is the standard treatment for active TB, effectively killing bacteria and preventing drug resistance.

An elderly male with a long history of heavy smoking and a change in character of cough is chronic bronchitis which is a clinical diagnosis (cough for most of the days of 3 months in at least 2 consecutive years).

Incorrect options-

• Emphysema is a pathological diagnosis (dilatation and destruction beyond the terminal bronchioles).
• Smoker's cough is not a formal diagnosis.
• Bronchiectasis presents with chronic cough and recurrent infection.

 After fracture, fixation (immobile), dyspnea means pulmonary embolism. You should start treatment with heparin for a few days then warfarin.

In Pulmonary embolism ABG will show decreased PaO2 and PaCO2.

• ECG - S1Q3T3 with sinus tachycardia.

Each option is a potential sign of TB in a child-

• History of exposure- Close contact with TB patient increases the risk.
• Chest X-ray findings can reveal abnormalities suggestive of TB.
• Splenomegaly and positive culture are indicative of precense of active infection.

Severe bronchial asthma features:

• PEFR<60%
• Sa O2 <90%
• PO2<60
• PCO2 >45
• Dyspnea at rest, inspiratory & expiratory wheezes, accessory muscle use
• Pulsus paradoxus>25 mmHg

Parapneumonic effusion/empyema especially seen with S. pneumoniae

These block beta-2 receptors in the airways causing bronchoconstriction, which can worsen asthma symptoms or trigger severe attacks.

Low oxygen levels in tissues trigger rightward shift in oxygen-Hb dissociation curve, helping Hb release oxygen more easily.

Incorrect options-

• Respiratory alkalosis shifts the curve to the left, making oxygen harder to release.
• Hypothermia causes shift to left.
• Respiratory acidosis causes shift to the right but is not the primary driver like hypoxia.

•  High risk because of contact + PPD 10mm induration

ECG in Pulmonary embolism:

• Sinus tachycardia
• Right axis deviation, P pulmonale, RBBB, S1Q3T3, and T wave inversion V1-V4.

A PPD positive, CXR-negative case indicates latent TB infection. INH for 6 months is the standard treatment to prevent progression to active TB.

Cystic fibosis is caused by a mutation in the CFTR gene, located on the long arm of chromosome 7.

Nephrotic syndrome causes protein loss in urine, increasing the risk of thrombosis, including recurrent DVT and SVC thrombosis.

Incorrect options-

• SLE can cause clots but is not the primary cause of recurrent DVT.
• Hemophilia B causes bleeding not thrombosis.
• Lung cancer can cause clots but is less likely to present as recurrent DVT.

The patient's history of cough with yellow and blood tinged sputum- suggests a bacterial lung infection like lobar pneumonia, often caused by Streptococcus pneumoniae.

Asthma is triggered by allergens like dust mites, cat hair, and others. Avoiding these allergens is key to managing symptoms and preventing attacks.

Special features of septic shock:

• 1) High fever
• 2) Marked vasodilatation throughout the body, especially in the infected tissues.
• 3) High cardiac output in perhaps one-half of patients caused by vasodilatation in the infected tissues & by high metabolic rate & vasodilatation elsewhere in the body, resulting from bacterial toxin stimulation of cellular metabolism & from high body temperature.
• 4) DIC

Severe pneumonia with cyanosis, tracheal shift, and hemothorax suggests a toxin producing organism. Stap aureus can cause significant lung damage and complications like hemothorax.

Incorrect options-

• Pneumocystis carnii affects immunocompromised patients.
• Strep pneumoniae usually lacks severe complications like hemothorax.
• Pseudomonas is linked to hospital acquired infections or chronic lung condtions.

Smoking is the leading cause of COPD. Quitting reduces further lung damage, slows disease progression, and lowers complications like infections and cancer.

Goodpasture syndrome is an autoimmune disease where the immune system attacks the lungs and kidneys, causing bleeding in the lungs and kidney inflammation.

The patient's hyponatremia, hyperosmolar urine, and chest X-ray mass strongly indicates SIADH, often linked to tumors like small cell lung cancer. Excess ADH causes water retention, diluting sodium levels.

Inhaled steroids are the primary treatment for long-term asthma control. They reduce airway inflammation, improve lung function, and prevent asthma attacks with fewer side effects than oral steroids.

The Mantoux test is used to diagnose TB infection. A positive result indicates exposure to TB, and a second test can help confirm the result before starting the treatment.

Ipratropium bromide is an anticholinergic bronchodilator that helps relax the airways, making it easier to breathe. It's ideal for daytime COPD symptoms and offers long-lasting relief.

The patient's use of both systemic corticosteroids and short-acting beta agonists suggests poor asthma control, indicating severe asthma. These treatments are typically for intense flare-ups or uncontrolled asthma.

.The patient's severe obstructive sleep apnea [OSA] requires CPAP, the gold standard treatment. CPAP helps keep the airway open during sleep, and monitoring ensures effective use and adjustments as needed.

Pneumocystis jirovecii pneumonia is an oppurtunistic infection commonly seen in patients with weakened immune systems, particularly those with HIV. Early HIV diagnosis is essential for appropriate treatment including antiretroviral therapy.

Functionl aphonia is when a person suddenly loses their voice despite having no physical issues with their vocal cords. The patient can still cough, which shows the vocal cords are functioning but not being used for speech.

Inhaled SABAs are the preferred treatment for mild intermittent asthma, where symptoms are infrequent. They help prevent asthma attacks by relaxing the airways.

Haemophilus influenzae is a common cause of pneumonia in patients with COPD, who are prone to infections due to chronic lung inflammation and weakened immune response. Also presence of greenish sputum is typical of bacterial pneumonia often caused by Haemophilus influenzae in COPD patients.

Tube thoracostomy is the standard treatment for pneumothorax, where air collects in the pleural space, compressing the lung.

Legionella causes Legionnaires disease which is a severe form of pneumonia with characterstic bilatral lower lobe infiltrates on chest X-ray. It often presents with high fever, chills, cough, and shortness of breath.

Tension pneumothorax can result from air entering the pleural space and becoming trapped, which increases pressure in the chest. Severe lung injury, like ARDS, can cause tear in lung tissue, allowing air leak into the pleural space, leading to tension pneumothorax.

Streptococcus pneumoniae is a common cause of commuity acquired pneumonia and typically presents with symptoms like pharygitis, high fever, productive cough, and bilateral pulmonary infiltrates on chest X-ray.

Inhaled beta-2 agonist is the treatment of choice.

The patient's history and pulmonary function tests suggest both obstructive and restrictive component.

• Obstructive component- The history of smoking and reduced FEV1/FVC ratio [95%] point to airflow obstruction, typical of COPD.
• Restrictive component- The reduced FVC and TLC indicate limited lung expansion, a hallmark of restrictive lung disease.

• Daily steroid inhalers are used for persistent asthma often in moderate to severe cases.
• Short-acting beta-agonists- Regular use of these indicate ppor asthma control supporting a moderate classification.

Beta-2 agonists are the go to treatment for acute astma excerbations, providing rapid relief from symptoms like SOB.

They are the go to treatment for acute asthma excerbations. They work quickly to relax the muscles in the airways, easing breathing during an attack.

Generally the right lower lung lobe is the most common site of infiltrate formation due to the larger caliber and more vertical orientation of the right mainstem bronchus.

In patients with chronic CO2 retention, their body relies more on CO2 levels than oxygen levels to regulate breathing.

• Giving 100% oxygen can trick the body into thinking that the oxygen levels are sufficient, reducing the drive to breathe, which leads to worsening hypoxemia.

Infectious mononucleosis caused by the EBV, is common in young adults and presents with fever, sore throat, swollen lymph nodes.

• Other symptoms include fatigue, muscle aches, and splenomegaly, all of which are seen in this patient.

The Horchover questionnaire is designed to differentiate between primary snoring and obstructive sleep apnea. It assesses symptoms and risk factors associated with OSA, such as age, weight, and neck circumference.

They help in inflammation control and are the first-line treatment for long-term control in this stage of asthma

Asbestosis is a chronic lung disease caused by asbestos exposure, leading to inflammation and scarring of the lungs. On a chest X-ray, it typically shows diffuse interstitial infiltrates, which are abnormal shadows throughout the lung, indicating widespread scarring.

According to the pneumonia severity index calculator (class IV and V need hospitalization class III depend on clinical judgment) high blood pressure is not involved in the calculation. 

The patient shows signs of severe asthma with tachypnea and dangerously high CO2 levels, which suggests respiratory faliure. Intubation is needed to secure the airway and provide proper ventilation in this critical condition.

Alpha 1-antitrypsin deficiency is a genetic condition leads to low levels of a protein that protects the lungs. It makes the lungs more vulnerable to damage, which can cause emphysema, even in non smokers.

It is a rare condition characterized by inflammation of blood vessels and a triad of symptoms - Asthma, eosinophilia and vasculitis.

Sarcoidosis is a chronic inflammatory disease often affecting the lungs, and symptoms like cough, dyspnea, and systemic involvement suggest the diagnosis. Bronchoscopic lung biopsy is the best way to confirm the diagnosis by obtaining lung tissue. This allows for the detection of non-caseating granulomas, which are characterstic for sarcoidosis.

First step - Inhaled B2 agonist

Photophobia is caused by adenovirus is treated by topical steroid.

In severe asthma attack, there is usually respiratory acidosis due to CO2 retention. The kidneys try to compensate by reabsorbing bicarbonate, which would lead to elevated bicarbonate,levels not low levels.

For moderate persistent asthma, the standard treatment involves adding LABA to the existing inhaled corticosteroid. This combination improves control by reducing inflammation and providing long lasting bronchodilation.

Clubbing is when the tips of fingers or toes become rounded and bulbous. It often indicates long-term lung diseases, including asbestosis, due to chronic inflammation and scarring in the lungs.

Adenocarcinoma is the most common type of lung cancer, especially in non-smokers. However, it typically arises in the peripheral parts of lungs.

In asthma, the airways are typically obstructed, and beta-agonists help open them up, improving airflow increasing FEV1. If FEV1 shows no change after using beta-agonist, it suggests obstruction is not reversible whcih is a characteristics of conditions like COPD, not asthma.

Pneumothorax occurs when air leaks into the pleural space, causing the lung to collapse. A chest tube is the most effective treatment to remove excess air and allow the lung to re-expand.

For COPD patients severe excerbations that don't respond to bronchodilators, IV steroids are the next step. they help reduce inflammation and imptove breathing by lowering airway resistance.

Haemophlius influenzae type b is a common cause of pneumonia, especially in endemic areas, and is often associated with crepitations and a monophasic sound on examination.

CHF leads to fluid buildup in lungs, causing pleural effusion. The pleural fluid in CHF often has a high protein content. Elevated HDL is also seen sometimes in heart faliure patients.

The patient presents with pleuritic chest pain, decreased breath sounds, and reduced chest movements, raising concern for a lung collapse or mass. A CT scan provides detailed images to identify issues like pneumothorax, pleural effusuion, lung mass. It also helps in determining the severity of the issue and guides treatment.

Both negative & positive can cause pneumothorax.  [If any one of them is there in the option choose it, if both are present choose positive because it is more likely].

First-line drug of choice in such scenarios is always inhaled beta-2 agonist.