Pulmonary/Critical Care

Mystery Quiz

March 17, 2010
Mystery Quiz

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

The patient is a 39yo male followed in pulmonary clinic for chronic breathlessness and intermittent sputum production, sometimes blood tinged. Symptoms were first noted eleven years earlier at which time pulmonary function testing revealed mixed obstructive and restrictive defects. The patient experienced some improvement with bronchodilators, occasional courses of oral steroids and antibiotics, but was never entirely free of his symptoms. Over an interval of ten years, the patient required…

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Therapeutic Hypothermia

November 12, 2009
Therapeutic Hypothermia

Catherine Lucero, MD

Faculty peer reviewed

A recent article in the New York Times highlighted the remarkable recovery of a doctor who regained essentially all his mental function just six weeks after suffering a cardiac arrest with a post -resuscitation Glasgow coma score of 4.(1) Although the ambulance had originally rushed the doctor to the nearest hospital in Nassau County, he was quickly transferred to New York Presbyterian Hospital, where the receiving team induced hypothermia for the subsequent 24…

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Mystery Quiz- The Answer

October 27, 2009
Mystery Quiz- The Answer

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

The answer to the mystery quiz is thoracic splenosis. The key to the solution is the past medical history of a gunshot wound. Shrapnel is seen on the plain CXR (Image 1) as well as in the soft tissue of the back (Image 5). The CXR also shows a lateral diaphragmatic abnormality (Image 1, arrow) likely due to adhesions. The left upper quadrant is notable for colonic gas where one…

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Mystery Quiz

October 23, 2009
Mystery Quiz

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

A 61 year old man was referred to the pulmonary service for an abnormal pulmonary function test (PFT). The patient was a lifelong smoker and had symptoms suggestive of obstructive sleep apnea. The PFT showed a mixed obstructive and restrictive defect. The latter abnormality was considered to be out of proportion to the patient’s obesity, hence a chest CT scan was obtained to evaluate for possible parenchymal lung disease (shown…

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Mystery Quiz- The Answer

July 23, 2009
Mystery Quiz- The Answer

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

The answer to the mystery quiz is bland alveolar hemorrhage. The CXR (image 1) shows cardiomegaly with mild increase in opacification of the right middle and right lower lobes. The CT images show areas of multifocal ground glass opacification, that is, the underlying interstitium is visible through the opacification, and the variably sized opacities are widely distributed throughout the lungs (images 2, 3, and 4). Image 4 shows prominent interstitium…

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Mystery Quiz

July 18, 2009
Mystery Quiz

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

The patient is a 74 year old man complaining of hemoptysis for four days. The patient has a history of hypertension, but had not been followed medically for many years until two weeks earlier when he presented with leg swelling, breathlessness, and atrial flutter. He was admitted, diuresed, begun on antihypertensive medications including hydralazine, aspirin, and anti-coagulated with enoxaparin and warfarin. After discharge, the patient felt well for a few days before…

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Meeting Perspectives: The 2009 American Thoracic Society (ATS) International Conference

July 8, 2009
Meeting Perspectives: The 2009 American Thoracic Society (ATS) International Conference

Commentary by Kristy Bauer MD and Nishay Chitkara MD, NYU Division of Pulmonary and Critical Care Medicine

The 2009 meeting of the American Thoracic Society took place in sunny San Diego, California from May 15-20. The ATS meeting is the largest gathering of pulmonologists, thoracic surgeons, nurses, respiratory therapists and other healthcare professionals, and features over 5300 original research studies and scientific presentations. San Diego has long been a frequent host to the ATS meeting, with its ideal location. The large…

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Does Acetazolamide Prevent Altitude Sickness?

May 7, 2009
Does Acetazolamide Prevent Altitude Sickness?

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 is the fall in atmospheric pressure with an increase in altitude. While at sea level, barometric pressure (Pb) is ~760mm Hg (1atm), whereas at…

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Mystery Quiz- The Answer

May 1, 2009
Mystery Quiz- The Answer

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

The answer to the mystery quiz is sarcoidosis. The CXR shows diffuse, bilateral infiltration with a predominantly nodular pattern. The pulmonary hila are also prominent. The CT image shows innumerable 2-3mm nodules, many of which have a perilymphatic distribution. The lymphatics, in parallel with the pulmonary vasculature, course through the interstitium. Hence, the perilymphatic nodularity has an interstitial distribution and appears as “studding” along the interstitium which is…

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Mystery Quiz

April 28, 2009
Mystery Quiz

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

The patient is a 42 year old man with a history of non-productive cough for several weeks. Three weeks prior to evaluation by the pulmonary service, the patient presented to the ER with a presumed vasovagal syncopal event that occurred on a subway platform. The patient’s prior medical history included allergic sinusitis and nasal polypectomy. Other than cough, the patient denied constitutional symptoms. The patient was not taking any medications.…

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Bedside to Bench: Clubbing Revisited

April 3, 2009
Bedside to Bench: Clubbing Revisited

Commentary by Judith Brenner MD, Associate Editor, Clinical Correlations 

Faculty Peer Reviewed 

For an internist, discovering a patient with clubbing is so rewarding since it appeals to the core of our profession, a profession which can often be very similar to that of a detective. The physical finding of clubbing was first described by the ancient Greeks, who recognized it to be a clue to much more.

When a clinician discovers clubbing of the fingers, he must consider that hypoxemia may…

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Grand Rounds: The New Frontier of Sleep Disorders

March 18, 2009
Grand Rounds: The New Frontier of Sleep Disorders

Commentary by Melissa Price, MD, PGY-3

Please also see the clinical vignette presented before last week’s Grand Rounds.

At Medical Grand Rounds on March 11th, 2009, the NYU Medical Community had the immense pleasure of hosting Dr. Allan I. Pack, MD, Ch.B, and Ph.D from the University of Pennsylvania Medical Center as he indulged us in his research on the biological functions of sleep and its regulation.

Studying the importance of sleep and its disorders has never been more relevant. Not only is the Accreditation…

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