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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…

Prabhu KvnOther

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…

Prabhu KvnOther

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…

Prabhu KvnOther

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…

Prabhu KvnOther

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…

Prabhu KvnOther

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…

Prabhu KvnOther

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?

Prabhu KvnOther

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?

Prabhu KvnOther

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…

Prabhu KvnOther

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…

Prabhu KvnOther

What are the indications and absolute contraindications for thrombolytic therapy in STEMI?

STEMI patient in a hospital without PCI facility. Door-to-balloon time will exceed 120 min. Patient has no prior stroke, no active bleeding, no recent surgery. Is thrombolysis appr…

Prabhu KvnOther

What is the management of complete (3rd degree) AV block with hemodynamic instability?

75-year-old presents with syncope. ECG: HR 38 bpm, P waves dissociated from QRS. BP 80/50. No reversible cause found. What are the immediate and definitive management steps?

Prabhu KvnOther

How does cardiac tamponade present clinically and what is the emergency treatment?

Post-cardiac surgery patient develops hypotension, raised JVP, muffled heart sounds, and pulsus paradoxus. Echo shows pericardial effusion with RV diastolic collapse. What is the i…

Prabhu KvnOther

What are the Modified Duke Criteria for diagnosing infective endocarditis?

Patient with fever, new murmur, and positive blood cultures for Streptococcus viridans x2. How do I apply the Duke Criteria to confirm or rule out infective endocarditis?

Prabhu KvnOther

When is coronary angiography indicated in patients with stable angina on optimal medical therapy?

60-year-old with exertional chest pain, positive stress test, on aspirin, statin, and long-acting nitrates. Symptoms persist. Should I proceed with coronary angiography? What are t…

Prabhu KvnOther

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