lungs

Question 1

• 3 D’s: dysphagia, drooling, distress
• Odynophagia, inspiratory stridor
• Tripoding
• Muffled “hot potato” voice
• Thumbprint sign on cervical x-rays

Answer 1

Epiglottitis

Question 2

Blunting of costophrenic angles on CXR

Answer 2

Pleural effusion

Question 3

• Chronic cough with sputum production
• Productive cough x 3 months/year for 2 consecutive years
• Dyspnea
• History of smoking (common)
• PFT: decreased FEV₁, decreased FEV₁/FVC < 70%
• Increased hemoglobin and hematocrit (erythrocytosis)
• Respiratory acidosis

Answer 3

Chronic bronchitis

Question 4

• Difficulty in ventilating patient
• Hyperresonance to chest percussion over affected side
• Decreased breath sounds on affected side
• Tracheal shift to contralateral side (very late, premortem)
• Jugular venous distention (late sign)

Answer 4

Tension pneumothorax

Question 5

• Dyspnea
• History of smoking (common)
• Decreased breath sounds
• Barrel chest
• Pursed lip breathing
• PFT: decreased FEV₁, decreased FEV₁/FVC < 70%
• CXR: flattening of diaphragm, increased AP diameter, decreased vascular markings

Answer 5

Emphysema

Question 6

• Dyspnea
• Wheezing
• Cough (nocturnal)
• Decreased FEV₁

Answer 6

Asthma

Question 7

• Exploring caves/exposure to bird or bat guano
• Mississippi and Ohio River Valleys
• Atypical pneumonia features (like walking pneumonia) or flu symptoms

Answer 7

Histoplasmosis

Question 8

• Flu-like symptoms
• Exposure to birds

Answer 8

Psittacosis

Question 9

• History of work in shipyards, construction, insulation
• Pleural plaques on CXR
• “Shaggy heart” on CXR
• Restrictive pattern on PFT: normal or increased FEV₁/FVC, normal or decreased FEV₁, decreased lung volumes

Answer 9

Asbestosis (bronchogenic carcinoma or mesothelioma)

Question 10

• HIV positive
• Dyspnea on exertion
• Fever
• Nonproductive cough
• Oxygen desaturation with ambulation
• Diffuse bilateral interstitial infiltrates
• Increased lactate dehydrogenase (LDH)

Answer 10

Pneumocystis jiroveci pneumonia

Question 11

• Honeycombing (reticular opacities on CXR)
• Ground glass opacification on CT scan
• Restrictive pattern on PFT: normal or increased FEV₁/FVC, normal or decreased FEV₁, decreased lung volumes

Answer 11

Pulmonary fibrosis

Question 12

• Pleuritic chest pain
• Increased with movement and deep breathing
• Reproducible point tenderness
• Absence of palpable edema

Answer 12

Costochondritis

(AKA: Tiezte syndrome if there is palpable edema)

Question 13

• Pneumonia
• Alcoholism
• Purple-colored (currant jelly) sputum
• Cavitary lesions on CXR

Answer 13

Klebsiella pneumoniae pneumonia

Question 14

• Pneumonia
• Fever
• Chills and rigors
• Blood-tinged “rusty” phlegm

Answer 14

Streptococcus pneumoniae pneumonia

Question 15

• Pneumonia
• Immunocompromised and age extremes

Answer 15

Haemophilus influenzae pneumonia

Question 16

• Pneumonia
• Contaminated water source (AC unit, cooling units and towers, Jacuzzi, pools)
• GI symptoms (diarrhea)
• Hyponatremia
• Increased liver transaminases
• Neurologic symptoms: headaches, confusion, altered mental status

Answer 16

Legionella pneumophila pneumonia

Question 17

• Pneumonia symptoms with URI and pharyngitis prodrome
• Previously young and healthy
• No chills or rigors
• Dry nonproductive cough

Answer 17

Mycoplasma pneumoniae pneumonia

(AKA: “walking pneumonia”)

Question 18

• Refractory hypoxemia with no hypercarbia
• Bilateral diffuse pulmonary infiltrates (may spare costophrenic angles)

Answer 18

Acute respiratory distress syndrome

Question 19

• “Seal-like barking” cough
• Inspiratory stridor
• Hoarseness
• Symptoms worse at night
• “Steeple” Sign on cervical x-rays

Answer 19

Croup

(AKA: laryngotracheitis)

Question 20

• Sudden onset of dyspnea, pleuritic chest pain, and possible hemoptysis
• Look for history of prolonged immobilization/venous stasis, intimal endothelial damage, and hypercoagulability (Virchow’s triad)
• Tachypnea
• Tachycardia
• S₁Q₃T₃ on ECG

Answer 20

Pulmonary embolism

Question 21

• Sweat chloride test elevated
• Meconium ileus (pathognomonic)

Answer 21

Cystic fibrosis

Question 22

• Tram-track appearance on CT scan (thickened bronchial walls with airway dilation and lack of airway tapering)
• Signet ring sign (increased airway diameter > adjacent vessel diameter)
• Most commonly noted in cystic fibrosis or recurrent lung infections

Answer 22

Bronchiectasis