Pulmonary/Critical Care

Should you Treat a COPD Exacerbation with Antibiotics?

September 3, 2011
Should you Treat a COPD Exacerbation with Antibiotics?

By: Aviva Regev

Mr. S is a 68-year old man with longstanding COPD and a 40-pack-year smoking history.  He presents to clinic with three days of increasing shortness of breath, and complains that he has been coughing up “more junk” than usual.  As I watch him spit a wad of chartreuse sputum into his tissue, I reach for the prescription pad and tell him he’ll need a week of antibiotics.  He wants to know why he can’t just go up on his inhaled medications instead…

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Mystery Quiz- The Answer

June 17, 2011
Mystery Quiz- The Answer

Vivian Hayashi MD and Robert Smith MD, Mystery Quiz Section Editors

The answer to the mystery quiz is lymphangitic carcinomatosis (LC). The diffuse interstitial and infiltrative pattern seen on CXR is best appreciated on the CT of the chest. On Images 4, 5 and 6, interlobular septal thickening is apparent (arrow) and is due to tumor infiltration of interstitial lymphatics. Also evident on these images (arrowhead) is diffuse peribronchial thickening due to tumor infiltration of the airways. Image 6 (open arrowhead) additionally shows pleural nodules,…

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Mystery Quiz

June 16, 2011
Mystery Quiz

Vivian Hayashi MD and Robert Smith MD, Mystery Quiz Section Editors

The patient is a 62 year old man presenting with increasing breathlessness for the past six weeks. The patient first noted symptoms of mild shortness of breath and cough productive of yellow sputum that he attributed to his yearly winter cold. The sputum cleared and at presentation the patient had largely unproductive cough. A construction worker until six months earlier, the patient’s unlimited exercise tolerance was now limited to minimal exertion. He denied current…

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From The Archives: Does Acetazolamide Prevent Altitude Sickness?

March 31, 2011
From The Archives: Does Acetazolamide Prevent Altitude Sickness?

Please enjoy this post from the Clinical Correlations archives first posted May 7, 2009

Seema Pursnani, MD

Because your parents have designated you as the family doctor, your Uncle Joe calls to ask you if he should take this medication called Diamox before going trekking in the Himalayas. You work at Bellevue in New York City: who climbs mountains here? What do you say?

Why do illnesses develop from changes in altitude?

The essential culprit…

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Mystery Quiz- The Answer

February 11, 2011
Mystery Quiz- The Answer

Vivian Hayashi MD and Robert Smith MD, Mystery Quiz Section Editors

The answer to the mystery quiz is pulmonary artery aneurysm. The chest CT shows a very round lesion in the left lower lobe with possible surrounding ground glass opacity. This perfectly round shadow suggests a vascular origin (Image 4, arrow). The apparent vascularity is further suggested by the sequential axial cuts on the CT (Image 5) which show a tubular dilatation (Image 5b) that bifurcates distally (Image 5d & e).…

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Mystery Quiz

February 4, 2011
Mystery Quiz

Vivian Hayashi MD and Robert Smith MD, Mystery Quiz Section Editors

The patient is an 84 year old man who presents with small amounts of hemoptysis for one week prior to admission. He is a life-long non-smoker who began having cough with sputum production for one year without fever, chills, nightsweats, orthopnea, weight loss, arthralgias or rash. The patient denied unusual occupational exposures, history of prior TB, travel, or owning pets. The past medical history was significant for coronary bypass surgery, hypertension, atrial fibrillation treated…

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Is Vasopressin Indicated in the Management of Cardiac Arrest?

February 2, 2011
Is Vasopressin Indicated in the Management of Cardiac Arrest?

By Brandon Oberweis, MD

Faculty Peer Reviewed

Case Report:

A 65-year-old male with a past medical history significant for NYHA class IV heart failure was found by his wife to be unresponsive.  Emergency Medical Services was subsequently called and upon arrival, initiated chest compressions and defibrillation for cardiac arrest secondary to ventricular fibrillation.  Intravenous access was obtained and despite two episodes of defibrillation, the patient remained in ventricular fibrillation.  The patient was given one dose of…

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Breaking News: Lung Cancer Screening Shows Mortality Benefit

November 5, 2010
Breaking News: Lung Cancer Screening Shows Mortality Benefit

By David Hormozdi, MD

The weather outside may be cooling off but the debate surrounding lung cancer screening is heating up once again as preliminary results released from The National Lung Screening Trial (NLST) showed 20% fewer lung cancer deaths in individuals that underwent screening with low-dose helical CT scans compared to chest X-ray. This is the first study to show a mortality benefit from lung cancer screening and could impact millions of people considered high-risk for lung cancer.  The study’s…

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Mystery Quiz- The Answer

July 9, 2010

Vivian Hayashi MD and Robert Smith MD, Mystery Quiz Section Editors

The answer to the mystery quiz is pleural effusion that is loculated in both the horizontal and right oblique fissures. Pleural effusion is seen as blunting of the right costophrenic angle and tracking of fluid laterally (Image 3, arrowhead). The horizontal fissure thickens due to fluid which becomes an ovoid density more medially (Image 3, arrow). This ovoid density, representing loculated fluid in the horizontal fissure, is often referred to as a…

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Mystery Quiz

July 4, 2010
Mystery Quiz

Vivian Hayashi MD and Robert Smith MD, Mystery Quiz Section Editors

The patient is a 61 year old man presenting with one month of worsening shortness of breath. The patient has a history of alcoholism and was diagnosed with atrial fibrillation during a hospital admission for detox three years earlier. Warfarin therapy was not begun due to a history of poor medication compliance. One year prior to admission an echocardiogram showed a normal global ejection fraction and mild mitral regurgitation. One month prior to admission,…

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Antimicrobial Therapy Geared at Pseudomonas aeruginosa for Bronchiectasis

April 7, 2010
Antimicrobial Therapy Geared at Pseudomonas aeruginosa for Bronchiectasis

Diana Hubulashvili, Pharm.D.

Edited by Tania Ahuja, Pharm.D., BCPS

Faculty peer reviewed

Bronchiectasis is an uncommon condition that is characterized by irreversible dilation of the bronchi. Chronic pulmonary infections and airway inflammation cause bronchial damage through destruction of the muscular and elastic layer of the bronchial…

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How Easily is Tuberculosis Spread?

March 31, 2010
How Easily is Tuberculosis Spread?

Molly Cason

Faculty peer reviewed

In a city of over 8 million people, New York City has an annual tuberculosis case rate of 11.4 per 100,000 people, which is more than twice the national average.  Seventy-one percent of these cases occur in people who were born outside the United States.1 As a student, I had a patient (Y) who was being evaluated for active tuberculosis because he is a household contact of a person (X) known to have active…

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