Illness Scripts 2

Question 1

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

Answer 1

Mycoplasma pneumonia

Question 2

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

Answer 2

Legionella pneumonia

Question 3

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

Answer 3

Air embolism

Question 4

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

Answer 4

Usual interstitial pneumonia

Question 5

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

Answer 5

Staphylococcus aureus pneumonia

Question 6

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

Answer 6

Pseudomonas pneumonia

Question 7

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

Answer 7

Small cell carcinoma

Question 8

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

Answer 8

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

Question 9

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

Answer 9

Pneumococcal pneumonia

Question 10

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

Answer 10

Aspergillus pneumonia

Question 11

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

Answer 11

Cryptococcal pneumonia

Question 12

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

Answer 12

Pneumothorax (spontaneous)

Question 13

Pretty much just like tuberculosis except no sputum

Answer 13

Histoplasmosis

Question 14

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

Answer 14

Lung primary adenocarcinoma

Question 15

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

Answer 15

Fat embolism

Question 16

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

Answer 16

Pneumocystis pneumonia

Question 17

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

Answer 17

Tuberculosis

Question 18

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)

Answer 18

Pulmonary thromboembolism

Question 19

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)

Answer 19

Pulmonary metastases

Question 20

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

Answer 20

Lung primary squamous cell carcinoma