chest “

3-b
bronchial asthma treatment
bronchial asthma treatment
in-between attacks

bronchodiltation during reverse attack

spasm

mast mast surface surface of IgE antigen 

attack bronchospasm leukotriens mediators

allergic exposure to antigen 

hyposensitization immunoglobulin 
allergic antigen allergic sin prick test
in increasing amounts intradermal
IgM & IgG IgE IgM & IgG antigen IntraDermal
blocking antibodies IgE igM & igG antigen

antigen allergic inhaled antigen

antibodies against genetic engineering IgE antibodies IgE 
expensive 8 antibodies IgE

relase of cells mast cells stabilizer mast cells 

disodium cromoglycate mast cells stabilizer mediators

tablets ketotifen  
asthma protective side effect

Singulair (montelukast) leukotriens receptor blocker 

88
cytokines histamine and serotonin leukotriens

100
 mentality Egyptian 
dilated spasm bronchi dilated overtime
salbutamol beta 2 stimulant long acting all the time
42 long acting salmetrol

iv or suppository aminophylin 
theophyllin

corticosteroids 

all other methods is failed corticosteroids 

corticosteroids measure

Respiratory functions test corticosteroids 

corticosteroids 51%
beclomethazone systemic side effects lung locally
low dose 800 4888 high dose low dose high dose
888 4888

respiratory function severity of symptoms grades bronchial asthma 

Grade 1
attack <1 attack less than 1 per day bronchial asthma 
attack per day <1 1
PEFR 
attack salbutamol 
in between
Grade 2
daily attack bronchial asthma 
80- 100 % PEFR 
low dose corticosteroid inbetween 
salbutamol steroid salbutamol

Grade 3
severe symptoms attack bronchial asthma 
50- 800 % PEFR 
high dose low dose 

Grade 4

101
 not responding to high dose very severe symptoms , attack daily bronchial asthma 
inhaled steroids
50- 800 % PEFR 
theophyillin , leukotriens high dose 
Long acting Beta 2 stimulants mast cell stabilizer receptor blocker ,
Grade 5
cortisol oral stage

bronchial asthma
Bronchial asthma with daily attack … PERF 18-80 % mcq
Which of the following drug should be added
stage
severe stage 2 corticosterois

Status asthmaticus

definition status asthmaticus acute severe asthma

Severe attack of bronchial asthma which isn’t responding to treatment for > 5 hour -
 status asthmaticus 42

status asthamticus ? 
infection precipitating factor infection 
bronchial asthma sudden withdrawal of corticosteroid 

status asmaticus betablocker or NSAID bronchil asthma 

Clinical picture

coma convulsions irritable , anxious , confused CNS 
brain 
brain
patient cant finish a single sentence sympathetic tone cyanosis , sweaty Face 
without single breath

congested neck veins Neck 

Sternomastoid and scalenus muscle re contracting 

102
 08 respiratory rate 08 respiratory rate chest 
08 respiratory failure

mainly abdominal respiration male respiratory alternans 

abdominal muscles mainly thoracic female
abdominal fatigue thoracic fatigue
alternating between abdominal and thoracic alternans

abdomen paralysed diaphragm respiratory paradox 

paralyzed fatigued diaphragm retraction with inspiration
retraction with inspiration
wheezes silent chest 
silent wheezes bronchodilator silent chest
wheezes bronchodilator

Heart
Tachycardia and arrthmia
sever pulses paradox
 dysentery bronchial asthma and copd


=D
:D

investigation
investigations status asthmaticus
CO2 wash tachypnea CO2 ABG 
late stage respiratory failure
pneuomothorax Xray 
hypokalemia salbutamol Serum potassium 
respiratory function 
ventilator test
ventilator 
workshop
alveoli pressure
status asthmaticus
chest xray investigations
respiratory function test 

103
if the doctor is crazy enough to ask fro respiratory function test the patient will be intelligent enough to refuse
=D

immediately

Treatment
nasal cannula high flow oxygen ICU 
salbutamol and cortisone 4 
combivent combination ipratropium 
aminophyillin iv salbutamol IV 
mucus bronchoscope under general anaesthia MgSO4 
bronchial lavage

Investigation , treatment , status asthamticus and differential diagnosis 

Lung collapse “atelectasis “

Lung collapse bronchial asthma

atelectasis

atelectasis
By definition: reduction of lung volume due to absorbtion of alveolar air * 

acquired congenital lung collapse

acquired 
bronchus obstruct bronchial obstruction 5
alveoli blood vessels absorption alveoli
collapse alveoli blood vessels
bronchial obstruction absorption collapse

bronchial obstruction 
wall lumen *
foreign body and secretions lumen 
stricture or bronchogenic carcinoma wall 
tumor or lymph node : 

this is the most common type collapse

104
 bronchial obstruction absorbtion collase

relaxation compression collapse 4

relaxation compression collapse 

which means 4288 5888 5088 lung
recoil lung is stretched
which means 2888 0 chest wall on the other hand
expand chest wall recoil lung expand

lung wall pleura lung

negative pressure
pleura

lung chest wall 

pleural effusion recoil lung expansion chest wall
pleural effusion and recoil lung bulge chest wall
chest wall bulge pneuomothorax

lung chest wall bulge chest wall

5488 lung
lung further accumulation of fluid in pleura lung
relaxation relaxation compression collapse 5488
compression

contraction collapse 0
contraction fibrous tissue alveoli fibrosis 
contraction collapse collapse alveolus

patchy collapse 2
collapse collapse lung 
ARDS surfactant 

acquired

Congenital
surfactant hyaline disease congenital 
baby during labour collapse premature babies diabetic mother
meconium aspiration birth canal

105
 clinical picture
symptoms **
Dyspnea , dry cough , chest pain* 
broncho disease haemoptysis and wheezes 
Symptoms of cause and complications 

signs **

signs most common type absorbtion collapse

inspection
retraction Shape
restricted on affected side Movement
shift to same side of lesion Mediastinum

palpation 
shifted Trachea
absorbtion collapse bronchi TVF
TVF

dull Percussion * 
bronchial absent breathing sound Auscultation 
breathing

General examination

hypoxia and tachypnea and tachycardia 

investigation
oxygen and co2 ABG blood lab Lab 
sputum 4
raised copula homogenous opacity , collapsed lobe xray Radiological
secretions foreign body obstruction bronchscopy Instrumental

treatment
secondry infection antibiotic bronchodilator oxygen 
106
 physiotherapy foreign body bronchoscope cause 

post operative lung collapse collapse



Acute postoperative massive collapse

story post operative lung collapse

gall bladder

post operative lung collapse step

chest 5
anesthesia
bronchi irritation inhalation type injection inhalation anaesthia 
inhalation anesthesia chest infection bronchial secretions
anesthesia bronchi secretions

nausea and anesthesia is nauseating 4

aspiration vomiting

under anaesthisa cough reflex 0

bronchi retained secretion

cough reflex tube 2

107
 1
upper upper abdomen
movement of restriction bandage abdomen
respiratory muscles
pain pai n
support wound bandage
pain

etiology collapse Inv and ttt

collapse

Respiratory function tests

respiratory function tests
respiratory functions of the lung

functions 0 lung
alveoli ventilation 
ventilation
perfusion alveoli 
diffusion gas 

functions testing 

ventilation test 5
radioactive xenon **
lung lung alveoli alveoli
ventilation test ventilation defect
inhalation of radio active xenon

spirometer **
spirometer
018

spirometer

108
 under basal condition lung
188 188 tidal volume
tidal volume 188

inspiratory
0 reserve

expiratory
reserve volume

residual volume
residual volume inspiratry and expiratry reserve tidal volume
0 inspiratory reserve 188 tidal

2 capacity capacity volumes 4 

volumes or more
inspiratory capacity tidal + inspiratory reserve
Functional residual capacity Residual + Expiratory reserve

total lung capacity

1- it’s the amount of air inspired and expired under resting condition
tidal volume

2- it’s the maximum volume of air inspired more than the tidal volume
inspiratory reserve
3- it’s the maximum volume of air that can be expired more than the tidal volume
expiratory reserve
4- it is the remaining volume in the lung after maximum expiration
residual volume
6- it is the total volume of air in the lung after max. inspiration
total lung capacity

7- it’s the max volume of air that can be expired after maximum inspiration
vital capacity

vital capacity
residual volume total lung capacity vital capacity

109
 total lung capacity

vital capacity residual volume

FEV1 % 51 2 vital capacity

peak expiratory flow rate

velocity

capacities volumes
lung disease

obstructive and restrictive

larynx or bronchs disease obstructive 5
restrictive bronchus r larynx restrictive obstructive

restrictive obesity pleural effusion restrictive interstital lung fibrosis

bstuctive Bronchial adenoma

interstitial lung fibrosis expansion of alveoli restrictive disease 4

capacities volumes expand alveoli
capacities volumes restrictive disease

MCQ
in a pation with Kyphoscoliosis the following respiratory func test is right

decrease restrictive isease decrease

expiration inspiration bronchial asthma obstructive disease

? expiration

during expiration
airway obstruction expiratory reserve volume

lung expiratory reserve volume

functional residual capacity residual volume

vital capacity

forced vital capacity

peak expiratory flow rate expiratory volume

110
 volumes and respiratory center suppression respiratory center
capacities
central
maximum breathing capacity volumes and capacity
2 51 as speed as you can
respiratory center suppression
test respiratory center suppression
respiratory center suppression
test


obstructive restrictive obstructive and restrictive diseases
respiratory functions test mcq expiratory

perfusion and diffusion ventilation

IV perfusion
gamma camera lung lung

carbon monoxide 18 diffusion

58 51 48 carbon monoxide
58 51 surface area 48 lung
carbon monoxide surface area diffusion
mcq blood

3b

111
 chest “

3-c

Dyspnea

definition of dyspnea *
uncomfortable awareness of respiration

mechanism of dyspnea 
process of respiration dyspnea
respiratory center in medulla process of respiration
intercostals diaphragm nerves anterior horn of spinal cord respiratory center
negative pressure negative intrapleural pressure contraction muscles
gas exchange blood alveoli Trachea and bronchi

dyspnea

congenital- respiratory center dyspnea 5

inflammatory – traumatic - neoplastic
respiratory center primary hypoventilation syndrome Congenital 
congenital depressed
fracture base of skull Traumatic 
encephalitis Inflammatory 
Glioma Neoplastic 
respiratory suppress opiates 
tachypnea dyspnea center
tachypnea or bradypnea dyspena

dyspnea opiates
Anemia *

spinal cord spinal cord 4

anterior horn cell menengies vertebrae

spinal cord vertebrae

112
 Congenital : kyphoscoliosis 
Traumatic : fracture , dislocation , disc prolapsed 
, inflammatory : pots disease 
menengioma meningies
, inflammatory , neoplastic and spinal cord
congenital
Congenital : syringomelia 
transverse mylitis , inflammatory 
glioma Neoplastic 

polio , motor neuron disease anterioir horn cell

peripheral neuritis specially Guillain barre nerves 0

myasthenia gravis 2
contract diaphragm diaphragm impulse nerves diaphragm
pregnancy abdominal mass ascitis

myopathy muscle 1

chest wall 0
Skin : obesity
Ribs : fracture rib
Pleura : pleurisy or PE
Trachea or bronchi: Foreign body , tumor , bronchitis , bronchiectasis
Alveoli : alveolar collapse , pneumonia , tb
Blood : pulmonary embolism or congestion

hysterical 5

acute trauma and inflammatory acute

acute dyspnea

respiratory failur ventilation bronchi Respiratory center

ventilation bronchi respiratory center
diffusion and perfusion alvoli + blood vessels + interstitial tissue

diffusion and perfusion ventilation

Carbon lung ventilation
carbon dioxide ventilation dioxide

113
 More times 488 CO2 physiology diffusion and perfusion
which means diffusion surface area CO2 diffusible than O2
diffusion and perfusion Oxygen surface area
oxygen oxygen surface area

Respiratory failur

respiratory failure
respiratory failure

Definition 
it is inability of the lung to perform its function leading to hypoxia

CO2 CO2 respiratory failure 08 oxygen

diffusion and perfusion defect ventilation

CO2 Respiratory failure

diffusion and perfusion ventilation

Type 1 & Type 2 2 types respiratory failure

oxygen perfusion diffusion Type 1 

alveoli , blood vessels and interstitial tissue dyspnea etiology

collapse , pneumonia , pulmonary edema alveoli 
interstitial lung fibrosis interstitial tissue 
embolism and congestion blood vessels 
type 1 etiology

acute hypoxia clinical picture

chronic
irritability , anxiety ,confusion acute hypoxia 
brady cardia sympathetic ,convulsions , tachycardia , hypertension
hypotension and death

114
 , lack of concentreation and defective apathy , mental dullness chronic hypoxia 
memory ,

pulmonary hypertension polycythemia clubbing

clinical picture of underlying cause chronic acute

CO2 ABG investigations

wash CO2 tachypnea

inv of the cause

Treatment

=D

suction of secretions pneumonia antibiotic foreign body underlying cause

type 1 respiratory alkalosis type 1 respiratory failure

respiratory alkalosis kidney respiratory failure

type 2 
larynx , trachea and bronchi , vertebrae , menengies , anterior horn cell , nerves Etiology
dyspnea

hypoxia and hypercabnia o2 and CO2 ventilation

hypoxia and hypercabnia clinic picture

hypoxia acute hypercabnia acute hypoxia chronic acute 

clinical picture
chronic hypercabnia chronic hypoxia chronic 
confusion , inverted sleeping rhythm carbon dioxie narcosis
flappy tremors
hepatic disoriented to time place and person
encephalopathy

CO2 investigation

Treatment
type 2 type 1
oxygen apnea chronic acute

115
 chronic acute chronic acute type 2
COPD

3c

116