Illness Scripts

Question 1

Pneumococcal pneumonia

Answer 1

Middle-aged any-race male smoker with acute onset of single strong rigor, high fever, productive cough, rusty sputum, tachypnea, pulmonary crackles, tubular breath sounds, lobar consolidation, leukocytosis and Gram-positive diplococci in sputum

Question 2

Staphylococcus aureus pneumonia

Answer 2

Any-age-race-sex hospital patient with acute onest of fever, cough, dyspnea, tachycardia, tachypnea, hypotension, pulmonary crackles, abscessing bronchopneumonia, leukocytosis and Gram-positive cocci in sputum

Question 3

Legionella pneumonia

Answer 3

Any-age-race-sex smoker with acute onset of fever, rigors, cough, dyspnea, diarrhea, confusion, pulmonary crackles, bronchopneumonia, leukocytosis, hyponatremia and non-diagnostic sputum

Question 4

Pseudomonas pneumonia

Answer 4

Any-age-race-sex intubated hospital patient with acute onset of fever, chills, confusion, purulent sputum, tachycardia, tachypnea, hypotension, pulmonary crackles, bilateral bronchopneumonia, neutropenia and Gram-negative rods in sputum

Question 5

Mycoplasma pneumonia

Answer 5

Young any-race-sex outpatient in winter with insidious onset of malaise, low-grade fever, persistent intractable dry cough, normal white blood cell count, cold agglutinins and bronchopneumonic, reticular or reticulonodular infiltrates that look worse than patient

Question 6

Tuberculosis

Answer 6

Elderly black male with insidious onset of fatigue, anorexia, weight loss, low-grade fever, chills, night sweats, mild cough, mucopurulent sputum, apical cavitary nodules and acid-fast bacilli in sputum

Question 7

Histoplasmosis

Answer 7

Pretty much just like tuberculosis except no sputum

Question 8

Aspergillus pneumonia

Answer 8

Any-age-race-sex adult with neutropenia, acute onset of fever, pleuritic chest pain, hemoptysis, tachycardia, tachypnea, pulmonary crackles and nodular infiltrates

Question 9

Cryptococcal pneumonia

Answer 9

Adult black male or female with immunocompromise, insidious onset of fever, cough, dyspnea, headache, tachycardia, tachypnea, stiff neck and nodular infiltrates

Question 10

Pneumocystis pneumonia

Answer 10

Middle-aged any-race male with immunocompromise, insidious onset of dyspnea, dry cough, low-grade fever, tachycardia, tachypnea, elevated lactate dehydrogenase and bilateral reticular infiltrates

Question 11

Lung primary adenocarcinoma

Answer 11

Late middle-aged any-race female smoker with insidious onset of persistent cough, anorexia, weight loss and peripheral lung mass

Question 12

Lung primary squamous cell carcinoma

Answer 12

Late middle-aged black male smoker with insidious onset of persistent cough, dyspnea, anorexia, weight loss, hemoptysis and central endobronchial lung mass

Question 13

Small cell carcinoma

Answer 13

Late 60ish any-race male heavy smoker with insidious onset of weight loss, cough, dyspnea, weakness and central parabronchial lung mass with hilar lymphadenopathy

Question 14

Pulmonary metastases

Answer 14

Late middle-aged any-race-sex patient with insidious onset of anorexia, weight loss, malaise, fatigue and numerous small rounded lung nodules (more in lower lobes)

Question 15

Pulmonary thromboembolism

Answer 15

Any-race-sex adult with recent surgery, central venous catheterization, malignancy, long-haul travel, obesity or smoking, sudden onset of dyspnea associated with chest pain, leg pain and swelling, tachypnea, hypoxemia and normal chest x-ray (not normal computed tomography)

Question 16

Fat embolism

Answer 16

Any age-race-sex patient with long bone fracture 1-3 days ago or young black patient with sickle cell crisis, now with acute onset of dyspnea, confusion, tachypnea, and hypoxemia

Question 17

Air embolism

Answer 17

Any age-race-sex patient with trauma, surgery or vascular catheter insertion or removal, sudden onset of dyspnea, single gasp or cough, lightheadedness, tachypnea, tachycardia, hypotension, hypoxemia and mill wheel heart murmur

Question 18

Acute respiratory distress syndrome (severe end of acute lung injury spectrum)

Answer 18

Any-age-race-sex hospital patient with shock, sepsis, pneumonia, acute onset of rapidly worsening dyspnea, respiratory distress, tachypnea, diffuse pulmonary crackles and progressive pulmonary infiltrates

Question 19

Usual interstitial pneumonia

Answer 19

Late middle-aged any-race male smoker with the insidious onset of dyspnea and persistent dry cough, bibasilar dry “Velcro” pulmonary crackles and bilateral reticular lung opacities in periphery and at the bases

Question 20

Pneumothorax (spontaneous)

Answer 20

Tall thin young any-race male smoker with sudden onset of dyspnea associated with unilateral chest pain and decreased breath sounds on the same side, and collapsed lung on chest x-ray