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Old 02-15-2011
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X Ray What is your diagnosis? (Respiratory)

A 62-year-old male complains of progressive dyspnea that limits his daily activities. He has smoked 1-2 packs of cigarettes a day for over 30 years. Physical examination reveals bilaterally decreased breath sounds and scattered wheezes. His chest x-ray is shown below. Which of the following parameters is most likely to be increased in this patient?




A. Expiratory flow rates
B. Carbon monoxide diffusion capacity
C. Lung elastic recoil
D. Forced vital capacity
E. Functional residual capacity
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Old 02-15-2011
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Your question is about a male while the X ray is that of a female lady with large breast
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Old 02-15-2011
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Quote:
Originally Posted by mary View Post
Your question is about a male while the X ray is that of a female lady with large breast
That happens all the time in our classes - it makes me laugh every time!

(and to be fair I only see a breast on her right side...)
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Old 02-15-2011
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'E' over inflated lung, smoking hx =emphysema....
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Old 02-15-2011
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Default E. Functional residual capacity

I see hyperinflation, so with the smoking history I'd guess emphysema -
so:
Decreased would be
  • expiratory flow rates
  • elastic recoil
  • vital capacity
Increased would be
  • forced expiration time
  • residual volume
  • functional residual capacity
I don't know about CO diffusion capacity?
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Old 02-15-2011
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Default E

Emphysema: h/o smoking, Xray shows hyperinflated lung, barrel shaped chest..
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Old 02-15-2011
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Quote:
Originally Posted by mle2resident View Post
Emphysema: h/o smoking, Xray shows hyperinflated lung, barrel shaped chest..
Isn't barrel shaped chest a clinical diagnosis rather than a radiological one?
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Old 02-15-2011
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Quote:
Originally Posted by patelMD View Post
Isn't barrel shaped chest a clinical diagnosis rather than a radiological one?
yes, it is clinical sign.. u r right, i got that wrong. Thanks for correcting.
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Quote:
Originally Posted by mary View Post
Your question is about a male while the X ray is that of a female lady with large breast

I'm sorry, I didn't notice that. I was looking for a x-ray with hyperinflated lung.

Man you are dirty minded, why you r looking at the large breasts. Just focus on the lungs. lol. Actually, you don't really need a CXR to answer this qn, I put it there to make it easy for you guys.

Here is the explanation for this qn:

What is your diagnosis? (Respiratory)-barrel.png
click image to enlarge

This patient’s clinical picture is consistent with chronic obstructive pulmonary disease (COPD). The chest x-ray shows hyperinflated lungs and a flattened diaphragm. COPD encompasses chronic bronchitis and/or emphysema. Patients with emphysema often have a barrel-shaped chest and decreased breath sounds on physical exam, as well as increases in both total lung capacity (TLC) and residual volume (RV). These spirometry findings are due to destruction of interalveolar walls and diminished lung elastic recoil which cause “air trapping” in enlarged distal airspaces. Since the functional residual capacity (RC) is equal to the expiratory reserve volume (ERV) plus the RV, and since the FRV is likely to be increased by the air trapping that characterizes emphysema, FRC will also tend to be increased in emphysematous patients.
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Old 05-29-2011
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hey plz explain me how to differentiate on xray that wheather this a male or female x-ray? i couldnt find breast shadows
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Old 05-30-2011
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Default COPD??

i'm thinking this patient got COPD.
so i will answer E.
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Old 05-30-2011
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Quote:
Originally Posted by amresh kumar View Post
hey plz explain me how to differentiate on xray that wheather this a male or female x-ray? i couldnt find breast shadows
I don't think they would ask you to tell a female X-ray from a male x-ray for Step 1, but in this picture, there is a breast curvature on the patient's right side just below the diaphragm. You can also see the shadow going up the rib cage.

@ Kelvin, yes the answer is E, see the explanation above your post.
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Physiology-, Radiographs-, Respiratory-, Step-1-Questions

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