April 29, 2009

SOB [Chest X-ray]

Study the X- Ray provided

A) Describe the findings (3m)

B) What is your diagnosis (1m)

C) Describe the pathophysiology of B (4m)

D) Name two type of drugs to be given to this patients (2m)


A) 1) Increase AP diameter

2) Increase Retrosternal airspace

3) Flattened diaphragm.



D) 1) Bronchodilator

- β- adrenergic agonist (Salbutamol 200µg every 6-6h)

- Antimuscarinic agents ( Tiotropium 18µg daily, ipratropium 40µg 4X daily, oxitropium 200 µg 2X daily)

- Long acting preparation of Theophyline

2) Corticosteroid

-Prednisolone 30 mg daily for 2w (measure lung function before and after treatment)

-Replace with inhaled beclometasone 400µg 2X daily when FEV1 > 15%

Nota tambahan (tak perlu mention kalau untuk exam purposes)

3) Antibiotic

-to prevent further lung damage.

-or as soon sputum turn yellow

- Cefaclor 500 mg 8-h daily, cefixime, 400mg once daily @ co-amoxiclav.

4) Diuretic therapy

- If Pt present with edema

5) α1 – Antitrypsin therapy

- when it serum level compound below 310 mg/L and abnormal lung function.

6) Vaccines

-yearly influenza vaccines

Sign and symptoms of emphysema

-Pink puffer


-Barrel chest

-prolong expiration, sitting forward in hunched-over position.


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