Pulmonology

Pulmonology A 69-year-old man presents with dyspnea on exertion (climbing stairs and walking short distances) that has slowly progressed over the last year. He has fatigue, palpitations, intermittent retrosternal chest pain, lower extremity swelling, dizziness, and "feeling faint." Associated symptoms occur upon exertion. He denies fever, chills, weight changes, cough, abdominal pain, early satiety, nausea, vomiting, diarrhea, changes in urine color/odor, flank pain, hematuria, or dysuria. No cigarette, alcohol, or drug use. Cardiac exam shows increased pulmonic component of the second heart sound (P2), wide inspiratory splitting of S2 over the cardiac apex, right-sided S3 and S4 gallops, left parasternal lift, loud diastolic murmur increasing with inspiration and diminishing with Valsalva maneuver, prominent "A" waves in jugular venous pulsations, and increased JVD. Enlarged liver with hepatojugular reflux, peripheral edema, and ascites. EKG reveals peaked P waves, rightward axis deviation, and prominent R waves in the early V leads. 1. Myocardial infarction 2 Cor pulmonale 3 Primary biliary cirrhosis 4 Left ventricular heart failure 5 Pulmonary embolism - Answer -2. Cor pulmonale A 16-year-old girl presents with shortness of breath, wheezing in her chest, and swelling of the lips that started several minutes after she had a snack. She had similar symptoms several months ago at a Chinese buffet. She appears restless. Her face is erythematous and her lips and tongue are swollen. She is able to repeat her name when asked. Her blood pressure is 89/60 mm Hg, and heart rate is 110/min rhythm regular, with respirations 26/min and shallow. On auscultation, diffuse wheezing is heard. Question What is the next step in management of this patient? 1 Take arterial blood gases. 2 Intubate the patient. 3 Give epinephrine. 4 Give corticosteroid. 5 Give a beta blocker - Answer -3. Give epinephrine A 57-year-old Caucasian man presents with worsening shortness of breath. While obtaining his history, you uncover that he has noted increasing shortness of breath with minor exertional activity and a persistent but non-productive cough. The patient admits to being a former smoker with a 34 pack-year history, admitting to cessation at age 50. He denies any known caustic occupational exposures and states he worked in an office his whole life. He admits to an uncle having some kind of breathing issues, although he is unsure of a definite diagnosis. Patient denies weight loss, fever, or significant recent illness. Physical examination is pertinent for significant clubbing of the fingers, inspiratory squeaks auscultated during the pulmonary exam, and a right-sided gallop found during the cardiac exam. What is the most likely diagnosis? 1 Sarcoidosis 2 Idiopathic pulmonary fibrosis 3 Silicosis 4 Cryptogenic organizing pneumonia 5 Lung cancer - Answer -2. Idiopathic pulmonary fibrosis