Lung: Clinical-Pathologic Correlation Quiz

A tall 18-year-old male presents to the emergency department because he suddenly developed shortness of breath. He was playing in a pick-up game of basketball when he developed a sharp pain on one side of his chest and then had trouble breathing. The patient has been previously well. He has a 6 pack-year history of smoking. He drinks on weekends and occasionally uses illegal drugs. He has not tried heroin.

Vital signs: Temperature: 98.9 F; RR: 26 /min; HR: 90 /min, BP: 124/78 mmHg; SpO2: 87% on room air

Physical examination: On the side with pain, there are decreased breath sounds, no vocal fremitus and hyperresonance to percussion. There is accessory muscle use on breathing.

The most likely chest X-ray finding is

A 57-year-old male presents to his primary care physician with complaints of a persistent dry cough for the last 5 months. He has otherwise been well. He drinks alcohol in moderation and does not smoke tobacco or do illegal drugs. He is on no medications. He works in an office as an accountant and plays tennis as a hobby.

Vital signs: normal

Chest X-ray: normal

The test that would establish the most likely diagnosis would be (a/the)

A 72-year-old male presents to the emergency room because he has developed a fever and a cough over the past 4 days. He is now coughing up green to yellow sputum with brown steaks. He is finding it increasingly hard to get his breath. He has previously been well.

Vital signs: Temperature: 103.4 F; HR: 112 /min; RR: 27 /min; BP: 123/81 mmHg; SpO2: 83% on room air

Physical examination reveals crackles over his right lower chest. There is tactile fremitus in the region. When the patient  repeats the sound, “EEEEE”; it is heard on auscultation over the right lower lung as the sound, “AAAAA”.

What pattern of abnormality would one expect to see on the chest X-ray?

A 41-year-old woman presents to her physician’s office due to a nagging, persistent cough. She has had the cough for 4-5 months and describes it as “dry”. She has otherwise been well. She takes no medications and does not smoke. She exercises regularly and denies any shortness of breath with her exercise. She has no known allergies and denies any sense of mucus or congestion at the back of her throat. There is no associated “throat clearing” with the cough. She does note that she has developed a sour taste in her mouth.

Vital signs: normal

Physical examination: Non-contributory

Pulmonary function testing:

• FEV1: 94%
• FVC: 95% predicted

Chest X-ray: normal

What diagnosis could explain these findings?

A 68-year-old woman is transported to the ED for respiratory failure. One week ago she developed an upper respiratory infection and 2 days ago she started to feel progressively short of breath with a constant cough and increased mucus production. She is a 68 pack-year smoker with known COPD. When the EMS team discovered that her oxygen saturation was 61%, they placed her on high flow oxygen by a non-rebreather mask. By the time they reached the hospital, the patient had an oxygen saturation of 96%.

On arrival in the ER, the patient blood gases show an arterial oxygen saturation of 95 mmHg and an arterial CO2 (PaCO2) concentration of 62 mmHg.

The best explanation of the PaCO2 is