ea sea man come tothe phyitan Bocas of cl cancenrting a wor and generalized age forthe past 5 mors Orig ths pelo he has ote fallen asleep whe aching his fear TV show His wife reports at he Sores ou an smetines stops betting fr ae seconds while esiep He has hypertarson vealed WM mecpIOOL ets smoked ane pck of igus day for 20 yeas He 168 rm (SS i tal ana weighs 67 by (19218 359m Hs temperatures 37. 8.87 pulses BE mn espratons are 14mm, and blood pressures 135/85 mig Pyscl examination shows no abaomaten, Sarum sues show Po Amey Ghee 897mg 3b Grete Omg aL mostly ning nts pater? fH pCOs tm Hg) p05 rm Hg) CU) COS Og)wos s a comes at ptm becaue difcdyconcwrtrting at wrk and generalized atin Fr pat 5 mors. Orig ths peo he as ote fan asleep whe aching is fear TV show is wife reports at he sd sometimes SO Bea ETN SEEDS whe steep He as hyperercion vested win merproo 7 Hehas smoted ane pack of cigartes day fr 20 yeh is IEG cm (Se all ane weighs 6719215), BMI Hs tempertires 37.1" (9887), pulses Br, respratins ae 14m and lod resus 135/85 mig Pyscal examination shows no sbaomaten, Sarum sues show Po Amey Grete Omg aL ‘mos ely ning pater? fH pCOs tm Hg) p05 rm Hg) CU) COS Og) ao a 29 =@- igh pt and decanted pCO, wth normal Herd, and HCO, are consent wth reper aloes, which scar Secondary hyperentaion ding a banc atc) Bu ot wth OS eaeours a ‘ordre ow pl ceate C0, elevated serum bicarbonate concentation, and decreased Serum chloride onceaton ae onsite th eompenstedrespaery cider Resprstory steseesops in patra vith Osa dng sleep de 0 UPrer sirnay obstucton that causes alveolar mppovertlston and subsequent retenon of COs, Prolonged pends of respratory ‘css ae evenly compensated by tel etenin of carbonate and decreased cle reabsorption, Whi asle, Pens with Osa donot have pera abtrctn, 2 areal pO, ype tures to nal ee ‘Low pt levted pCO and seduced pO; aed normal HCOs ae constant wth cue respiratory audons wthowt mtabole ompenation (een of beatbonate) Th ra fining in pater th acuta rap fare ypovardlton duc 12 Grg-indued CRs depression or preumona apse th COPD. Athaugh this pater Ia smoker he does rt present ‘uh sigs symptoms of COPD or alana nection ea, fer and productive cough adaon, Ne des Hot havea ‘story of opoe’ or bezadarepne use ‘Low pt, aereased pCO, decease sarum bicatonate concerto, and ceased serum Conic concenaton we ensistnt th arma anion gap metal edoss wah appropriate expan cmpensation fated on Wins formula ‘hss efrana patents wth eral tubular acest (RAY or noni ney ase (CKO) TS Pate has ro Sigs OF RTA (oF CKD ana tbortoryanayss show ro abnormalities, mag M5 ah unely 6G costeaion Os patent. ‘A nocmal ps created 260 decreased serum beatboate concent, apd normal seu chords eel af omeatet ‘thigh anon gap metabolic actaeAceording tthe Winter formula he expected value for peo, gen = re ‘barbnate concerto o 18 meg 1535 = 2 mm g, wich Is much higher than he mesure abe of 26 een ‘nakeates the acarional presence of espa alos TMS combration (metabo acs and esp ator aka) 5 ‘spiel ning n patents ith aselte toxic sep shock but nt OS.lain outdoor wih his grandson He as 2 story fasta but des rot ke ary mest for On aha he Sle and orem He ouc of teat ad nak ih ni eemences ts pulse e120) mf, rexpraione ae 23m ‘uti ute Pulmonary exam stows poo ar mveman ster bat ne wheeang carac examination shows no “normale, Onygen is distor a on-ebreater atk, Hes hen te butt nebulzerteatmants ha (pratopiim, and ravenous matnptednaclone The pent i confused and dzanented Anteril Blood gus ans Pos sami hich oF he followings she most appropriate nex sen managenen? (© extract tate be (©) rwarerous neophytine Deapy (© commons atorerlrebuier therapy (© rwamuscuerepinepvine therapy (© Aowwie rorenscopywos s Peing oudoors with hs aendson. He asa Wstory of anna but does noche any mesctons fork Qn aval es ‘et and oem Hes out of enh and "Hs pulse 120m, esas ae 22min ‘RSE. Puimonary exam stows Caria evarsnatin snows 99 lbnormalies, Onygen is distor vanon-ebreater math, He shen te butt neulzerteatmants ha ‘prtropum, end intravenous metmiprednisclon. The patents confuse and Sorte, tel blond su nays Which of te following ite most appropriate ex steph management? J exacerbavn: ms case, the eisode may have bean ageed by execs andr exposure to emoneatlargens (e. poe “a deal bon of accessory sds tndeang worsening estoy Fatigue) ad sing Pos 42mm Ha) ate cnceming for impending ‘espracrytatute an, thee, ncn fr endetiachel nubaton ates wi aut sta exacefbatonQererally reentry sou, Pes ncrees and pt ceseaser. The aoeee of messing Ao acu enaoing the seventy of He enon wheezing ot heard becuse here's not ough af movement co generate He should be wtubatedgenty (8) neovenove oon einyoua ‘haope phoxghosiertaratehbior wih ant ammatry and Honchadlatoryefce ated nthe chron estrnt of coPD and astra It canbe used 2 an adjunctive therapy nace asthe exacerbations, although thas ot been show Deetectieanais no longer corsidred santa trap) Addon Ms alow therapeu nde ah sk aavetse cri cb eke Kala eit pater ae not responded 0 hes rounds of tbutrel ange zaetation are of acserry mer, and igh normal Fee "Mesians of respator fauqe and impeding espatory fe, Addona albuterol unl eben hs att “nsavenous magnesia sua can be use as an ajuncne ery in ache asia exacerbates that donot spond to ‘mule round of nhled bonetodstors uch a utr, acheter ap aupperemal cnygen However th patents eventation ate of acestry mrss and high normal Po, ae sighs cones that warts 2 are lugar neeion hh soviet be delayed by adinsraton of mapnesiom sare nramuscalreneptnne therapy saproprat fr patents woh araphlns which an als cause dyspnea du to ver 2irnay edema and bronchospasn However, enaphyans is SuaySocte wih ther 6st Symptoms such 38 uci pe ee fr eee es ect re ie ie ole eee eee Injections ae not need ‘nls hel-onygen msture he can mprove te dle of supplemental ongen nthe seg of away cbsoucton omer, ths patents disonetation ase of acessory muse, and igh otal Pe Meg OF Impenr Fespatryomnes al 2a > ‘Conroe nae albuterol ebuize therapy iste went for mera ro severe asta exacerbations. TS pen has not sponded 9 hree rounds f sure ang is isaventaton pe of acestry muses and gh nama Fes Ietign of eepator fatigue and impending repay fare, actions bute rune to bana hs pate ‘nravenous magnesium sae can be vee a5 an alunce tery in acute asta exacerbates tht donot espns 0 muti rours of ales bencroaatos Guch as buted, aichonergs, ters, a supperenal enygen However, this patents isrentation veo acestrymsces, and high normal Pog ae sighs ofa condton tht warts more Urgent nterenton, he soul ot beled by admin of magne aut Se ee sirnay edema and bronchospasm. However, anaphans usualy ss00sts wh other 5staMe SYMOTOMS uch 35 UREA, ‘rypotesian, nausea, vomiting, and/or angosdena, This patent pases witha ai antha exacerbation, and epinephrine Injections ae not neat ‘ale alar-onygen minture ion can mprove the dlnery of upplmerta oxygen inthe seing of away aberacton ‘omsver the patents aeorentanon, see accessor nue ana nan nora Fens ar sane opening repro Fare ar wera 2 ore wrgetinererton. ‘ronchscopy has many clagnostc and therapeutic dications, ncing suspicion of arnay obstucton a om asoion, Tocazed edema, mace, ec le away obstructon coulda cute sate dyepne, sor woud be expected, The patents Sees ele etal ee eee ree> © ea | procul heathy 25-year-old woman come ote ersten department Beaute of muon eset fiilty ‘reathing ta began when she woke up that moming She aso reports 2 dy cough and chest pain hats woe with Irspatlon She does 1tsake, ek alcool, o use Hx rugs. He ol meaaon sa fal contacetve, Her temperstareis 281 (100-), ple 80min, respirations ae 22min nl bod peau 120/70 mm Hg. Oxygen "sturaton 193% on oom a ll examinston euiemakable An shows non-rpei st segment changes AR ‘tay ofthe chest shows ne abrmaiies.In addon Co oxygen Suppemerain, wih othe following isthe most @ measure gadient be ©) Anse pete (D) over Cr pulmonary anaraphy 22 Measute toon degrada products #) Ferorm pulmonary anioaraohy cease “distr aeplaeouns al oO p | procul heathy 25-year-old woman comes ote ects departmant beaut of Es orcas that began when she woke up that mening, She als reports ay ough and chest pan hats ‘She doesnot emake, dink col or se Mice Gage ren ean a Her _ temperstare's 28 (1007), ple 8D min respirations ae 23min an bod preaure 120/70 rm Hg Oxygen a satraton Psi exeminavons uearhable An EC shows ron-speii sT seamen changes. At = ‘scray ofthe ces stows no abnormalities In aon ongen Supplementation, which ofthe folowing isthe mst je “This pater resents wth acute dspnes peaches pain, dy cough, an hyposene These findings shoul ase ‘Sis pulmonary embolism (PO, espedaly hen her rl contacaave use “a “The A rae, obtained fom an ABC canbe used hep her the uadrng pathophysiology of hypoxemia Shun V@mismaten, we the a0 is ype ow i paleats wth PE AS Is mee a Ses nor sede esas Fo comdered wef for te dngst of url tobe bell tpt who ata mera probaly of F- En c= ba a prs ste ea lg IMD ny ds ma epee ted huucv ng dea ogy aus COPD oath cescraton orplmanar aan. Te pat cot esr (sess and her presentation sro consistent with cena Fo whieh BAP would be nde, buproten, an NSAID, can be used for we eatment of peicaras, which an aso present wih leet ces pal achypnes low grade fever, ap cough Hower ths patent ssa hes ypaxera hich at cnsnen tha diagrons of pearCT pulmonary enalatepy the bet efit lgnostc test for pulmonary embplsm, This conast-ehanced mega ‘ud btn senstve and specie haghosng ilu ling detec inthe plmnary artis bats eroded ‘oth cenain aks eg conas-nduced nepiropatn) CIPS woul the next tap im management oa eradynamealy ‘able paten ths high pron iy ot al ear fore}. Hower, hi pants Walle score ot 2 ly pute er 3 moderate isk, ‘Massurement of 0-drer i recommended for pans wt nto concerning fr puknandyetosm Buc he ae ‘thers Healy ith ny a moderate probity of Feels score or PE of 3) Dve asin degradaon product FF) that formes dung fori nds useful fer rung ox venus thrombeem@ctm I aint wth ow 0 moderate probabil score 2 sv Sense but noc pei 50K should ere be used to conf he cages nhs re Wee er pi oe func trg esi ed vldWeVuges oPE ‘hls sna O-diow mould ans to Pulmonary ansography en lenge rutnly wet hagose Fen is nly recommended fa patent ha a high probaly TEE ORC Fens a 1 5a sll Cx mag esnips aah ee ccclahe aa ex tke eor aCayCota ceoua By Pumonary embots -monaryanglography in longer routinely wed to agose FE as nl recommended a patent ha a igh probaly Of eet score for Pe> 4) and/CTantaraphy is unavalle, Ts bent ony asa moderate sk of Pe Wes sor of 3 hich means ts eas not rcommended \etlatio and peruionsomtgray(V/@ scar canbe uEed to augrote patients wih a igh ees probablty of Pes ora for) but thohave contandeaton fo CT anglogrphy ptfunon alae na rarmalyvelsed pulmonary ‘yea ismaten is suagesve oF. Ths dent ony has a moderate OBEN fF, which Means That a V/O Scans ‘eplse, 2 thrombotic agent indated forthe emergent veatment of massive fe-deatning PE wih dence of at eat fate oF aes emodyeanc tality. lrough ths pute’ prsenation i concring or Pe, Sheen diate for thrombi gen be tale wal ga and the Ick of a ete gentaed tera) nthe aes ofthe et bepehrmeneceren Seer eerouns al nie for 3 das We sustained waumato the nah hemitherax cing bat fhe 3 wees ago. He hed significant pin andl Sora of breath followag the caer but id na eek medic care, He does na eke Odin acho He - ‘ontrection woke, His temperatures 28-9 (1011 pubes 95min, espratons ae 18min and ood pressures al 120/75 mm Pls oximetry on rom a shows an ongen seuration of SEN Pulmonary examination shows ceased : est sounds onthe ight lava ang elds. Cr scan of he chs shows atures eight an 8 ibs ight 2a @® wratpreansy ung abscess B)| chettora @ CLL (©) NesoteomsOuns al o Soe ‘or 3 days. We sustained during a bar fight 3 weeks ago. He had significant pain and mild ae Anas eee ern eae ee NT _ SS ee ee ee a eae eS 4 a eee (ee a emcees nc am are nee = ‘eared cei oes ee hid eieton ith alae Yvan otc ee ey — es them aeetimratacaaisisesesnaens ~ al leur can cause 2 wancuatve plewaleftusion tut ian unkeyGagnoss given at eee oreo of pluie w shes pain. Tare alsa no story of recent appar respiratory symptoms eter than cough) or eer pie to presentation See stnnaes rst, eT nny tutu othe sep epravsaon ao oss et aor ‘While deceased breath sounds and presence of fever make a ung absces possible, the clletion of Rudi the pleura Space suggests a leat! process ater that at nvaparencumal pabln In adn, te Slt eral ig st assoaated and symptoms (ei, shorness of breath) woul likely appear sooner then 3 weeks afte the injury adi, a fevers not ‘ssodaed witha hamethorx ti aly ath pater ial rad aemenorax and devoped complication causing hisOW Dera ‘A emothorak is pomitle follwing Bur tau othe chet, bu sstcsed gh eg lateral decened ret suns) tna sypeome eg, shorter of Brest wey spear ona nan 2 wesue sero ry. asen afar enok ‘ssoceted wth a hemethoran 5 ihely ha ths pater ny hada hemeshorax and developed complication causing his Civent resentation because the Blood ia We leva space was Wot and ‘A cvlemoraxs possible otowng bint auma to the chest, but assoc sins iaeal deceased een Sounds) and symptoms shares f beth ough wld tly appear cone than 3 weet afer the ny. In eton, fevers ule to ker with = chyathorae CT imaging of schotorx ll show denee Mas deny clacton he pla! pace, Suit i ot ssoceted wth the Spt pews san The prsence ofa dese Ma cabecuen ite pleut space, spit pleura ign anc eer suggests te gross o = pewal tempyema present leclaons on CT ae ang soc wth a agnosis of pleural empyema, Empyeras mot often rest roms progetson stan uneamplstes ster) paraprsumanietsion tit secret complete nets) aa fore Feank es, but can so acu eliotn a raumatic hemor, sti pater. Test for empyemas ime chest ube Placerent oar he empyema and sytem arabic westmert. The may Be Toroued by hraccopk etrigemene ‘Reual mesothelioma the most common ype of mesotheloma, aa efter resus n a magna pleural esr whieh could present wth acesred reth sound ad covtophveni bling. Tes pet wotk In conection, maiéng expeture 0 bests possible, buts conden usualy occas much aterm fT pater’ fever, Spt pews san, end Moy af {rauma make anoterdlagnsis mor key,Ounss ‘eth ody spuar forthe pas 3 hours. Te pain state fer moving fre at hove and worsens when taking ep eats Me puter has astoy of ypertnsion. he has smoked one ace of gaetes daly oe pase 20 ears She (Ss 2 go spy Conc rece cn: ele er ner orcs Her trp S52(10n87, pee Toman respravon ate 20 min ae lee peste r110\70 mm He. Cnynen straton 2 2% on oom a Physical examination shows daceasea bath sounds over th laf ang bas. Tare calpain on sa Peters mot ks to show whieh fhe allowing ndings? 2a OG wedge-shaped tng defect on chest CT Die ffy eter lung nates on CAR @ be Decreased expratey Tow on peak Tow meter @|¢wos s forthe pas 3 hours. Te pain state fer moving frre at home and he pater ha Soy of ypetesion. se has smoked ot pack of Cues daly fo he past 20 yeas SMe (Seni 1-2 gles of wine pr dy. Coren mca lt coalap ond on MERE Her cpater Physical examination shows decreased breath sounds over the left lng base Theres Peters mot ksh f show whieh of he allowing ndings? “spate presents wir tchyaria, low-grade fever, chest pal, and dyspnea The postve Homan Sgn ca gln wah orien ofthe foot) suggests posible OV fru she hasan mernsed rik of evelping Besse of er atry of smoking and oral contacepve se. 2a 6 (B) Thrombin heeft tam on =e ‘Thvombus formation ne atu mest common occurs a patents wi ava yin A), hich causes anaeal Ingest her resentation sot consistent wh ths dagnoss. Abs usualy asymprorat, Buc can presen wth ‘aires, aigu, and ighteadsdness, Perc chest pan and hemaptsae ot conor Fetes os agro eG) wage stapes ing eet on est CT “he patent presents wth symtoms of puimonsry embosm ano ha Wel soe for FE of 5 She also heya ot Pulmonary efron, which occre when thar is bots of smal segintlaneres, Pulmonary nactoncescaly ‘the she of the arterial oclslon, with a languar area of non-pecusion where the downstream vascular suppWy i cit ofNY_METHODIST HOSPITAL ‘causes abnor Josien, ohooua al Widespread ST lvaton en FR-Segment depression on ECG Suggest acute pcr, WNC presets wh ple chest pan However, patents with pacar wil aten Nees prodrome af fete, Maas, and myst. an the pas yea ‘tnved By ating or ening foward Aon rubs commcn on aac sven ant pecan wee pot use hemopyss nor explants patent af pan. ‘he presence fase, Fu heel, bistera lang infinates on chest x-ray suageste of pulmonary edema In & Devo bath adi thot Known cardiac saat or oter har fale symptoms eg, peiheal adena ND, tthopne| this dng would be concering for ADS. Ths cotton could exp ths patent cough and yop, ba [kos ao caus sever resto der, ncuaing even more marked types 2 hypoiahan pore ete 2 often an aered mental tts Las, ARDS would case fuse acl on selon Preumotorx can presen wo sudden-onset pei chest pa at spre, Tachel deviation on esa aay om ‘hese ofthe lesion sa more concerning festure and suppets tension pearothoay life-threatening endian that ‘ure immect tavern fo prevent hemaaynamic alapre, We satng atk far fr sponaneaut Pneumothora, hemopts would ot be expected ek exratory flow ates decreased obstructive lng ese, and peak flow meter measurement soften used as 2 agnostic ad prognosic wo patents peseting with cue astheva exacerbations oth sta ar CORD can case Sop and ough aswel at nese tek of espatoy infec However the sudden cnet of smpoms thou preceding eps or crone spre malas tet lagoses las kay and ths pat pluie het pa aed Femopvats woud oc be consent with ene asa or COPD. Crete inee-MO (CK-ME sos ten vee oagnose acute mace narcton. alhewgh an Acie MI may age cute Cee et pe el pp er rei ace ee anda ed ect eaeoupea Gas + isi Cau temogys nor elon t patents aon. " ‘he pesence of fe, ff (ola, laters lang inftratr on chest ray i uggestie of pulmonary ase In revousy heathy aut tout Known cardiac esease rote Per fare sympoms ea penoheral edema NO, bntbaprel ts tndig woul be concern or AS. This Conlon could expla his pet's cough and spre, Dut RDS ao causes severe vestatory dates, ning even More marked chypnes an hyponiahenepote ete Ae ‘ten an stares wert stu aly, AS0s wala enue re rca om aurelatan Preumechorx can presen wih sudden-onset pleut chs ain a spre. Tachel deviation on chest xray away om ‘hese ote leso sa more concerning estue an suggests ein aneumatharay life-threatening cndion tat neumotora, Remopsi would Not be expected Fes exratory fw ates derased in obttutelngdecae, nd peak fou meter messes often weed a2 Atagnosec and oregnostc too patents presenting Wh cue astra exacerstns oth staan COPD can cause {yspnes and cough aswel at nese tek of espratoy ecto Homer, te sudge onset ymptars without preceding eps or cron symptoms makes tes agnoses es ke and ths pate pluie chest pi aed hesopeyete ous nota easton uth eaner seins oF COPD Creatine nse CK-MB) Is most often used co dagnose acute moc nfarcton hough an acute MI may aso cause Susser onsat cast pan and spre, substaral tessur ply escbed ari woud ot change I mens wih Inepaton- atin, ete Ml wuld nat aun hemoptyas and fete woul be unas [Feo and coadianae | roar tage Noten | ayBs al year-old man com ta the phyoonbeeaeof4-momth Hstny of essen cough produce of te shogm. He coughs consist thoughout he dey and he has noc rotced any parcel wagers that make worse. He has 350 ‘sce experienced some snrmess Oba fh xeon, Me has mothe any wah s,s, or ei. He had ‘worked in construction for he past 10 years. He has smoked a pack of emaretes per day fr 30 years. Val sans are “atin normal nts, Exaiaion shows an nd-expatry wheeze thrughNt al lung Zones. Wich fhe lowing it he most aly apres? za B) seven Hypersensiity preumanis (© aston (©) chrowc trot (© Adenocarcinoma (F) Ayo pneumenis keouns al Astral nan cnet pin ec aR (LS fee ere eee ae eee ee ene ies es bina ope pracie e n mopem pact rein he areterintee \orkee constuction forte pss 10 years. He nas smokes iaGh of emarees per oy for SOARS Vil ans ae “retin normal nts, Exaian shoms n voughou al hing ones hich ofthe folowing is he most aly egress a “a 6 | _Asbestosis can also present with nonspecific symptoms such s chron cough and exertional dyspnea, Having worked in ‘consvuction, iis posible rat this pauent has had cupatonal exposure 0 asbestos, ana his smoking history would further ‘exposure before any sins of asease mantest. Furthermore, asbestosis okay presents with end-nspatory les rather Hs mediated by a combined ye and eT hpesenstty rescton oan aed enone allergen rpc ean pares te course of eccupauona exposure aes un) rough te subscale orm cah als present wth Produce cough ana cope, ths patents symptoms are costa an donot have an ef iger, main nis ae Untkly agnosis smears are acwaly a reduced rk of developing this tpe of pumonts because thy have adresse Immune response oem led ania ‘asta can also present wat CoM Cough olen dy, sane, ad end-xprtoywheezieg on exarneaton, Howe a ne ee ae ern ce ee ene ee eee eee res‘asthma can abo preset wit chon coug ten ly), sen 2d end-expratery wheezing on amination. However, ‘spel afc younger patents lommony chet and vehapee) nar an ntfale Wigge, adie much more uae lonse and eps than hs patents stor supgest Ts pebens roduc cough ad Sinan smoKg SOT make ‘roe option mere nel. ‘onic bronchi 2 subtype of COPD, she mest ihe ignoss in a patient with ahistry of oredutive cough for {Sons each yea rte past 2 years. The vast majority of easks af COPD ca be atWibute o song, opal wer © 20-20 peck yous have an 80-80% tie isk of deelping COPD, Occupsions expesre to crgnicnonorgme dust can also sipicarty merease isk, Oysnea wl conte to worsen unt is leas preset. smokes shoud therefore Be unsaid about cessation to rdce the rat of expiratory dc, ‘Non-snl cl ang cance, 2.9 peripheral ung adenocarcinoma ste most common cause of ung cance overall. would 2s present win a cough ad apes Honever, elec of hemopiys, fv, Weg les, ad weaess "PS paLe make ‘roter option mre aly, even though Neer 20 pck-yerrmling Maton. nda, we veal ng ane mre evalertm men (= 31, denocaranome is much more common women (=) ‘ypc poeumon, which mor common in ety popultins can ao have an ndlent presentation eth hori cough {and cso, Homer, te cough spray nonproductive, ad is usually accompanied By prominent extrapulmonary Features Such os aow-grade ee, atu Pesdaces, ad als.Chronic roneits,x subtype of CORD, ee moet ly goss na patent wha ety of pret cough fr mont ach yea forte as 2 years, The vst mart of cases of COPD canbe ateibte o smoking ar patents wh 2 20-30 pack yeas Nae a sso te rs of deloping COPD, ccupations expesre organic nono’gamc dust can ‘ise signtcanty rene sk: Oypnen wl contin to worsen ntl lees present. Smokers shoud terefre be reese ia meme rates eles ey lang ancer, =. perpheral lang adenocacnoms, she mas conmen cae of ing cancer overall would Also present wth a cough ad spree. Homer, the ack of hemp Fev, mes le, and weakest ts Palen make otter option mre kay, even though Mes 420 pak-yutsmoling istry. ndatonaly, whe veal ng cancers more Prevalent n men (~ 3 lvadenocarsname a much more caro in women (= 6) ‘Apical pneumonia, hich mote commen n cry popuators, can alse rave an indolent presentation wi crore cough tnd cyapnea. Honever, the cough a typcly honprocurine, a esully exomparied by prominent extrepulnonary feosre sucha lon race oer, atoun, besgaches sna mya ‘onchectsis ca alo present ith acon productive cough spa, and wheezing on ascukatin. This patent's ftoling sory and occupational expsute do pur im st kof dewoping bronchi betvcion, However, the stun {hs consiton Hypa mucopulent. no whe, a res fan undying loa infectionBs al Sinoed hal pack of ues day for 10 yeas but toed 8 year’s ago Ms pulse 72min blood presses = 135/75 mig an respirations ae 20a Examination shows ahead antropateor lame a Oe ret. 4 flastanes latragm, ana blaterahyperuceny of he luna bases Ths patents condition pus ima aratest risk for Vic ofthe follwing condtons? 5) Are eplamesody-pontve varus ‘ole DI Brome obkerane { 98 nephropathy 4 |Ge ouns al 4 an cme th pcan ect of 2-yr try “ By ‘rote ta a puck of cues da 10 es bt spped 8 e's ab Hs puse 672, Dows peste = {fs(7s mig angexpratons we 20/rn Carian saves aceacdaopttetor mee oe Ae |aflarenes claohragm, ar ltl yBePUCEnEY OF NE IUNRIEAGES. This pavers condton puts him at greatest sk for ‘ec of elon conn “hp pretant wth worsening dyspnea and ign f emphyam ural chee, minha breath ound, lang hoetnflaton on cra). The chest say specially shows parloulr emphysema iste astor perce) 5 OY posed to cntoblar empysa wich pedernnardy acs te uppe oes. Cer his young ae (<5 yas) and ‘he dati maging nding. heme! ety ages alpha anteypsin define AD) 2a ‘ANCA-sesocatea vasculueithaniboces rected aginst iter myeloperondise (MFO-ANCA) or protnae-2 @R2-ANCAL ‘spell ives ral vessel cause phat anrypain AT ib PRS acy, eaten hypotheses suggest he! the Ince AAT nites wth AAD det excesve Pores sue derraction 8 inti mare ike eines ‘oinmune response, However, tees cient wo evidence to suppor an ncessed sk of developing ANCA-posiie ‘Aout 40% of pants lth AAT ceicency develop icant wer damage ard cass which ate common precusces © TEs alttough promession HCE can ala ocr sens of ches thee pan In one ote enkaned rotece sb lating te exerts braakoun of slacin ht caver exy-onat eprom, ar dear thongt 6 ‘cer due wo eowie cclaton of the mistled AT potin neat sve, which sgn increases he rk fi famape, cmos ena HC.oua ‘onc obiterans which occurs as result of repented cys of ifarimation and scaring inthe smal iene ‘ypcall det nalation of toe famesgrateersuechot seas in ung ansplan paar or cron ing neon, once alpha! anirypundefeeny not ances with an intend rat of orclisbteran Pavens wih 0 can hve associated respratory compar, Ining parenchymal 8sease ana aay fanmaton, ily Pumonary manifestation otk, would presen mith 2 prize cough anc ony nontpectie branchial wal hickenng on Imaging rete of which occur inthis patie Furthermore, AAD des not nciase the sk of developing. Iga nepieopay sa raze complication In pants th AAD When I See, usualy cus longs ver IS, heh 'Simest ikl to por cesace of gé-contaningcmplees by Kuper cel n tect iver, ating to Deresed epositon of gam he hore ‘Pulmonary frosts GF) ean mtr king dete hat rest commonly Wopthcm gn espana hazards sieoss,chemotherapeute agents (ea leomyein, smoking, and ifectous diseases ed tuberculosis) inary Increase {hensk of progressing irevesne ross Hower, 015 nt asected wi an ceased Sk oF Taghar kof lng cancer, harem igh-qualhy eter of such an sroEa |A.33-yar-olf woman comes tothe pyactan bacaue of 4-day sory of chat pn ae cough with us-clored Satur The chest pln hap, tabbing, ad exacerbated by coughing Ten days go, she hada Sore tot and 2 anny ose. She was diagnosed wth mulipe scsi ath age of 40 yeas at uses a hela for oD) She Mas moked “tntslene, her termpertire fe 37.2 (100.2) Bona prseure e110 50 rma as clei 15 myn few seater Inspietoryeacls are hear in the ight loner lng. Cadac examination shows to abiormaltes, New alogic {he charte shown Which ofthe flloangie the mot Wkly aut herent symtoms 2a :) Pesearas Becta! prevmenia (© tronehogen carom be> ‘asad wnat pcan aca of yy SNR x en day go, steed asore Most andetunny ‘Ire ees pan sar, stabbing, and exacerbated by coughing Te or melt, Sha has Sroked ose. She was agnosed with mulupe scsi ath age of 40 yas an {puck of ogerettes dll forthe pur 40 years, She does ot dink sles, Curent eaten nce oeezura end Ganolee, Her temperatures 37.9% (100.27), Bleed pressures 110/60 rm Wa, and cls 105mm few scarred Inspitetoryeacls are heard in the ight loner lng. Crdlac examination shows to abnormales, Newbie [Beha shown whch of the flloungie he mor kely ute her crert symatona| “Ths patien resent with chest pn Remon and & Hamoton hump on her chest >a Another commen fing a batts th ti condtan hypo. 2a ecards may resent wth sap pleut ees pan an often precsed by symptoms of URL. Chest x-ay may be ‘oral r show an erargaecardae shout rom pra sion, The wedge shape on tis pats chest Pulmonary steatosis often asymptomatic bu may pate wth cough, ches pan and yatemie symptom ef, rate hich are seen tn tis patent, The casi chest» nding Sarid itera mohadenopthy it Fecal opacties my ao be San. However, ths pales chest 1a es hot hve Show ence of Mat lymphadenopathy, mating ths egnsis vty unsey ram eee tot) ee ame ee eee Pee eee Peter eerste na Perea nn om er para eenerary aa eed carer Seedey ram eee tot) ee aes ee eee Pee eee Peter eerste na peer omnes er para eenerary eed carer SeedOma s al ‘Preumnia should aves be considered a patent prsering th w-rade Fever ané cough wh a preceding uBper ‘espiratry fein, Homeve, the opacy Seen ons pains chest ay nt consent wh his laghoss ‘Ths pavens acute peutic chest pate, hemoptysis, ow-gfade fever, an X-tynaings (Hampton Hump) ate cncening fot fvlanghsten chest snr eye ony abaies tla at akematne colonic (2.3, ancumons pulmonary sce, 51a eter pareculy sere o Speci for FE. The Marpn hump is very ar fading but when present Suppers me aiagnoss oe ‘Acie pleure chest pam ard cough n a chronic smoker cou be asgn of peumethrax Hower, Seomaneous neumotora is aren patents > 40 yas tout ueryng ung sas eg, COPD, emphysema) Lng exarination ‘Mrced area The cagrontei tablished akon anaes of ceny between te ung spe potas aed om chat 313, nds featur rot present on this patents ry Sa ee nai an Si aa a's pA AAA a A ea Nr‘Center for Diagnostic and Interventional Radiology, SJKP eet Creu) Soe eens penny aera Eremeereneerny cai Sse‘Center for Diagnostic and Interventional Radiology, SJKP- eet Creu) Soe eens penny aera Eremeereneerny cai SseOnDs a <> te aiagnoss oF FE 9 3} ulmonary emote ‘neumothorx is aren pavers > 0 years without undying lung dsese (ea, COPD, emghysema. Lung examination Ih Paes with preumetorax dail eves decreases of abser breath sounds and hypetesonance io peusion Oe ‘ced area The agro etalsed ahen anaes of ceey Bete he ang ana peas ened on chet 3, andes featur snot resent on ts panents xy. Caiogenic pulmonary edema shoul always be consider patent th het pan and cough, even if heres ne known asoy of catiovescular disease. lod-Unged sputum and aces may be present on examination, ahough acs ate ‘ype bstrl Ts paints chet 12 does not show ay ofthe characte ndings pulmonary essa eae, fury intraes Kee 6 ines, andlor prominent pulmonary vasculature, male ts ages unk. ‘he poten har an eansie sling hry an presents with cough, hamopiye and chest pain, we should ae Suspicion of borchogeic catia Hower the ace natu of het symotons makes ths daghosis whey Wile 2 bronchogenic lesion ny not amas be ete on chest ray brencogeme carcinoma ne local zed wedge-shaped infrte scm om ths tts cays cnet wh oreCg Podeon oie PodOunss ‘As-yar-old pate coms tthe phyiconbecante of 3 €-month str fpersstet dry cough and shrines of ‘eat wth il exertion, He regors ecg 00 weak to ve he house on most des He has a ator of pertesion ara conic atl bilaton He as smoked a pack of cates aly for 45 yeas is mediaons aclu watt, ralapd and araodaone is erperatie i 36.1'C (87, ple 85min an regulary regula, aa blod pressure Ir 145/62 mm bo. Pysel exarvnanon shows enaypernent oe Angerps wth erates cong othe ra nepatony ‘aches ate heal over bth lng bases. promt shows deceased tal capaci CT Scan of he chest shows vig mecha fe per epee? 2a ee callagendenoion he extracel max of he ana 1B) Maton neoplasm ofthe bronchus be (©) Bonen mypenesponsnenes ana obstructionmos a be 1.55.yarold pate comas tthe phyian Beaute af 6-month etry of He rears fee ing oo weak eve the house on mast das He has a Wor of ype fara cvonicatial bvlaton Meas smoked a pack of cates aly for 45 yeas is medion aclu watt, 36.1197), ple 85min ans realy replat, blod peste Sn shousenarement fe ngetns wth ees coving fhe ral nspsory over both ung bees. Spire shows et scan ofthe chest shows chan of he patents ee ‘Ts pata’ presemation CT can an spromety fading late pulmonary Nos Amleceone can cause hs 2a (A) eo te he rst ad et . Flug ea te tension ang abo sme undering mechanism of pulmonary edema, m Inet, pulmonary edema pclae an act pesettion, wth dynes tat worsens in sone potion ad se ot Increased smpatetc fone weang, aye Frtarire CT scan woul tow pera pulnonat dea, as ‘(sacs cllagen deport nthe sealer matin of he ang Excess colagen postion the erat maui of he ung du 0 abrorma prleraton of mesenchymal as the SHasstss a: iedaduldia Mad ok dc ac tachoeo” Sauer wa asec cana nls aches ademas wemace nd:‘Center for Diagnostic and Interventional Radiology, SJKP Se eae peer tt cos reeset recs eos Sos Perens erm See ee SES peronee ebet ts Sty ay Grows. hs enters oer tes Seated peerurrereant) Ss pore eater td Precio Pee rca easoP er Pee Pea Se eae peer tt cos reeset recs eos Sos Perens erm See ee SES peronee ebet ts Sty ay Grows. hs enters oer tes Seated peerurrereant) Ss pore eater td Precio Pee rca easouns al < ori > Excess colagen postion the erat maui of he ung du 0 abrorma prleraton of mesenchymal as the results pogressve boss of te lung parenchyma whi tum causes Severe pulmonary mparmert, reduces vl pact, andthe dspres, conc dy cough, at fatigue See nhs patent. Whle mest cases are opi (optic monary fires ths patents expoeure to amiodarone othe most ly cause, La BS ers ng sense (Corb), wen shouldbe sapecesn patients prevening wth chon cough, cypnea fig, a derared al epaey 20 Spivey with long histor of smoking, However, patents th CORD aso tert present with earert pulmonary ‘hacatbatons win roduc cough ee, ad espatoy isuTicen)- Atay Would ely Pow hypedoMcuon ara possby tmphysma det ls of ng parenchyma and away Wapping Malgnatneoplaim ofthe bronchus ue. bronchogenicarcinema) san important fete dagroiin patents wih 3 trent scang tavor (3 pack yea) povenng wih cone cough, depen, fates andl mal cng Hower, her ‘hana ustered a spaces and vetalaropactes on CT scan, alata! nel o mass would be expectedomnes al 9 Malgnatneoplaim ofthe bronchus ue. bronchogenicarcinema) san important fete dagroiin patents wih 3 trent scang tavor (3 pack yea) povenng wih cone cough, depen, fates andl mal cng Hower, her ‘hana ustered a spaces and vetalaropactes on CT scan, alata! nel o mass would be expected Perl searing cn ocr a8 consequence of tengnpeua diseases eq. recutentnfarimatin recent preumothoracs, atest) of malgnantleatalSasases (eg esothel Pral nees may resent wth exeronal [Shep na ough etn mt patent Mousver, ule the CT san nding mths pate, pleural thicken ie pea ‘sidervin these conions ‘onc hyperesponsveness and obsructon she underng mechanism of asthma, whch can so presen woh fg ‘dry cough However, chest asc patents wt axa rypicl] revels end-expratry whacaes and btn is ot tye Radographic imaging would show pulmonary hyperifton low, fattened éaphagr de nero spaces) Increased pressure nthe pumerary artes s sen pulmonary hpetension ch canbe pathic or dete chronic fuonar 9D, COD, con sep spnes ard crac dear ej, mia vane eee, fen 4ympOMACE: Fore avanced tages may preset with apes, fatigue and al usb ap acm tha patie Bt ala en peta celta eel ce pee tee ee ae orale ter eter‘Center for Diagnostic and Interventional Radiology, SJKP rE) Cored ey ere Peisbencereen eine error nny ere ered Spe es i ees Poestentemeneeeny eens PacersLoe a rr Pe eee ee Peat Co er reet ED Cored ey ere Peisbencereen eine error nny ere ered Spe es i ees Poestentemeneeeny eens Pacersoua al Perl searing cn ocr a8 consequence of tengnpeua diseases eq. recutentnfarimatin recent preumothoracs, atest) of malgnantleatalSasases (eg esothel Pral nees may resent wth exeronal [Shep na ough etn mt patent Mousver, ule the CT san nding mths pate, pleural thicken ie pea ‘sidervin these conions ‘onc hyperesponsveness and obsructon she underng mechanism of asthma, whch can so presen woh fg ‘dry cough However, chest asc patents wt axa rypicl] revels end-expratry whacaes and btn is ot tye Radographic imaging would show pulmonary hyperifton low, fattened éaphagr de nero spaces) Increased pressure nthe pumerary artes s sen pulmonary hpetension ch canbe pathic or dete chronic fuonar 9D, COD, con sep spnes ard crac dear ej, mia vane eee, fen 4ympOMACE: Fore avanced tages may preset with apes, fatigue and al usb ap acm tha patie Bt ala en peta celta eel ce pee tee ee ae orale ter eter Pebronhoar accumulation of angehans cals she pathological alia of pulmonary Langhans ell ishocyox, whieh ‘spell presents wth exetona depres, faigue, and crane y cough, ar scthn this peor ower pea CT Binge Include neues aa yt, wih a mito uppe-2ore predominance and Spting of he costophreni eins wich snot onstnt ih his aden inings Furrmere,pmonar angers ce isis ray occurs in young ats (20-40 years of apeea < orn > "ype 2 dabetes malts that ls wel-convlled with metformin Her mother ged of progres ung deve athe age of 50 yeas. The paves senualy ace wi Me hustand and tay ase Condoms conte, She as Smoked ote pak of Son rn or lmts, Examination, nena opnsmelen easton hohe No anormal. Aborto Sues incuding arom Gating and eslcom concetraton, are nahin pom Hts. An shows wo abcrali, (online monomneranyouns al < orn > ‘ype 2 diabetes melitus tats wel-convoled th metformin Hr Hie STS BOTRESNEMTASRREE «he age of 50 yeas. The pauec is senualy ace wi Mer husband and iey use Condoms consstey. She as Smoked one pack of Stns are nn normal lms. Examination, nding operamoleic esavaten, shows no abnormal ‘the patent’ »-ay shows bates, ceufower-stapea har masses consistent wth lateral lar Wmphagenopathy. Ths 6a casi higing paves wth sacs w wy 2a < eee ‘ANCA esting Important the lgnost workup for auteur vasclde, nding granulomatosis th olen (cha, wich can alo caus ler ears on chest ray amex, the sors seated wth GPa ae tpl cout notes no the ster! ae mphadenopathy aten nhs pate Ala, patent sully experete symptor nelung ACT sean ofthe chests mae este than xa and can reveal abnormal nt wil on x1 oF prone areata etal omer, rhe mags unnecessty nts Woman wes shmptomac wih ay Tadigs tac fe Casio the ease‘Center for Diagnostic and Interventional Radiology, SJKP Peete Dou) eee eres enn errr preening alo ean‘Center for Diagnostic and Interventional Radiology, SJKP- Peete Dou) eee eres enn errr preening alo eanouns al < orn > ‘ype 2 diabetes melitus tats wel-convoled th metformin Hr Hie STS BOTRESNEMTASRREE «he age of 50 yeas. The pauec is senualy ace wi Mer husband and iey use Condoms consstey. She as Smoked one pack of Stns are nn normal lms. Examination, nding operamoleic esavaten, shows no abnormal ‘the patent’ »-ay shows bates, ceufower-stapea har masses consistent wth lateral lar Wmphagenopathy. Ths 6a casi higing paves wth sacs w wy 2a < eee ‘ANCA esting Important the lgnost workup for auteur vasclde, nding granulomatosis th olen (cha, wich can alo caus ler ears on chest ray amex, the sors seated wth GPa ae tpl cout notes no the ster! ae mphadenopathy aten nhs pate Ala, patent sully experete symptor nelung ACT sean ofthe chests mae este than xa and can reveal abnormal nt wil on x1 oF prone areata etal omer, rhe mags unnecessty nts Woman wes shmptomac wih ay Tadigs tac fe Casio the easeoun al So eS ‘A blopsr of fected ss s the gle standard for lagosing sarcoidosis, sopathologc examination tpl shows roncaseaing granulomas ith lar calls, However, patents who ae asymptomatic wth ngs feel hier Imphadenopathy dono requte bepy, the rake cui he benefin of etelahing a fini agnosis. Adena, [ets mate methods phyla examination, lboratry sue, promety) ae suflantto mont! the eae 9 cra mematoat harap ecard Hesinent forgave wth smptomane puns sarsase ie. Apne ough, chest pa and patents nth exvepulmoray manestzon eco cianeoussyMGIONS) of sroHOS. omer, ds patent oy ma elute asympioma pulmonary SIcaoss. ‘1 lucoconcsd heap she rstnereaumenc or patents wh symptomatic eg. yspnex, cough, ces pan Pumonary secokons or etrapuimonary manfestations of acide eeu Catena sympa cae thi Paton ny ar wots, sympa pulmonary seco ofl seccoreaid hereby ot need ‘The mterferor-gama reese assay (GRA) test fo atert tubercles infcton Which s portant rue out m patents unde going eauatn fx sfcoidossn genera IRA nas gteterspciy than TST. Howse! pals wih scolds have smiined skin racy, aking the TST very pee hough os senate) Rca this pte aks puonsry symptoms stds hetryinaesting Ts = negsve To i stien fuse ne sagen Moe patents wth ltd plmnary saraiose do ao regu eaten, athe daca often apport ane rowprgressve with ah ate of portaneous remission. This patent has aaa receved a herough ml evaluation, Including eT, chest ty, €, and option exeminadon.Pulronery Tncon testing would as Ge spropia fo this potiene. There ia a lack of dats en the optimal Inequeacy end type of montaring lor pulmenery ssecaidesi, bot typicaloua all 3S) 10+ 14 > omever, hs pat ony har elated asymptomatic plenary saeoios. (rl lucocoicod therapy is the st-ine treatment for pate wth symptomatic eg. dyspnen, cough, chest pain) puimonary sscokon of werapulmonary mansions of ecldori (esa Cataneou mp ees tN Palen only has isolated, esymptomae pulmonary secede ofl luccoricotd ere ot need ‘The seteror-sunera eae assay (GRA) 1s or latent ube infcton hich is porant ruleout patents ‘undergoing evaluation fr srcovdons In genera IRA has greater specify than TST. Howe, patients wih srcoids rave cmesned sam react, making the TST ver eae hough less sense) Because hs patent aks puonary Symptoms and 2 story indeatng T, 2 negative TT's suffice fo excludes sagress ost pavers wa slated pulmonary saroioss donot requ treatment, athe diseases offen asymptomatic and ronprootesive with a nigh ato spontaneous femssion. Tis paet has aed) recehved 2 orough mil vation, Inclidng a TST, chest sry, &C, and optthaisiage examination Pulmonary fncton testing we aso Se apropiate Fo {he patent. Thore in ack of cats onthe optimal equeney a ps of mantring or pulmonary sstador, Bet Mypel opoaches include reqular examination wo 2255 sptoms and labetry suds, induding Sem creatinine a clean Paves with tet uberuosis econ sould ec eal sonazd menotteap for 9 months Homes, ts pauen has 2ouns a ‘As-yar-olf woman comes tothe pyican fr 2 1#-month sory of grade elrgement of fer Anges ae 2 month Wistar of hoarse voice. She as had deceased appetite ate a respratory Yat fection 3 months agp ard a kg (175-1) wlghoss drag hs period. The pate Mas neve smoked She was ugncsed wn stucve seep alege 5 Yar go. she appears ted He wl igs are wn normal Its, Pysiclevarnaon shows mereased “amen cf then fe and pail weling ofthe sf sve fer ngars and ankles, "ere sna colton of her 2a (© Reet opsctes on estxcray beea ‘A-yar-olf woman comes tothe py for 2 ae a 2 von stn of ‘Shes hed decresseeappete afte 2 espitory act infection 3 months age and a uring tus ped The patent ARIES, She was dagnsea wie cbstctve seep ‘lege 5 years ago: she appears tea, He wl gs are win normal its, Psa evaringn shows har no dacoloraton of her . eee Along tn hyperopheonecartropaty ndsted by nal eubing and pfu ine alin, th anes suplon paraneoplastic snarome as aes of malignant ulmonsry process. Further, hs patent hoatsaness and lean of - ‘anezing in ight upper ung shuld ae suspicion forthe imolement ofthe ancl spate nerves ancoast, nor “a 7 ‘o(B) eeand serum ADH Increased lvl of serum ADH cane cause by syndrome of appropriate andrei Ronan secretion SIH ich most ommely scum paint wh mal eal lng ance SCLC Ths patent hs sore eaten of SCLC, ung weight a ‘agua and horsence i eave of advaead tumor youth) Hyprrohle pulmonaty ateosrhopathy may orem some cases of C46, but is naa common fing, While SCLC rca ocalzed i ceil parts ofthe la is pate resents on wneezig mth igh-apoe lu ld naczing mete ky 2 eipetal mor, Mareoe, We aba of URN an a Frtor of guete smakng ral cet ing ances very ne, =@) mo ‘Ts ponent most ey has aung adenacarroms, which s te mos common typeof ng cance nonstrakrg women. As lang tenets Spiel acs the perioral pat fe kn, may ea io Herr syne, whch pretens wth Inate ote compresson of ne cers synpstate nee by te tmer Panenae tro. The patents hoseenese "iggest invotement eth recurrent laryigea nerve usa agn of advanced tumor grout, nein 8 woe outcomeounz a nie ‘cumshot nound ih aps nan alecaon Outside of aba. On aval es alr and erent 0 petson pace, and “me Hs temperature 37-7 (957, pulse 106 mn espaons ae 16min, a loos pressures 79/55 mim He oe a ee eee I ee a ee eo ee Pea | ee pa lr per | . se Pa eres a lors paren G o Diagnose laparoscopy 4> & ouns ul < ein > | 20-year-old man brought tthe emergency department, 40 minus aftr he was nce 2 SBR He uctres x ‘ ounstornound ith aps nan alecaon Oude of ba, On aval es alr and rented 0 peson pace and— En acenpeae 372 apse IR, praia 18min ros prea iS ‘ora Thee 2 !-em Ain wth ral beeding onthe nae ofthe chest 5-cm 4 (HBB. cecopunonary examination shows no abnormalis. abdominal examination shows difuse mld tendemess (0 Falpston with no guarding oroound: a hemgicnin concentration 141 g/d eukeye count 61D my and Piel coun 716009 ra! A fouted sermon ith sonography shows No fee ld nthe abdomen. Tage are canola are nseted an ravenous noms sine admin ree, Oxgen i senses hich ote fllowna isthe mos appropiate nxt step n management? ‘ny shooting wound located anenor between te mpple me and te arom rses is considered &poertal penetrating A seminal injury. Ths paves hemodynamically unstable 2a < Inserng chest tube nto the fifth eros space at he daily ine ndcats forthe weatment ofa hemothor. amotorax may develop ars guns wound and presets wth ches par, dyspnea, dactessed Desh sounds, dle 10 Ice italy. fren process inact for poacrting sidominal ney nthe seing of bemacyami neta. pneumothorax. Tension oneumethorax may deel afer agurshet wound ard presents wih ches al sone, ultra (ecensd breath sounds, conltrl Sevan ofthe athe, snd Memodynar ably Vypetension, tached onetr th patent has norma breath sounds The eaton of ha gmstot mound oupled wth hs hemedyrame stabi,CT scans eed to assess aptient tha peneating abdominal wound that appa stable on examination. hebps detect, lmucabomia Heeger f he ny ACT sas neti is enon ostae ertontis,exsceration and heredyramicstabity may undergo CT pro our interenton, cal mound exparaton WE con be usd esas the depth and act of ab wounds and eatrmins 2 waaton ofthe peaneu has occured However, hi not edn hemodamiclyunsabe paler ‘Th poten presen witha penevatig abdominal wound ands Nemodyeamiady unstable. Curse wounds most commonly Inu the sail eel eal, ad er and ance a negate FAST exam cannot rule out al ottees of alors Seeing ‘at need an emergent exporetrlpartomy. Ths procedure wl Ss for potent Wa-abaornal mre tat maybe the cause of hs hemodynamic nti. nthe sting of penetrating chest rams, ieo-astedthoracoscople sargery VATS) may ned diagnose and rat Suspected daphvapmatc ines na hemodynaricaly stable pee The presentation of Saphagma nies varies based Gn the mecrarism of uy (penetra slut) But Would Mealy resert wth verlaary sus suchas spe a8 secrensed breath sounds. The loaton of his patents mr pts hm at riakfor a hptragmatic ry. However, his Semeesstsasr sas best Seemtctss eabbaaa desk Sar as a9 se aeney akin cee Pecan teManagement of penetrating penetraIn he seting of penewatig chest rama, eo-assted thoracosconi surgery VATS) may Seat diagnose and reat Sspcts pivagmaticinjies in a herodnaricall sae paver. The resenaton of dap agai mais ves ase nthe mechanom of muy (penetrating a lt) but nol ely rent th veriaary anus sucha apnea Slecrentad breath sound. The laton of his patents my puts hrm aris for a haptragmatie ry. Never, Me respiratory rates nt scanty increased and he hs no auscutatory abnormal of he ces. This aber hemodumesiy vase and would net rom an emergent procedure to pote Sagnoss and west the Source of is ‘A atagnort apaotcopy indeed nthe Eating of abdominal aur with naga maging AST, CT ean) when an Intaaodomigl inury suspetd. ts especie for ispecing the apa an dtening the fessbiy of rotopeative management of soued Sold ogan sy. However, ths procedure saved fot hemoaynamal tableManagement of penetrating rowos al allay ad is unconscious for 30 seconds, Afteraards, he complain of shores of beth and cet pin wth de Ithlaio. He as nyertersion and wypripema He Smoked ore pac of daar fo 25 yeas bu ut para ‘tmision othe bap He dos not nk alee Hein tes and appears Hi temperatures 26°C 87.79, Bieed pressie £050 mm tq. and pulse 135/mm and Weak, Oxygen stration is BEN on room a rsa “haninaton shows elevated jog venous Sisterion. Cadac examination shows elt, rapid heat ae sed Aedes etre tl creer ra ep is lier oot tl etter pees evel ie ‘hatinaton emer itely to eve hich of he flowing tage? ‘olapsed nirvana cava le sa) plea le versa baloning Dilated nat veenclarcavry OG Reduce eon! veer wall motion 4|® be= ouns al year-old man colapace in he hori rox a oem allay ae is unconscious for 30 seconds, tera, he comets of Hehasnygerersion ang nyparipdema He Smoked ore pac of Gaur for 25 ens bu ul poe a [caro othe boapt He dos ot nk alco Hes in cites and appears Hi temperature a 269°C 87.79, eed aressire £050 mm Hg. and ule 135/min and weak, Oxygen strecn is BENG FSOME Psa) Catla exanation sows eye apd Net rate and « sins diy pun ae = ‘raninaton shone elevated egeal te. xaminaton of hi exteme heh ‘saninaton/e mor tev 0 eve hich of he fowina faa” . “hs pate resent wh ayeope chest pa, eymmeti laerentery ders an yponta. The presence f bot 1G remedyname stabi and carcogeric sock en, clé an Cammy extremes) sugges & masse pulmonary Oe totam - ee peers Za « w spc aberrant contactons af the ati te suggetine of arial fibilaton, whch ie not uncommon i the postoperative se enod.ANough Afb wth RVR ca present wth syncope, MypotENIon, ces par and sPrEa hs SAVERS MypOWa an Syme love extent sling ste inconsistent wth NS 0.3 ‘A colepsed infor vera cas characteristic of hypwoanic shock or istbutve shock ne cas of hemothan, lena, eps, and of anagryanis. Whe sepals ana postoperative hemorhage shouldbe onthe aferenal for hs patent hes alebrie and hashed no supcous Hinge on abdominal examination Ha and hypo te sggeatie of Geren elon. | Severs bilateral aot artery stenosis can cause syncope, but are and no associated wth any ofthe other dings resents pstent we Cac arcery tense lo sesoatea wih mceaed ik ot hem stoke, aut stoke elyOuns a present mth stant he carci artery sensi ala seecatd wth ineeaed ik of chem stoke, seat state arch uses scape ard would no expan spate other finings ‘Apa eft ertnclar ballooning san echocardiography finding Seen Takotubo carhomyopathy form of cue hear fare thats asc assoctad wih sigticanemavona stessrs Whi ean also poset with acateonse chest pin, hope, yncone, and eariogeni stork ths pens aymmeticlowatextremty edema sogget afte ebology Aight venice citation secur in response to elevated pulmonary artery veal eeistanc. A massive pulmonary fertaiemy 2 eon in hepa wl ene sles of pulmonary aay presse, lang 1 RY prema vein and ‘acon eight mene sai Tis imately ads ogecreses ne ail ling a level cardlac op, and tsetnuely to cdg shock This pet shows evidence of hmodaric stat rom a FE soa Sted RY cavity and ‘reuspid rogrg tation would ba expt fndnge on echocardiography. ‘An anecoc space between the pnicaum and eplcrium is» raracesic ecocaaog apc nding o pence ‘ffson pera fui lrge croup to cause cade tmponace cul ao presen nih shortness of reat VD, nd egonl wal motion aonoealtes can be seen on ecocarsioaraph patents wih acute or pror myeearda actin. M as ocean he pestopeatie phase ad can also preset with scope, est pl, spre and sign of catogen Shock, neers leer xtrerty edema suggests «ferent tigy forth patents symptomsBs al < win > esd man with 2 20-pekeyearhstory comes tothe physica for 2 follow-up examination 3 panther 2 ‘hestCT stowed a sotary 5mm sold nodule he wot lobe othe igh lng The fllon-up CT shows tha te Size of ‘me nodule as wens te 2 cm. pslatralmelastha yp ode ivohement ote. A eps Of te purmonaly ede shows ama dark Hue tumor ala ith yperchtomate mle and scree topo, Cranial a and skeletal Sentarapy show ro edenceof ther metastases, Which ofthe fllong she wos appoorate net SEPM ivanagenens ke © wetae eecton (© Rasauen ery (© | ephvacue canal radiation © Rom oeecemy © esto apyyo rh 2-pk-ay ome oth pcan flip cman en aa B o=- est Cr showed scary Scr safd nade ne parle ofthe ean, The lon-op CT shows he cma us minicom ese a tention oe ‘eo foeseg ste mast aprsrat nen a caper - ‘hs bop hws al cl lng ener AE, Th potent oven of aan ped ond medal yh 4g Greening ashe sane se 2 _woagerexecon for ing cance generally ented fx patents wth non-rmal cl lang cance who anne tlie 2 lobectomy fq, pate wih poor pulmonary function o combi) SCLC Is usualy umesecable a Suge ony Consiered we hed-stage disease wah very Sal sors and no evidence of nodal mehement ‘Wl radiation heap is typiclly par of he ill vest fr initedexage small el lang cancer SLO adaton alone is rot themaisty of tenet ard ino caste ‘ophyse rami itadaton ued to provat he cccence of bras metaratt i patent wh ema all lang cance [SCLC ne nav respond to mal cheretherapyteatrient. This paver shel rst underge mal teatmen before ensiowingprophyacic cana Wradaion =a Alea lcci Wi Waa cack i a ce Sac acacia a a@ so OM MS al < win > | oe "nie alan ray steal par of ental Test or tes-Rage smal el lung NEE SCLC, alton alone rate mainstay of weno ars ntcttve Prophet rama iradaton ued to prevent the accrence of bas metasacs i patient ith aml ell lang cance [SELc} eno nave responded oma chertheapyteatene. This pao! shal fet underge nal vestments Censiéeing prophylactic cana radon ‘The combinanon of ptyenemetherany (th cpt and etapesie and radiation therapy she treatment of che for Small el tng cancer SCLC pate wth ited-sage seas. ndMauas wih inited-sage SCLC shoul ecg trement th crave tant SCLC ie uualy unresectable and surgery ony corsidered in ited-sage ear wt ery Labectony for lng arcrs uualy rated for patent whe have non-small clung cance (NSCLC SCLC Hypa unresecable and surgery is nt consiered lmited-sape essen whch there are ery Srl sions andro eugene oF ‘Targted therapy with ECFRinhiots uch 25 gefthi) sinate in pate th EFR-postve,advanced-stane rosa cal ung caRcar (NSCLC). Ths patent Momeve, as Smal ung cance SCL, which equres a erent