Problem I
Mr. G is a 74-year-old male with no significant past respiratory history except for "asthma" presented to the chest clinic for preoperative clearance for a cholecystectomy. He had a 7-year history of episodic cough productive of white to yellow phlegm, which cleared with antibiotics, but was recurring at more frequent intervals. The cough had been constant for several months at the time of presentation. He also complained of progressive dyspnea on exertion over the same period such that she could now walk only about 4 blocks. He does not smoke cigarettes. He is a retired builder and sandblasts classic cars in his garage as a hobby. Physical examination was remarkable for an increased second pulmonic sound and jugular venous distension. Lungs had rare rales and rhonchi. No clubbing was noted.
A CT of the upper lungs (B) in 3/98 shows multiple round and irregularly-shaped small nodules, many of which appear to be in a centrilobular/peribronchiolar distribution. A large, irregularly-shaped mass on the right appears to be a conglomerate of small nodules.
• Discuss the differential diagnosis.
• What is the most likely diagnosis?
• Explain the pathophysiology.
Problem II
A 60-year-old man with no prior history of illness had a mild upper respiratory infection for a few days, and yesterday suddenly developed fever, rigors, and right-sided chest pain with inspiration. This morning, he was coughing up yellow sputum with rust-colored blood tinging. His temperature on admission was 102oF. Rales were audible over the lower right chest posteriorly. Chest x-ray demonstrated a right lower lobe consolidated infiltrate with air bronchograms. CBC revealed a white cell count of 18,000, with 70 polys, 10 bands, and 20 lymphocytes. The remainder of the CBC was normal.
• Discuss the differential diagnosis.
• What is the most likely diagnosis?
• Explain the pathophysiology.
• What are the common pathogens causing pneumonia in patients of different ages and comorbidities? (i.e. infants, elderly, young adults, smokers, HIV+...)
The response should include a reference list. Using one-inch margins, Times New Roman 12 pnt font, double-space and APA style of writing and citations.