Gario
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a. pulmonary embolism, b. bronchial asthma, c. bronchogenic carcinoma,
d. tuberculosis, e. bronchitis, f. fibrosing alveolitis, g. heart failure,
h. Pickwickian syndrome, i. respiratory failure, j. rheumatoid lung,
k. pneumonia, l. rheumatic heart disease, m. emphysema, n. pneumothorax
( ) 1. A 30-year-old accountant presents with a chronic cough, dyspnea and wheezing. He produces copious sputum. His arterial carbon dioxide is low and arterial oxygen is normal.
( ) 2. A 50-year-old smoker with chronic cough and copious yellow sputum presents in a state of agitation. He is confused. His pulse is bounding. He has a terrible headache and you find papilloedema on fundus exam.
( ) 3. A young women complains of wheeze, dyspnea, and cough. She cannot sleep at night because of her chronic cough. She and her mother love animals and together they have 14 cats. Her peak flow is normal but her CXR suggests hyperinflation.
( ) 4. A middle-aged housewife presents with exertion and dyspnea. She also has a dry cough, and general malaise and is mildly cyanosed. On auscultation of chest, you find crepitations. She has a history of arthritis.
( ) 5. A middle-aged smoker presents with chronic cough and phlegm. His sputum is tenacious but not yellow or blood stained. His chest is hyperinflated. His arterial carbon dioxide is high and arterial oxygen is low.
Edited by Gario on 11/25/05 - 04:14 AM
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| DrS
Forum Elite
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1 e
2 i
3 b
4 j
5 m
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| frontal
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Agree with DrS for the most part.
1. ?bronchitis, e.
2. respiratory failure, i.
3. very confusing. i can only think of 'b' and 'm' as causes of hyperinflation. had PEF not been normal, i'd put 'b' here.
4. rheumatoid lung, j.
5. emphysema, m.
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| Gario
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Answer:
1. m. emphysema
2. i. respiratory failure
3. b. bronchial asthma
4. j. rheumatoid lung
5. e. bronchitis
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| DrS
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Gario : Any explanations to the answers?
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| Gario
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Sorry, DrS. It's not supplied. Perhaps you can propose your opinion.
I think physiologic test is more reliable in distinguishing between chronic bronchitis and emphysema than clinical manifestations, which are sometimes similar and confusing.
As to the emphysema, PaCO2 tends to be low until end-stage and PaO2 tends to be slightly to moderately reduced, whereas the chronic bronchitis demonstrates an elevated PaCO2 and moderately to severe decreased PaO2.
I must confess that my statement is not convincing enough.
Any opinion is welcome. Thanks in advance.
Edited by Gario on 11/22/05 - 12:46 PM
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| mani
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well there is no doubt abt 2, 3 n 4.
about 1 n 5, yes i think the clinical presentations given r confusing n we can tell them apart on the basis of ABGs, Chr bronchits results in blue bloaters n emphysema in pink puffers
Edited by mani on 11/22/05 - 02:24 PM
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| frontal
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Please explain how PEF can be normal in a patient with bronchial asthma, especially when she continues to experience symptoms.
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| Gario
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In the early stages of bronchial asthma, it is frequent to find subjects with a positive history and an "FEV1" or FEV1/FVC > 80% of the predicted value.
As to the PEF variation in the diagnosis of asthma, the Ulrik CS, Postma DS, and Backer V.' study* reveals that only 13.3% of the participants with current asthma (n = 609; 288 males, aged 13-23 years) had positive PEF test (amplitude percentage mean > 20%).
Frankly speaking, the question is still unsolved.
*Ulrik CS, Postma DS, Backer V. Recognition of Asthma in Adolescents and Young Adults: Which Objective Measure is Best? J Asthma. 2005 Jul;42(7):549-54.
Edited by Gario on 11/24/05 - 07:32 AM
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| DrS
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Frontal : The vignette doesen't say that the PEFR was done while the patient was experiencing symptoms. It says "She cannot sleep at night because of her chronic cough." This probably indicates nocturnal asthma. As you know there is a diurnal variation in the PEFR which is exaggerated in asthma and it is entirely possible to be having severe nocturnal symptoms and be entirely asymptomatic the next day with a normal PEFR. So a normal PEFR in no way excludes a diagnosis of asthma. But i must confess these questions are quite confusing.
Gario, could you please tell me the source of these questions?
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| Gario
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Thank you, DrS. The questions are from the PLAB exams.
To Frontal, I'm sorry for the inappropriate reply.
Edited by Gario on 11/24/05 - 08:44 AM
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| frontal
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Thanks for pointing that out DrS. Gario: good try. I'm sure you gained something doing all the research.
I think we can just be glad it wasn't a usmle question.
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