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6 Cards in this Set
- Front
- Back
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A 30 year-old white male arrived to the emergency department complaining of severe dyspnea and persistent non-productive cough for the past 7 days that worsened overnight. He mentioned similar episodes over the past several years, but nothing of this magnitude. He denies any recent infections or history of tuberculosis. His past medical history is unremarkable. His father died at the age of 57 from lung disease. He has no brothers or sisters and his mother is currently in good health. He admits to a 30 pack-year history of smoking and binge drinking on occasional weekends. He denies illicit drug use. Patient is afebrile and his physical exam is unremarkable except for a few expiratory wheezes. A chest X-ray and lung biopsy were performed which showed hyperlucent lung fields and abnormally large air spaces with loss of septa, respectively. What findings (if any) would most likely be present in this patient that when coupled with his tobacco use could account for his condition? A. Elevated IgE titer B. Goblet cell hyperplasia C. Enzyme deficiency D. Swelling in his left leg below the knee E. Dullness to percussion in the lower lung fields F. Nothing, his symptoms are simply the result of his tobacco use |
C. enzyme deficiency
*The patient is suffering from emphysema caused by an alpha1-antitrypsin deficiency that has been exacerbated by tobacco use. The smoking plus X-ray findings would point to some form of COPD. While all forms of COPD have overlapping characteristics, each has something that sets it apart. “A” represents changes commonly found in asthma as a result of allergen exposure. While this can be made worse by smoking, the key difference is that asthma causes episodic bronchoconstriction. Answer choice “B” is directed towards chronic bronchitis. While smoking is the biggest risk factor for developing bronchitis, it is characterized by hypersecretion of the mucous membrane with 3 consecutive months of chronic productive cough. Our patient has not produced any sputum over the course of the illness. “D” and “E” are there to distract the reader and are supposed to be significant of pulmonary embolism and pleural effusion. The fact that the patient is 30 years old indicates that this is not just a chronic inflammatory course from smoking, but is linked to a problem adjusting to the effects of smoking. |
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A 60 year old male with a history of COPD presents to his physician complaining that he has had, over the last 3 months, worsening shortness of breath. He states that, previously, he would walk his dog a few blocks each day and that currently, all it takes is walking from one side of his home to the other to cause him to be short of breath. During the visit, he is coughing continuously and when asked about the cough, he states that it has gotten progressively more frequent over the last few weeks and has been accompanied by an increasing amount of yellow sputum (it started out clear and has progressed to yellow over the last few days). He has also been increasingly tired and states he feels as if he has been breathing faster than normal. Which of his symptoms are suggestive of a COPD exacerbation? A. Increased Sputum volume B. Increased cough frequency C. Worsening shortness of breath D. Change in color of the sputum from clear to yellow (increased purulence) E.All of the above |
E. all of the above *The Global Initiative for Chronic Obstructive Lung Disease defines COPD exacerbation as “an acute event characterized by a worsening of the patient’s respiratory symptoms that is beyond normal day-to-day variations and leads to a change in medication.” An exacerbation may manifest as symptoms such as increased cough severity and/or frequency, increased sputum volume and/or purulence, worsening dyspnea, and rapid breathing (relative to normal). |
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which doesn't contribute to dx of granulomatous polyangiitis? A: bloody nasal discharge B: chest CT revealing multiple nodules with cavitations C: red blood cell cast in urine D: blood serum tested positive for P-ANCA, ANA, and rheumatoid factor |
D |
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which is not true about selection of kidney biopsy over lung biopsy in pt with suspected Granulomatosis with Polyangitis: A: lung bx is commonly assc with iatrogenic pneumothorax B: differentiation of GPA from Goodpastures can be made with immunofluorescent staining of renal tissue C: pts with diffuse alveolar hemorrhage, detect of both C-ANCA and proteinase-3 cannot substitute for bx when making a final diagnostic determination D: even lung bx might be preferred because evidence of necrotizing vasculitis and granulomatous inflam are readily obtainable, lung bx lacks sensitivity and specificity E: timely and correct determination matters since 80% die within a year if not treated |
C: that counts |
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african guy with sx of TB. BCG vaccinated. CXR suggests TB. what is next test? |
IGRA |
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42 yo M with TB being given isoniazid, rifampin, pyrazinamide and ethambutol. 2 precautions to keep in mind |
visual acuity and AST/ALT levels |
