Gyrus Daily Questions; Internal Medicine #22

[cingulate.gyrus]

A 32-year-old male is brought to the emergency department after developing sudden-onset shortness of breath and chest pain while coughing. He reports a 3- month history of increasing dyspnea on exertion, nonproductive
cough, and anorexia with 15 lb of weight loss. He has no past medical history and takes no medications. The patient smokes one or two packs of cigarettes a day, uses alcohol socially, and has no risk factors for HIV infection. A chest radiogram shows a right 80% pneumothorax, and there are nodular infiltrates in the left base that spare the costophrenic angle. After placement of a chest tube, a chest CT shows bilateral small nodular opacities in the lung bases and multiple small cystic spaces in the lung apex. Which of the following interventions is most likely to improve the symptoms and radiograms?

A. Intravenous α1 antitrypsin
B. Isoniazid, rifampin, ethambutol, and pyrazinamide
C. Prednisone and cyclophosphamide
D. Smoking cessation
E. Trimethoprim-sulfamethoxazole

[step_enhancer]

Answer B

Patient seems to be having TB ,not sure

Nice Question

[step_enhancer]

I got it ,the pt has pneumothorax secondary to coughing,spontaneous pneumothorax .He has COPD due to smoking

also no fever history

I always miss this

Answer D -smoking cessation

[cingulate.gyrus]

Originally Posted by step_enhancer

I got it ,the pt has pneumothorax secondary to coughing,spontaneous pneumothorax .He has COPD due to smoking

also no fever history

I always miss this

Answer D -smoking cessation

Answer is correct but the explanation is wrong ...I think its a bit difficult question....

[XpaezX]

Smoking cessation

This dude has COPD and is young as f.u.c.k
only option is a1| antitrypsing deficiency

the best way to improve patient symptoms is by smoking cessation

no one, if genetically normal, will develop COPD even if you smoke 50 cigarettes a day for 10 years XD, pts with a1 deficiency will develop emphysemafaster than normal, and if you add smoking well.. you see the picture.

[shima]

answer is D...it is spontanous pneumothorax in tall yaoung patient who is smoker and have blebs in the apex ....

[Novobiocin]

Individuals with A1AD may develop emphysema during their thirties or forties even without a history of significant smoking, though smoking greatly increases the risk for emphysema.

Severe A1AT deficiency causes panacinar emphysema or COPD in adult life in many people with the condition (especially if they are exposed to cigarette smoke), as well as various liver diseases in a minority of children and adults, and occasionally more unusual problems.[3] It is treated by avoidance of damaging inhalants, by intravenous infusions of the A1AT protein, by transplantation of the liver or lungs, and by a variety of other measures, but it usually produces some degree of disability and reduced life expectancy.