By Juzar Ali, Warren G. Summer
Now up-to-date to mirror the USMLE Step 2 examination, with better emphasis on case displays and diagnostic abilities. nearly four hundred new medical vignettes with accompanying questions (500 questions in all)--now that includes increased solutions referenced to best textbooks or magazine articles. Reviewed via McGraw-Hill's scientific pupil Advisory Committee to make sure simulation of the USMLE test-taking event.
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Additional info for Chest Radiology: PreTest Self- Assessment and Review
Specific Discussion 8–9. The answers are 8-b, 9-d. This elderly patient has all the stigmata of chronic illness. Although the PPD skin test and sputum studies are negative (seen in about 30% of cases), the history and CXR are consistent with miliary TB. Hyponatremia and hypercalcemia are common findings in TB. In this age group sarcoidosis is unlikely. In the absence of occupational exposure, silicosis is also unlikely. Bone marrow aspirate may be positive for TB culture in 60% of patients with miliary TB, and aspiration is a logical step in the diagnostic evaluation.
Complicated silicosis or progressive massive fibrosis refers to larger confluent densities or conglomerate upper lobe masses. Patients usually have progressive functional impairment, and cor 26 Chest Radiology pulmonale is common. Tuberculosis occurs with increased incidence in silicosis, and a positive PPD in such patients with no evidence of active disease warrants chemoprophylaxis. Bagassosis due to exposure to sugar cane residue presents with a hypersensitivity pneumonitis, and chlorine gas exposure causes upper airway dysfunction.
C. d. Change of antibiotics Sputum for TB Flexible bronchoscopy Open lung biopsy Lung Masses Fig. 11 33 LUNG MASSES Answers Description of X-rays in This Chapter Figure 9. A large, 7 × 11-cm mass is seen in the left parahilar area. This has a well-defined edge and silhouettes out the hilar structures. The diaphragms are flattened, and there is no pleural disease. There are mediastinal (sternal) wires from prior CABG. Figure 10. 5-cm rounded masslike shadow in the right middle zone with slightly irregular margins.
Chest Radiology: PreTest Self- Assessment and Review by Juzar Ali, Warren G. Summer