SAGES Web Quiz #22 -- February 2000

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A new pulmonologist calls you to discuss a patient he just saw in his office. She is a healthy 29 year-old woman who has had a chronic cough for the last year. This has been ineffectively treated for both bronchitis and asthma. Lately, the patient has started to complain of shortness of breath that has gotten acutely worse over the last week. Her respirations in the office were 23 breaths per minute. Her lungs were clear to auscultation. A recent chest x-ray was unremarkable. A room air office ABG had a pH 7.67, PCO2 14, PO2 97, BE -2.1.

1. You discuss the differential diagnosis, which includes all of the following except:

a) pulmonary embolus
b) hyperthyroidism
c) multiple sclerosis
d) anxiety disorder
e) irritative lesions of the airway
f) Don't Know

2. The pulmonologist tells you that the patient has been evaluated for all non-pulmonary etiologies. You recommend a helical CT scan of the chest. A helical CT scan is superior to conventional axial CT imaging because:

a) reduced time of examination
b) reduced volume of contrast media
c) improved multiplanar and 3-dimensional imaging
d) all of the above
e) Don't Know

3. The helical CT scan is read as normal by the radiologist, although the pulmonologist feels there is some increased nodularity in the left lower lobe. The patient's PFTs and a V/Q scan are also normal. The patient undergoes an exercise tolerance test. A room air ABG drawn prior to exercise has a pH 7.62, PCO2 14, PO2 103, BE -2.0, sat 98.7%. After riding a bicycle at 70 watts for 17 minutes, her room air ABG is redrawn, revealing a pH 7.35, PCO2 21, PO2 79, BE -10.8, sat 95.1%. You conclude from this data that her ventilation is:

a) normal
b) impaired
c) Don't Know

4. Given the above results, you debate whether a video-assisted thoracoscopic surgery (VATS) procedure is indicated. You finally recommend:

a) thoracoscopic lung biopsy
b) open lung biopsy
c) continued work-up for non-pulmonary causes
d) Don't Know

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