Pulmonary/Critical Care

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 enhanced by vascular contrast …

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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. His social history was …

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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 be present, whether secondary …

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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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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, …

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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 …

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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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