Questions
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278
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What is the diagnostic approach to interstitial lung disease - when is HRCT sufficient vs surgical lung biopsy needed?
60-year-old male with progressive exertional dyspnea, dry cough for 1 year. HRCT shows basal bilateral honeycombing with traction bronchiectasis. No identifiable cause. How do I ap…
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335
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When should asthma therapy be stepped up from ICS alone to ICS/LABA, and what triggers biologics?
25-year-old with diagnosed asthma. Currently on moderate-dose ICS, still using SABA 3x/week, waking at night twice a month. What step is this and when should I add LABA vs refer fo…
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252
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How is spontaneous pneumothorax managed - needle aspiration vs chest tube, and when is surgery indicated?
25-year-old tall male, first episode of right-sided pneumothorax, 3 cm on CXR. Mildly symptomatic. Do I observe, aspirate or insert a chest tube? And at what point should VATS be c…
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236
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What is the initial management of massive hemoptysis and when is bronchial artery embolization indicated?
Patient with TB history now coughing up >200 mL blood in 24 hours. SpO2 dropping. Is this massive hemoptysis? What are the immediate airway/positioning steps and when should we pro…
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191
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How is pulmonary arterial hypertension classified and what are treatment options for WHO Group 1 PAH?
35-year-old woman with progressive exertional dyspnea, mPAP 45 mmHg on right heart catheterization, no secondary cause found. How is PAH classified and what drugs should be started…
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205
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When should BiPAP/NIV be started in COPD exacerbation with hypercapnic respiratory failure?
COPD patient ABG: pH 7.29, pCO2 68, pO2 55 on controlled O2. Currently on nebulized bronchodilators and IV steroids. Drowsy but rousable. What are the criteria for NIV initiation a…
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184
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Which severity score is better for community-acquired pneumonia - CURB-65 or PSI? And what are ICU admission criteria?
70-year-old with fever, productive cough, RR 28/min, BUN 28, confusion, SpO2 90%. How do I score severity and determine hospitalization vs ICU admission?
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164
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How do you diagnose pulmonary embolism - when is D-dimer enough vs when is CTPA needed?
35-year-old post-surgery patient with sudden onset pleuritic chest pain and tachycardia. Wells score 4. D-dimer is elevated. Should I go straight to CTPA or is VQ scan better here?
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147
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How do you approach diagnosis of a unilateral pleural effusion — when is thoracentesis mandatory?
45-year-old with unilateral dullness on percussion and reduced breath sounds at left base. CXR shows left-sided opacity. No prior known disease. How do I differentiate transudative…
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150
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What is the stepwise management of acute COPD exacerbation in the ED?
65-year-old with COPD (FEV1 40% predicted) presents with increased dyspnea, purulent sputum, and SpO2 84% on room air. RR 28/min. What are the immediate and subsequent management s…
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101
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Diagnosis and management of moderate-severe obstructive sleep apnea: when to use CPAP vs BiPAP vs mandibular advancement?
A 48-year-old obese male (BMI 35) presents with excessive daytime somnolence, witnessed apneas, and morning headaches. Epworth Sleepiness Scale score is 18. Polysomnography shows A…
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110
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Comparing smoking cessation pharmacotherapy: NRT vs varenicline vs bupropion — which to choose and when?
A 50-year-old male smoker (25 cigarettes/day for 30 years) wants to quit. He has mild depression and is currently on sertraline. He has tried NRT patches twice without success. How…
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101
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Systematic approach to hemoptysis: when is bronchoscopy urgent vs CT-guided intervention?
A 58-year-old male smoker presents with 3 episodes of hemoptysis, each ~30 mL, over the past week. He has a 40 pack-year history and prior TB treated 15 years ago. Vitals stable. C…
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106
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Optimal lung-protective ventilation strategy in moderate-to-severe ARDS — tidal volume, PEEP, and prone positioning
A 40-year-old patient with sepsis-induced ARDS has PaO2/FiO2 ratio of 95 on 60% FiO2. They are on volume-controlled ventilation. What are the current evidence-based recommendations…
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75
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How to differentiate asthma from vocal cord dysfunction (VCD) in a young athlete with exercise-induced dyspnea?
A 22-year-old female track runner presents with recurrent episodes of inspiratory stridor, throat tightness, and dyspnea during intense exercise. Spirometry is normal between episo…
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58
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Management of malignant pleural effusion: pleurodesis vs indwelling pleural catheter?
A 62-year-old patient with advanced lung adenocarcinoma develops a recurrent large right pleural effusion causing significant dyspnea. After two thoracenteses, the effusion rapidly…
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61
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Criteria for initiating long-term oxygen therapy (LTOT) in stable COPD patients
What are the current GOLD guidelines criteria for prescribing LTOT in stable COPD? Specifically, what PaO2 and SpO2 thresholds trigger initiation, how many hours/day should it be u…
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59
views
Role of HRCT in diagnosing interstitial lung disease — when is it indicated?
A 55-year-old non-smoker presents with progressive dyspnea and dry cough over 6 months. PFTs show a restrictive pattern with reduced DLCO. CXR shows bilateral basal haziness. At wh…
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62
views
How to differentiate pulmonary embolism from pneumonia on initial presentation?
Patient is a 45-year-old female presenting with sudden onset pleuritic chest pain, tachycardia, and mild hypoxia. She recently returned from a long-haul flight. CXR is essentially …
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67
views
Best approach to managing acute exacerbation of COPD in the emergency setting?
A 68-year-old male with known COPD (GOLD stage III) presents with worsening dyspnea, increased sputum production, and SpO2 of 82% on room air. He is tachypneic with RR 28/min and u…
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52
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Non-CF bronchiectasis with chronic Pseudomonas colonization — inhaled vs IV antibiotics and airway clearance?
58F with post-TB bronchiectasis, multiple bilateral dilated airways on HRCT, baseline FEV1 55%. She has been chronically colonized with Pseudomonas aeruginosa (2 sputum cultures po…
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63
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Severe OSA with low CPAP compliance — alternatives: APAP, BiPAP, MAD, or upper airway surgery?
48M with BMI 36, severe OSA confirmed on PSG: AHI 55 events/hour, T90 (time SpO2 <90%) 22%. Referred to sleep clinic after hypertension and daytime somnolence (ESS 16). Trialed CPA…
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74
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Group 1 pulmonary arterial hypertension — initial therapy choice: ERA, PDE5i, or prostacyclin?
32F with newly diagnosed idiopathic PAH (Group 1). RHC confirmed mPAP 48 mmHg, PVR 8 Wood units, PAWP 10 mmHg. WHO FC II-III. 6MWD 340m. Echo shows RV dilation, TAPSE 14mm. No vaso…
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64
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Sarcoidosis treatment — when to start steroids and what are the indications for second-line agents?
38F diagnosed with Stage II pulmonary sarcoidosis (bilateral hilar lymphadenopathy + parenchymal infiltrates), FVC 75%, DLCO 62%. Currently asymptomatic with only mild fatigue. Ser…
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73
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Primary spontaneous pneumothorax management — observation vs aspiration vs chest tube?
22M tall, thin male presenting with sudden right-sided chest pain and shortness of breath. CXR shows right-sided pneumothorax with 20% lung collapse. SpO2 96% on room air, HR 88, B…
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70
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Exudative pleural effusion workup — Light's criteria and when to do thoracoscopy?
45M non-smoker with right-sided pleural effusion on CXR. Thoracentesis done: pleural fluid LDH 280 U/L (serum LDH 190), pleural protein 4.2g/dL (serum protein 6.5). Fluid is lympho…
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67
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IPF diagnosis — UIP pattern on HRCT, is surgical lung biopsy still needed?
72M non-smoker with progressive exertional dyspnea and dry cough over 18 months. HRCT shows bilateral basal-predominant honeycombing with traction bronchiectasis — typical UIP patt…
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53
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Asthma step-up therapy — when to add LABA vs LAMA vs biologics in uncontrolled asthma?
29F with moderate-severe asthma on ICS (budesonide 400mcg/day) with persistent symptoms despite good inhaler technique and adherence. FEV1 68% predicted, FeNO 48 ppb, blood eosinop…
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95
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Pulmonary embolism risk stratification — PESI score vs simplified PESI, when to thrombolyse?
55F presents with acute onset dyspnea and pleuritic chest pain. CT-PA confirms bilateral PE with right heart strain. BP 100/68, HR 118, SpO2 88% on room air. Echo shows RV dilation…
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64
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COPD exacerbation management — when to initiate NIV vs invasive mechanical ventilation?
68M with known COPD (GOLD Stage III), presenting with acute exacerbation with increased dyspnea, productive cough with purulent sputum, and confusion. ABG: pH 7.28, PaCO2 68 mmHg, …
For peer discussion only — not a substitute for clinical judgment. Verify with authoritative sources.