Pulmonary/Critical Care

Mystery Quiz- The Answer

March 10, 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 allergic bronchopulmonary aspergillosis (ABPA). The CXR shows right upper lobe opacities, two of which appear round (Image 3, arrow) and another tubular (Image 3, arrowhead), and a left upper lobe opacity which has the characteristics of subsegmental atelectasis (Image 3, double arrows). The CT scan, performed ten days after the CXR, shows central bronchiectasis of the RUL (Image 4, arrows); tubular branching shadows (Image 6, arrow) as…

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Mystery Quiz

March 6, 2009
Mystery Quiz

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

The patient is a 42 year old male non-smoker with history of poorly controlled asthma (first diagnosed in 1994, recurrent need for steroid treatments but never intubated), severe seasonal allergies with chronic sinusitis, hepatic steatosis, GERD and gout who presented with complaints of five to ten days of myalgias, productive cough, wheezing and chest tightness. His medications included albuterol, fluticasone and formoteral inhalers, montelukast, colchicine, indomethacin prn, and fexofenadine. Exam was significant for T 97.6,…

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Diseases 2.0: Sepsis

February 5, 2009
Diseases 2.0: Sepsis

Diseases 2.0 – Bringing you the latest updates on disease pathophysiology and treatment

Commentary by Andrew McKinstry MD PGY-1

Faculty Peer Reviewed

For anyone who has stepped into an ICU, the septic patient is a familiar sight. Despite advances in research and management, including goal directed therapy and recombinant human activated protein C (Xigris), sepsis continues to be a major cause of mortality in the critical care setting, with an estimated 215,000 deaths annually, and costing roughly 16.7 billion dollars per year. Despite these staggering…

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Breaking News: FDA Advisory Committee Calls For Ban on Long Acting Beta Agonists in Asthma

December 12, 2008
Breaking News: FDA Advisory Committee Calls For Ban on Long Acting Beta Agonists in Asthma

Commentary by Denise Pate MD, PGY-1 

The FDA released a 460 page document regarding the safety of long acting beta agonists (LABA) for the use of asthma, in addition to a two day advisory committee meeting this week on the call to ban LABA when used alone and not in combination with an inhaled steroid. The FDA found through a meta-analysis of 110 trials studying 4 drugs—2 LABAs, Foradil and Serevent, and 2 LABA/ICS (Inhaled Corticosteroids) Advair and Symbicort. The study found that there was…

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Mystery Quiz- The Answer

November 8, 2008
Mystery Quiz- The Answer

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

The answer to the mystery quiz is heart failure.  The CXR shows bibasilar opacities with hilar fullness on the right. The CT images are remarkable for bilateral effusions, with dependent opacities that increase in density along the anterior-posterior axis.  The lung appears clear in the anterior zone (Image 5, arrow; Coronal Image 1); ground glass opacification, characterized by parenchymal haziness which does not obscure the underlying pulmonary vessels, is evident in the mid lung (Image…

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Mystery Quiz

October 30, 2008
Mystery Quiz

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

The patient is a 61 year old man with a history of diabetes, chronic kidney disease, and poorly controlled hypertension on five medications who was in his usual state of health until three days prior to admission when he noted increasing exertional dyspnea associated with chest pain, abdominal distention, bilateral lower extremity edema (left greater than right).

Exam notable for BP 105/54 (lower than all other prior measurements), HR 74, O2 Saturation 90%. PaO2…

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Propofol Infusion Syndrome: An Unusual Case of Lactic Acidosis

October 1, 2008
Propofol Infusion Syndrome: An Unusual Case of Lactic Acidosis

Commentary by Bani Chander MD, PGY-3 and Reviewed by Laura Evans MD, NYU Division of Pulmonary and Critical Care Medicine

Case presentation:

The patient is a 26 year-old female with long-standing refractory epilepsy, status post corpus callosotomy, and vagus nerve stimulator placement, who was admitted to the intensive care unit for management of status epilepticus. The patient was initially admitted to the inpatient epilepsy unit and placed on multiple anti-epileptic medications with little response. However, after having more than ninety seizures over the…

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Mystery Quiz- The Answer

September 27, 2008
Mystery Quiz- The Answer

Posted by Vivian Hayashi MD and Robert Smith MD,

Mystery Quiz Section Editors

The answer to last week’s mystery quiz is pneumatocele/pseudocyst likely due to ventilator associated lung injury (VALI) in a patient with ARDS. The patient had

ARDS on the basis of diffuse infiltrates, hypoxemia with a PaO2/FiO2 <200mmHg, and no strong evidence of LV heart failure. His risk factor for ARDS was pneumonia, evident on his admission CXR with bibasilar infiltrates (R>L); Streptococcus pneumoniae grew on sputum culture. The…

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Mystery Quiz

September 19, 2008
Mystery Quiz

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

The patient is a 76 year old man with history of moderate-to-severe COPD who presented with three days of fever, breathlessness, and productive cough. Past surgical history is significant for vagotomy and partial gastrectomy 16 years earlier and a cholecystectomy 10 months prior to admission. On exam, the patient appeared acutely ill with a blood pressure of 75/45 mmHg, tachycardia, marked hypoxemia and course breath sounds throughout all lung fields. Labs revealed a white…

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Grand Rounds: “Acute Respiratory Distress Syndrome and Acute Lung Injury”

September 17, 2008
Grand Rounds: “Acute Respiratory Distress Syndrome and Acute Lung Injury”

Commentary by Matthias Kugler MD, PGY-3

Please also see the Grand Rounds Clinical Vignette

Leonhard D Hudson, M.D., Professor of Medicine, Pulmonary and Critical Division, University of Washington, Seattle, spoke at Medical Grand Rounds about the Acute Respiratory Distress Syndrome (ARDS) and Acute Lung Injury (ALI). He started his lecture with a history of the disease, starting with the first published description of ARDS in The Lancet 1967, where it was defined by the presence of diffuse alveolar damage, increasing pulmonary…

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Meeting Perspectives: 2008 American Thoracic Society Meeting

June 18, 2008
Meeting Perspectives: 2008 American Thoracic Society Meeting

Commentary by Laura Evans MD, NYU Division of Pulmonary and Critical Care Medicine 

The 2008 American Thoracic Society (ATS) meeting took place from May 16-21 in Toronto, Ontario.  Over 16,000 physicians, nurses and respiratory therapists attended the meeting.  There were more than 400 sessions, 800 speakers and 5,500 original research abstracts focusing on pulmonary, critical care and sleep medicine. 

The NYU Division of Pulmonary and Critical Care medicine was well represented.  The division presented more than 20 original research abstracts and…

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Its okay to smoke…we’ll screen you

May 9, 2008
Its okay to smoke…we’ll screen you

Commentary by Shrujal Baxi MD, NYU Chief Resident

One of the first things you learn about critically analyzing a medical journal piece is to go to the end and see who sponsored the study. Corporate financing is known to have subtle effects on research which can lead to an unconscious bias. Disclosure of funding is paramount for a researcher in order to remain above reproach.

In a recent New York Times article, the impact of such relationships is investigated. In 2006, Dr.…

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