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A five-year-old with severe asthma is being treated in the ER with an IV aminophylline drip. The child is slowly becoming sleepy and less responsive. Physical exam reveals less wheezing than on admission. Representative lung histology is shown.
- Cystic fibrosis
A 3-year-old boy with a history of recurrent pneumonia and chronic diarrhea. His mother states that he has 6-8 foul smelling stools per day. PE reveals a low-grade fever, scattered rhonchi over both lung fields, crepitant rales at the left lung base and dullness to percussion.
- Acute bronchitis
- Alpha 1 antitrypsin deficiency
A 46-year-old male presents to the emergency department complaining of progressively worsening shortness of breath. On chest X-ray his lungs appear hyperinflated. On physical exam, he demonstrates rhonchi and wheezes, and the physician notes hepatomegaly. Laboratory findings are concerning for elevated liver enzymes. The FEV1/FVC ratio is decreased.
A previously healthy 30-year-old African American woman has fatigue, arthralgia, and a nodular rash over the trunk and upper extremities for three weeks. There are twelve 3-8 mm, pale, indurated plaques over the chest, back, and upper extremities. The liver is palpable 2 cm below the right costal margin with a percussion span of 14 cm, and the spleen tip is palpable 3 cm below the left costal margin. There is no pain or limitation of any of the joints. A chest radiograph shows bilateral lymphadenopathy.
– chronic bronchitis
- Idiopathic Pulmonary Fibrosis
A 64-year-old doctor from China presents to a hospital in Hong Kong with a week history of fever, headache, dry cough, and worsening shortness of breath. He is in Hong Kong on business. Patient is a family practitioner and there is a history of contact with an unprecedented number of patients presumably suffering from influenza. Temperature is 102°F (39°C). Patient is admitted to the ICU with contact isolation. He expires shortly thereafter. PCR assay of the post-mortem lung is positive for SARS-CoV. The local health authorities are notified.
- Pulmonary embolism
- Pulmonary hypertension
A 27-year-old male presents to the urgent care clinic with a two-week history of fever, a macular rash, and generalized lymphadenopathy. He denies sore throat, genital ulcers, and urethral discharge. Sexual history reveals the patient habitually has unprotected sex with both male and female partners, the last encounter a month prior to onset of illness. He was treated for gonorrhea about four months ago. An ELISA screening test came back positive and this was confirmed by Western blot.
- Goodpasture syndrome (nephritic syndrome)
A 14-year-old boy presents with hematuria, problems with vision, and deafness. Approximately 2 weeks prior to symptom development, he recovered from a viral upper respiratory tract infection. Family history is significant for deafness and early initiation of lisinopril in his father. His temperature is 99°F (37.2°C), blood pressure is 140/90 mmHg, pulse is 75/min, and respirations are 18/min. Physical examination is signifcant for anterior lenticonus and sensorineural hearing loss. Urinalysis demonstrates dysmorphic red blood cells and red blood cell casts. (Alport syndrome)
A 3-year-old boy is brought to the ER by his mother who is concerned about a “barking cough,” mild fever, and hoarse voice. Last week, he had a runny nose last week that has since resolved. Physical exam reveals an inspiratory stridor. An anteroposterior radiograph of the neck is shown.
A 2-month-old male infant presents with a 5 day history of cough, post-tussive emesis, and episodic spells of apnea. Mom reports that her 16-year-old cousin, who babysits, has been coughing for 2 weeks. There is no history of immunization. Temperature is 100.4°F (38°C), pulse is 160/min and respirations are 68/min. Physical exam reveals a dehydrated infant, who is coughing and in respiratory distress. Fine crackles are heard bilaterally on auscultation. Patient was admitted to ICU and a complete bood count showed a WBC of 15,000 mm3 with 40% lymphocytes. Chest radiography shows peribronchial cuffing. Nasopharyngeal swab was sent for culture.