About the MedStudy Internal Medicine Core Scripts™ Flash Cards and Core Scripts answer book pages you will see here: These are the Core Scripts Flash Cards and answer book pages for the Pulmonary Medicine section of the product. The actual cards in the product measure 3” x 5” but may display at a different size on your screen depending on your computer/monitor computer/monitor settings. For each Flash Card in this presentation, you will see the front “Script” side rst, followed immediately by the back “Answer” side of the card. Note on the “Answer” side that the number in the upper right corner corresponds to the number in the answer book where you will nd the correct diagnosis and other information for the Script on the card. (The answer book pages are in the separate PDF le you downloaded.) Note also that the bar bar along the top top of the card on on the “Answer” side is in color whereas whereas the bar on the the “Script” side is not. These color bars identify which topic areas the Scripts cards fall into. There is a unique color for Pulmonary, Pulmonary, Gastroenterology, Gastroenterology, Infectious Disease, etc. Since all the cards in this presentation are Pulmonary Medicine, the color bar will be the same for all. When you have the actual product with the full set of cards for all topics, the varied color bars enable you to sort your cards so you can focus your study and review by specic topic if you wish. But if you prefer instead to do a randomized review, review, you simply use your cards with the “Script” sides face-up and mix them up, which keeps the topic area of each card unknown until you turn it over. Now click here to begin reviewing the Pulmonary Medicine Core Scripts Flash Cards.
SCRIPT
A previously healthy patient patient with history of a troubled past and/or substance abuse presents with: • Acute coma with stable BP • ↓ RR • ↓ pO2, ↑ pCO2 • Miosis • A-a gradient = normal The cause of the hypoxemia is ______________________. ______________________. In conjunction with hypoxemia, miosis is a physical exam nding that suggests overdose of _______________ ______________________. _______.
SCRIPT
A previously healthy patient patient with history of a troubled past and/or substance abuse presents with: • Acute coma with stable BP • ↓ RR • ↓ pO2, ↑ pCO2 • Miosis • A-a gradient = normal The cause of the hypoxemia is ______________________. ______________________. In conjunction with hypoxemia, miosis is a physical exam nding that suggests overdose of _______________ ______________________. _______.
ANSWER
429
The cause of the hypoxemia is ______________________. ______________________. In conjunction with hypoxemia, miosis is a physical exam nding that suggests overdose of ______________________.
2011-2012 Edition Internal Medicine Core Scripts™
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SCRIPT
A previously healthy patient patient with no PMH presents with: • Coughing and wheezing that begins approximately 1/2 hour after exercise and with exposure to cold air. air. Symptoms self-resolve within an hour. • Spirometry: normal FEV1 and FVC • Normal DLCO
What is the diagnosis?
ANSWER
430
Diagnosis is ______________________.
2011-2012 Edition Internal Medicine Core Scripts™
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A middle-aged smoker with a daily productive cough has the following spirometry: • FEV1/FVC < 0.70 • ↓ DLCO
What is the diagnosis?
ANSWER
431
Diagnosis is ______________________.
2011-2012 Edition Internal Medicine Core Scripts™
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SCRIPT
A young smoker with exertional dyspnea and a productive cough has the following: • FEV1/FVC < 0.70 • Chest radiograph: bullous emphysema at the lung bases
What is the diagnosis?
ANSWER
432
Diagnosis is ______________________.
2011-2012 Edition Internal Medicine Core Scripts™
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A patient presents 2 years after a signicant inhalation exposure to pool chemicals with: • A chronic productive cough • Sputum Gram stain: multiple gram-positive and -negative organisms • Sputum culture: Proteus
What is the diagnosis?
ANSWER
433
Diagnosis is ______________________.
2011-2012 Edition Internal Medicine Core Scripts™
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A 30-year-old patient with PMH of recurrent sinusitis and pneumonia presents with: • Chronic exertional dyspnea • Cough with purulent sputum • Sputum Gram stain: gram-positive cocci in clusters and gram-negative rods • Sputum culture: S. aureus
What is the diagnosis?
ANSWER
434
Diagnosis is ______________________.
2011-2012 Edition Internal Medicine Core Scripts™
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A middle-aged patient who owns a parakeet presents with: • Recurrent fever, cough, and dyspnea • Chest radiograph: interstitial inltrates • CBC: Normal • Sputum: no eosinophils
What is the diagnosis?
ANSWER
435
Diagnosis is ______________________.
2011-2012 Edition Internal Medicine Core Scripts™
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A foundry worker with a history of cough and “egg-shell” calcications on chest radiograph presents with 3 months of: • Weight loss • Night sweats • Productive cough • Occasional hemoptysis • Sputum: + acid-fast organisms
Diagnosis is ______________________ associated with ______________________.
436
ANSWER
Diagnosis is ______________________ associated with ______________________.
2011-2012 Edition Internal Medicine Core Scripts™
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A middle-aged male with no PMH presents with: • Progressive exertional dyspnea and dry cough • Diffuse ne crackles • Clubbing • Chest CT: reticular opacities and “honeycombing”
What is the diagnosis?
ANSWER
437
Diagnosis is ______________________.
2011-2012 Edition Internal Medicine Core Scripts™
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A young healthy patient presents for a routine pre-employment physical: • Intermittent cough for years • Chest radiograph: signicant hilar adenopathy with normal lungs • TB skin test: non-reactive
What is the diagnosis?
ANSWER
438
Diagnosis is ______________________.
2011-2012 Edition Internal Medicine Core Scripts™
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A young, male smoker presents with: • Bone pain • Polyuria • A spontaneous pneumothorax
What is the diagnosis?
ANSWER
439
Diagnosis is ______________________.
2011-2012 Edition Internal Medicine Core Scripts™
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A 40-year-old, premenopausal Caucasian female with a history of dyspnea presents with: • A spontaneous pneumothorax • ± A chylous pleural effusion • Chest radiograph: diffuse “honeycombing”
What is the diagnosis?
ANSWER
440
Diagnosis is ______________________.
2011-2012 Edition Internal Medicine Core Scripts™
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A male presents with: • Dyspnea • Productive cough • Occasional hemoptysis • A nasal ulcer • ↓ Hgb and Hct with normal MCV and MCHC • U/A: + protein,+ RBCs, RBC casts • CXR: cavitary lesions and nodules
What is the diagnosis?
ANSWER
441
Diagnosis is ______________________.
2011-2012 Edition Internal Medicine Core Scripts™
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An asthmatic on montelukast develops: • A chronic cough and dyspnea • CBC: ↑ eosinophils • U/A: + protein and RBC casts
What is the diagnosis?
ANSWER
442
Diagnosis is ______________________.
2011-2012 Edition Internal Medicine Core Scripts™
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A young male with intermittent, vague abdominal pain presents with: • Cough • Testicular pain and swelling • + HBsAg
What is the diagnosis?
ANSWER
443
Diagnosis is ______________________.
2011-2012 Edition Internal Medicine Core Scripts™
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A young, male patient from a southern state, who frequently walks barefooted during the summers, presents with: • Cough • ↑ WBC (differential: ↑ eosinophils) • CXR: migrating pulmonary inltrates
What is the diagnosis?
ANSWER
444
Diagnosis is ______________________.
2011-2012 Edition Internal Medicine Core Scripts™
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A male patient, age 20–40 years, presents with: • Acute respiratory failure that requires intubation, with no obvious inciting cause • CXR: diffuse alveolar and interstitial inltrates • Bronchoalveolar lavage: + eosinophils
What is the diagnosis?
ANSWER
445
Diagnosis is ______________________.
2011-2012 Edition Internal Medicine Core Scripts™
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A middle-aged, asthmatic female presents with: • Intermittent cough and dyspnea • CXR: diffuse alveolar inltrates • Bronchoalveolar lavage: + eosinophils
What is the diagnosis?
ANSWER
446
Diagnosis is ______________________. ______________________.
2011-2012 Edition Internal Medicine Core Scripts™
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An asthmatic presents with: • Asthma exacerbations every 2 months while while on an inhaled long-acting beta-agonist and medium-dose inhaled corticosteroid • Sputum: branching hyphae
What is the diagnosis?
ANSWER
447
Diagnosis is ______________________. ______________________.
2011-2012 Edition Internal Medicine Core Scripts™
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A young young patien patientt with with histor history y of iron decien deciency cy anemia anemia presents presents with: with: • Hemoptysis • ↑ DLCO • Normal serum creatinine • U/A: no protein, red cells, or RBC casts
What is the diagnosis?
ANSWER
448
Diagnosis is ______________________.
2011-2012 Edition Internal Medicine Core Scripts™
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A healthy female presents with: • Exertional syncope • Large v waves, a loud P2, and a holosystolic murmur at LLSB
What is the diagnosis?
ANSWER
449
Diagnosis is ______________________.
2011-2012 Edition Internal Medicine Core Scripts™
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A patient with atrial brillation on warfarin is given piperacillintazobactam for 10 days to treat ascending cholangitis. The normal dose of warfarin is given, but the patient’s INR increases.
What is the cause of the increase in the INR?
ANSWER
450
The cause is ______________________.
2011-2012 Edition Internal Medicine Core Scripts™
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A patient with history of bilateral hand and knee pain presents with: • Dyspnea • Pleural effusion • Active synovitis of bilateral MCPs and PIPs • Soft tissue nodular lesions over the olecranon bursa • Pleural uid glucose: < 30 mg/dL • TB skin test: non-reactive
What is the diagnosis?
ANSWER
451
Diagnosis is ______________________.
2011-2012 Edition Internal Medicine Core Scripts™
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A young, healthy patient presents with: • Fever • Dyspnea • Cough, productive of rust-colored sputum • ↑ WBC (differential: ↑ neutrophils with band forms) • CXR: lobar consolidation • Sputum Gram stain: gram-positive, lancet-shaped, diplococci
What is the diagnosis?
ANSWER
452
Diagnosis is ______________________.
2011-2012 Edition Internal Medicine Core Scripts™
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A male with HIV/AIDS with a CD4 count ˃ 300/µL presents with: • Fever • Dyspnea • Productive cough • ↑ WBC (differential: ↑ neutrophils with band forms) • CXR: lobar consolidation • Sputum Gram stain: gram-negative coccobacilli • Blood cultures grow the same organism.
What is the diagnosis?
ANSWER
453
Diagnosis is ______________________.
2011-2012 Edition Internal Medicine Core Scripts™
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A college wrestler presents with: • Fever • Dyspnea • Cough, productive of salmon-pink sputum • ↑ WBC (differential: ↑ neutrophils with band forms) • CXR: patchy alveolar consolidation with pneumatoceles • Sputum Gram stain: gram-positive cocci in clusters
What is the diagnosis?
ANSWER
454
Diagnosis is ______________________.
2011-2012 Edition Internal Medicine Core Scripts™
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An elderly smoker with FEV1/FVC 0.35 presents with: • Fever • Dyspnea • Worsening cough • CXR: lobar consolidation, in addition to chronic changes • Sputum Gram stain: + gram-negative cocci
What is the diagnosis?
ANSWER
455
Diagnosis is ______________________.
2011-2012 Edition Internal Medicine Core Scripts™
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Young female presents with: • Fever • Dyspnea • Productive cough • Pulmonary consolidation • Erythema nodosum • ↓ Hgb and Hct with ↑ I. bilirubin and ↑ reticulocytes • + Coombs • + Cold agglutinins What is the diagnosis?
ANSWER
456
Diagnosis is ______________________.
2011-2012 Edition Internal Medicine Core Scripts™
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A patient presents with: • Sore throat for 7 days with gradual onset of low-grade fever, cough, and hoarseness • Normal WBC • CXR: patchy inltrate
What is the diagnosis?
ANSWER
457
Diagnosis is ______________________.
2011-2012 Edition Internal Medicine Core Scripts™
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A healthy patient with a history of fever, dyspnea, and a productive cough is given empiric amoxicillin/clavulanic acid for audible pulmonary consolidation. He returns with: • Severe dyspnea • Persistent fever • New diarrhea • Confusion • pO2 < 60 mmHg • Serum Na+ < 140 mEq/dL What is the diagnosis?
ANSWER
458
Diagnosis is ______________________.
2011-2012 Edition Internal Medicine Core Scripts™
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A young patient returns from a visit to Arizona with: • Cough • Arthralgias
What is the diagnosis?
ANSWER
459
Diagnosis is ______________________.
2011-2012 Edition Internal Medicine Core Scripts™
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10 days after returning home from a spelunking adventure, a healthy patient with a well appearance develops: • Cough • Fever • CXR: patchy inltrates and hilar adenopathy
What is the diagnosis?
ANSWER
460
Diagnosis is ______________________.
2011-2012 Edition Internal Medicine Core Scripts™
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A non-smoking hunter from Alabama develops: • An indolent productive cough • CXR: mass-like lesion • Sputum KOH: + broad-based budding yeasts
What is the diagnosis?
ANSWER
461
Diagnosis is ______________________.
2011-2012 Edition Internal Medicine Core Scripts™
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An alcoholic patient presents with: • Weight loss • Night sweats • Chronic cough, productive of bloody, “fetid,” purulent material • Pulmonary consolidation • Halitosis
What is the diagnosis?
ANSWER
462
Diagnosis is ______________________.
2011-2012 Edition Internal Medicine Core Scripts™
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An elderly female with chronic cough and dyspnea presents with: • Increased cough • Night sweats • Weight loss • Unsuccessful sputum sampling because the patient swallows sputum • CXR: patchy inltrates and apical bullous disease • CT chest: nodules and evidence of bronchiectasis • BAL: + acid-fast organisms • TB skin test: reactive to 8 mm What is the diagnosis?
ANSWER
463
Diagnosis is ______________________.
2011-2012 Edition Internal Medicine Core Scripts™
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A healthy, female patient presents with: • An indolent, draining wound 10 days after vacationing in the Bahamas • She is 4-weeks status–post “tummy tuck” surgery.
What is the diagnosis?
ANSWER
464
Diagnosis is ______________________.
2011-2012 Edition Internal Medicine Core Scripts™
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A patient with HIV/AIDS and a CD4 count < 200/μL presents with: • Progressive exertional dyspnea • Cough for 1 month • Fever for 1 week • CXR: diffuse interstitial inltrates • ABG: pO2 < 70
What is the diagnosis?
ANSWER
465
Diagnosis is ______________________.
2011-2012 Edition Internal Medicine Core Scripts™
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A patient with AML, undergoing bone marrow transplant, develops: • Cough and dyspnea without fever • CBC: absolute neutrophil count < 500/μL for previous 14 days • CXR: no acute changes • HRCT: “halo sign”
What is the diagnosis?
ANSWER
466
Diagnosis is ______________________.
2011-2012 Edition Internal Medicine Core Scripts™
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A patient with PMH of treated cavitary tuberculosis presents with: • Hemoptysis • Weight loss • CXR: obvious cavities with a mobile intracavitary lesion
What is the diagnosis?
ANSWER
467
Diagnosis is ______________________.
2011-2012 Edition Internal Medicine Core Scripts™
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A male patient with BMI > 30 presents complaining of: • Dyspnea • New lower extremity edema • ↑ Serum HCO3 –
What is the diagnosis?
ANSWER
468
Diagnosis is ______________________.
2011-2012 Edition Internal Medicine Core Scripts™
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A non-smoking patient presents with 4 months of: • Progressive, indolent cough, productive of “frothy, salty sputum”
What is the diagnosis?
ANSWER
469
Diagnosis is ______________________.
2011-2012 Edition Internal Medicine Core Scripts™
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A non-smoking female presents with: • Intermittent cough with hemoptysis • Long bone pain • Clubbing • Pain with palpation of the anterior tibias
What is the diagnosis?
