What is the differential diagnosis for cough?
Yes, I'm serious.
Bronchitis, URI, pneumonia, sinusitis, asthma, ACE-I use, CHF.
What is the differential diagnosis for hemoptysis?
Bronchiectasis, Bronchitis, Cancer, Vasculitis, Tuberculosis, Trauma, presumably many others...
Name two clinical signs that provoke a high suspicion for neoplasm.
Which lung neoplasms are generally seen in smokers?
Where are they distributed?
Squamous & Small-cell carcinomas.
Both are central.
A lung biopsy reveals submucosal expansion of what appears to be lymphocytes. However, they are CD3/TCR/BCR negative. What is this expansion?
Small cell carcinoma.
Why is the workup for a small cell carcinoma to MRI the head, CT the body, and conduct a bone scan?
Describe its staging.
To look for metastases, which have probably already occurred before the visit.
Small cell CA is staged either "limited" or "extensive".
What is the differential diagnosis for dyspnea?
Cardiac insufficiency, musculoskeletal decompensation or deconditioning, renal/hepatic disorders (eg protein loss), psychiatric/anxiety, and many many pulmonary causes.
What is the differential diagnosis for Erythema Nodosum?
Drugs, autoimmune diseases (IBD, Sarcoidosis), pregnancy, infections, various cancers.
What is the significant finding on this CXR?
What disease is this?
Bilateral hilar lymphadenopathy.
Sarcoidosis (stage I)
What are some alternatives to bronchoscopy and open-lung biopsy for specimen collection?
If superficial enough, fine-needle aspirations can be done non-invasively.
What is the differential for non-caseating granulomas?
Necrotizing (caseating) granulomas?
Non-caseating: Wegener's, Crohn's, HSR, Sarcoidosis.
Caseating: TB & Fungal infections (Histo/blasto)
A patient presents with fever, tachycardia, tachypnea, confusion, and BP 120/80.
Is this patient in SIRS, Sepsis, or Septic Shock?
Sepsis; SIRS requires fever and tachypnea/tachycardia. CNS involvement progresses the diagnosis to sepsis, but there is not sufficient hypotension to be considered septic shock.
What is the significance of bronchial breath sounds where there should be vesicular breath sounds?
Indicates consolidation or cavitation.
What is the most common cause of pneumonia?
Distinguish between the gross appearances of bronchopneumonia and lobar pneumonia.
Bronchopneumonia has multiple foci which may coalesce later in disease.
Lobar pneumonia uniformly affects a large section of lung, generally an entire lobe.
What are the 4 stages of progression of lobar pneumonia?
What is seen in each of them?
Congestion (septal engorgement), Red hepatization (more neutrophils), grey hepatization (more fibrin, inflammatory debris), resolution.
What are the clinical requirements for ARDS diagnosis?
What can cause it?
Acute onset, severe hypoxemia, (fluid overload?), bilateral diffuse interstitial infiltrates.
Many causes: Infection, HSR, emboli...
Describe the progression of ARDS.
What is seen in histology?
Initial stage is Exudative; Later stage is Proliferative.
Hyaline membranes, RBC infiltration.
How many patients survive ARDS?
How is their long-term prognosis?
Probably slightly more than half, nowadays.
Many experience chronic symptoms.