Question of the Week # 329

329) A 62 year old man presents to your office complaining of dry cough for past several months. Recently, he also noticed shortness of breath on exertion. He denies any fever, hemoptysis or weight loss. He has no history of infections. He does not smoke. He worked as a soft-ware consultant for past 40 years. He has no other medical problems and has never been hospitalized.  On examination, he is afebrile, blood pressure 120/80 mm Hg, RR 18/min and Pulse 82/min. There are no palpable chest-wall masses or lymphadenopathy. On auscultation, fine crackles are heard at bilateral lung bases. A high resolution CT scan of the lungs shows sub-pleural cyst formation with honey combing. The patient undergoes an open lung biopsy for confirmation of diagnosis. Which of the following histo-pathological patterns is likely to be found in this condition?

A) Non-specific Interstitial Pneumonia ( NSIP)

B) Desquamative Interstitial Pneumonia (DIP)

C) Usual Interstitial Pneumonia (UIP)

D) Bronchiolitis Obliterans Organizing Pneumonia (BOOP)

E) Acute Interstitial Pneumonia (AIP)

Question of the Week # 328

328) A 66 year old man is seen in your office for progressive shortness of breath on exertion for the past one year. He also reports dry cough. He denies any fever, hemoptysis or weight loss. He has no history of infections. He denies smoking. He has no other medical problems and has never been hospitalized.  On examination, he is afebrile, blood pressure 120/80 mm Hg, RR 18/min and Pulse 82/min. There are no palpable chest-wall masses or lymphadenopathy. On auscultation, crackles are heard all over the lung fields, more pronounced at lung bases. Extremities show mild digital clubbing.

A chest x-ray is shown below:

 

Which of the following is expected to be seen with this disease?

A) Young age at onset

B) Rapid progression

C) High Resolution CT scans showing ill-defined cysts and pleural plaques

D) Poor or no response to steroids

E) Obstructive pattern on Pulmonary function tests

Question of the Week # 243

243) A 65 year old man with a long history of COPD and history of metastatic colon cancer presents with complaints of increasingly severe shortness of breath that occurred at rest today. He reports that his symptoms are much more severe than his usual baseline. On examination , he is afebrile and tachypneic. Blood pressure is normal. Chest exam reveals occassional rhonchii. EKG shows sinus tachycardia. Arterial blood gases are obtained on the room air and show Ph : 7.45 Po2 40 PCo2 50 and Bicarbonate of 36. Chest X-ray shows changes of emphysema. His home medications include ipratropium and albuterol inhalers. He is placed on 4 liters oxygen by nasal cannula.

Which of the following is the most appropriate next step?

A) Intravenos corticosteroids

B) Intubation

C) Spiral CT scan and empiric Low molecular weight heparin

D) Non invasive positive pressure ventilation

E) Bed-side Spirometry

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