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  #1  
Old 01-20-2013
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Lungs Smoker with Ground Glass Lungs!

A 51-year-old man presenting to the clinic for routine examination mentions that he has not been able to get over the flu. Further questioning clarifies that he has had a nonproductive cough for the past 3–4 months and is unable to sustain his normal walking pace for prolonged periods. He reports feeling more fatigued than he recalls feeling last year. His medical history is significant for hypertension, alcoholism, and obesity. His blood pressure is well controlled on losartan and hydrochlorothiazide. He has no known drug allergies. His mother died of complications of type 2 diabetes mellitus. His father had a fatal myocardial infarction at age 56 years. The patient smokes half a pack of cigarettes per day and has done so for the past 7 years. He has worked all his adult life as an accountant and has no known exposures to asbestos or organic dusts. His blood pressure is 134/96 mm Hg, heart rate is 78/min, respiratory rate is 16/min, temperature is 37°C (98.6°F), and oxygen saturation is 94% on room air. Lung examination reveals bilateral resolution CT shows patchy areas of ground glass, reticular abnormalities, and traction bronchiectasis. Laboratory findings are normal except for an elevated erythrocyte sedimentation rate of 54 mm/hr. What is the recommended treatment for this patient’s cough?

(A) Change the antihypertensive agent
(B) Prescribe amantadine
(C) Prescribe bronchodilators and long-term domiciliary oxygen therapy
(D) Prescribe glucocorticoids
(E) Resect diseased lung fields
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Old 01-20-2013
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(D) Prescribe glucocorticoids

Looks like Interstitial Lung Disease based on CT findings.
Since his ESR is raised he might benefit from steroids.

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Old 01-20-2013
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prescribe steroids.....early stages of Interstitial lung disease....
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Old 01-20-2013
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(A) Change the antihypertensive agent= not related to current problem
(B) Prescribe amantadine= yeah for flu but we need to treat interstitial lung Dz
(C) Prescribe bronchodilators and long-term domiciliary oxygen therapy= bronchodilators may benefit in bronchiectasis but no indication for long term O2 therapy
(D) Prescribe glucocorticoids= decrease inflammation and modify progression of fibrosis
(E) Resect diseased lung fields= if the damage ( fibrosis and bronchiectasis ) occurs in one localize area yeah it can be resected but the open thoracic surgery is last resort when the condition is not improve by nonsurgical measures
So i confuse between D and E, but i will go with D
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Old 01-21-2013
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Quote:
Originally Posted by heartbeat View Post
(A) Change the antihypertensive agent= not related to current problem
(B) Prescribe amantadine= yeah for flu but we need to treat interstitial lung Dz
(C) Prescribe bronchodilators and long-term domiciliary oxygen therapy= bronchodilators may benefit in bronchiectasis but no indication for long term O2 therapy
(D) Prescribe glucocorticoids= decrease inflammation and modify progression of fibrosis
(E) Resect diseased lung fields= if the damage ( fibrosis and bronchiectasis ) occurs in one localize area yeah it can be resected but the open thoracic surgery is last resort when the condition is not improve by nonsurgical measures
So i confuse between D and E, but i will go with D
Nice explanation.
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Old 02-13-2013
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Quote:
Originally Posted by aknz View Post
A 51-year-old man presenting to the clinic for routine examination mentions that he has not been able to get over the flu. Further questioning clarifies that he has had a nonproductive cough for the past 3–4 months and is unable to sustain his normal walking pace for prolonged periods. He reports feeling more fatigued than he recalls feeling last year. His medical history is significant for hypertension, alcoholism, and obesity. His blood pressure is well controlled on losartan and hydrochlorothiazide. He has no known drug allergies. His mother died of complications of type 2 diabetes mellitus. His father had a fatal myocardial infarction at age 56 years. The patient smokes half a pack of cigarettes per day and has done so for the past 7 years. He has worked all his adult life as an accountant and has no known exposures to asbestos or organic dusts. His blood pressure is 134/96 mm Hg, heart rate is 78/min, respiratory rate is 16/min, temperature is 37°C (98.6°F), and oxygen saturation is 94% on room air. Lung examination reveals bilateral resolution CT shows patchy areas of ground glass, reticular abnormalities, and traction bronchiectasis. Laboratory findings are normal except for an elevated erythrocyte sedimentation rate of 54 mm/hr. What is the recommended treatment for this patient’s cough?

(A) Change the antihypertensive agent
(B) Prescribe amantadine
(C) Prescribe bronchodilators and long-term domiciliary oxygen therapy
(D) Prescribe glucocorticoids
(E) Resect diseased lung fields
Answer: (A) after hold the ACEI if couph does not leave ,we will go to CXR if its normal then check for three condition :PND,alergic asthma,eosinophilic bronchitis,GERD

Last edited by umit; 02-13-2013 at 11:03 AM.
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Old 02-13-2013
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Default Interstitial lung dz

(D) Prescribe glucocorticoids
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