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13 Cards in this Set

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A 60 yo diabetic patient presents with “crushing” chest pain, diaphoresis, and shortness of breath for 1 hour. Physical exam demonstrates diffuse rales and chest x-ray reveals diffuse bilateral infiltrates. What is the most likely diagnosis? Although not routinely necessary, what would most definitely differentiate cardiac versus non-cardiac pulmonary edema?
acute MI leading to ARDS (blood is backing up into the lungs)

to distinguish b/w cardiac vs. non-cardiac pulmonary edema, can insert a Swan-Ganz catheter into pulmonary artery (if pressures inside artery are normal, then you know that it's non-cardiogenic pulmonary edema)
Pt is a 65 y/o construction worker, with a history significant for 38 pack-year smoking history, who comes to the clinic complaining of slowly worsening cough and dyspnea. On CXR, fibrosis may be seen, particularly on lower lung fields.

what would PFTs show?


what are possible complications in this particular pt?
pulmonary fibrosis due to chronic asbestos exposure (asbestosis)

PFTs: normal FEV1/FVC ratio, decreased TLC (restrictive pattern)

complications include mesothelioma (not related to smoking hx) and later, lung cancer (bc of smoking). in fact, he has a 50-fold increased chance of lung cancer bc he's an asbestos worker who smokes
a truck being loaded with sulfuric acid was driven from loading dock prior to disconnecting hoses.

a 39 y/o welder was working 30 ft above the ground surface, when he and 6 co-workers were exposed to a cloud of flames.

pt's eyes were coagulated; CXRs show bilateral infiltrates.

ARDS (non-cardiogenic pulmonary edema from toxic gas exposure)
65 y/o woman with a history significant for smoking, presents with shortness of breath and dry cough. PEx reveals rales (crackles), clubbing and exercise desaturation (with minimal activity, O2 sat plummets).

CXR reveals chronic interstitial changes.

idiopathic pulmonary fibrosis (type of ILD)
50 y/o pt is a foundry worker who presents with dyspnea, productive cough. CXR reveals upper lobe fibrosis and hilar adenopathy.


what disease is he at greater risk for?

45 y/o homeless and HIV positive pt comes into the ER presenting with night sweats, severe weight loss and persistent hemoptysis. He reports that these symptoms have been ongoing for the past several months.

what's your dx?

how would CXR show up?
secondary TB infection (reactivation TB)

CXR: most likely reveal infiltrates in the apical posterior lungs
65 y/o male pt, significant for a 30 pack year smoking history, presents to the ER with persistent, productive cough that began after difficulty breathing during movement.

on physical exam, pt is thin, tachypnic, and barrel chested.

CXR reveals hyperinflated lung chambers bilaterally.

dx? (be specific).
COPD (predominant emphysema due to age, cough onset after dyspnea starts, thin body frame)
45 y/o homeless man presents to the ER with recently developed hemoptysis. he has a history significant for recurrent lung infections and chronic coughing which would usually produce large amounts of mucus. pt complains of additional difficulty breathing and you note clubbing on his hands.

bronchiectasis (possibly due to TB or other infection)
65 y/o pt is chronic smoker who complains that "every winter I keep coughing, got better and then this winter I got it again."

pt also complains that large amounts of mucus are produced in his coughing episodes.

possible dx?
chronic bronchitis COPD
A patient presents to you with acute onset of SOB after a prolonged international flight. You suspect PE. What factors might you use to determine PE likelihood? What diagnostic test would you most likely order? What findings on physical examination may indicate a massive PE?
factors = having signs/sx's of DVT, fast HR, immobilization/surgery within 4 wks, previous DVT/PE, hemoptysis, active malignancy

massive PE = fixed split of S2, and S3 or S4, dilated neck veins, and cyanosis, hypotension

dx test = spiral CT
Pt presents fever, cough, and chest pains. with E-a changes, whispered pectoriloquy. Do they have bronchitis or pneumonia?
A 28-year-old asymptomatic black male is referred to you for evaluation of an abnormal chest x-ray. A chest radiograph is obtained and shows bilateral hilar adenopathy.

(bilateral hilar adenopathy = pathomneumonic for sarcoidosis)
The patient was a 60 year former insulation worker, a member of the New York City Heat and Frost Worker Union which he joined 30 years previously. He was developing progressive dyspnea. A chest x-ray revealed bilateral interstitial lung disease, more severe in the bases, as well as pleural plaques and fibrosis.