Pulmonary Question Help Please !!!

[medInUSA]

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Please help, have pulmonary exam tommorow

question:
A 50-year-old male developed chest pain, hemoptysis and peripheral wedge shaped densities on a chest X-ray. A perfusion defect was found. This is:

answer:
uncommon and occurs in 10% of patients with vascular compromise.

what are they talking about??

 

[thesauce]

Please help, have pulmonary exam tommorow

question:
A 50-year-old male developed chest pain, hemoptysis and peripheral wedge shaped densities on a chest X-ray. A perfusion defect was found. This is:

answer:
uncommon and occurs in 10% of patients with vascular compromise.

what are they talking about??

It sounds like pulmonary embolism off the top of my head.

 

[Bitsy3221]

Sounds like a PE to me.

 

[medInUSA]

I'm sorry i should have given all the answer choices, here they are:

-a common sequela of embolization.

-due to obstruction of a bronchus with peripheral collapse.

-due to a bronchopneumonia.

-due to a lobar pneumonia affecting multiple lobes.

ANSWER: uncommon and occurs in 10% of patients with vascular compromise.

 

[medInUSA]

I initially also thought a pulmonary embolus, however that was the firts choice that turned out to be wrong.

(in case you were wondering this is a question from a practice quiz that my school provides. )

any other ideas on what this could be?

 

[Bitsy3221]

I'm sorry i should have given all the answer choices, here they are:

-a common sequela of embolization.

-due to obstruction of a bronchus with peripheral collapse.

-due to a bronchopneumonia.

-due to a lobar pneumonia affecting multiple lobes.

ANSWER: uncommon and occurs in 10% of patients with vascular compromise.

Yes, it's a PE. Peripheral wedge shaped densities on CXR (also called Hampton's Hump) is indicative of a PE, not pneumonia. A bronchial obstruction would show distal atelectasis in a more lobar (or entire lung, depending on the size of the bronchus) pattern, not just at the periphery--I think I had a similar question at some point!

 

[Bitsy3221]

I initially also thought a pulmonary embolus, however that was the firts choice that turned out to be wrong.

(in case you were wondering this is a question from a practice quiz that my school provides. )

any other ideas on what this could be?

I think they are getting into semantics of common vs. uncommon presentation for a PE

 

[medInUSA]

Thank you for replying,

But what does PE stand for? I thought it stands for pulmonary embolus? if so then that would be percluded, beccasue the first answer choice is wrong???

thanks again.

 

[medInUSA]

I think i got you!! thank you very much. A very badly worded question.

thanks again

 

[Bitsy3221]

PE stands for pulmonary embolism.

From http://www.emedicine.com/EMERG/topic490.htm:

"The classic triad of signs and symptoms of PE (hemoptysis, dyspnea, chest pain) are neither sensitive nor specific. They occur in fewer than 20% of patients in whom the diagnosis of PE is made, and most patients with those symptoms are found to have some etiology other than PE to account for them. Of patients who go on to die from massive PE, only 60% have dyspnea, 17% have chest pain, and 3% have hemoptysis. Nonetheless, the presence of any of these classic signs and symptoms is an indication for a complete diagnostic evaluation."

"A rare late finding of pulmonary infarction is the Hampton hump, a triangular or rounded pleural-based infiltrate with the apex pointed toward the hilum, frequently located adjacent to the diaphragm."

I think the point of the question is NOT whether or not the pt has a PE, it is whether his presentation is COMMON for a PE, which according the stats listed above, clearly it is not.

 

[Bitsy3221]

and I agree, it is a poorly worded question. You just made me sooo glad those crazy "what am I thinking" tests are behind me 😛

 

[medInUSA]

thank you so much you were very helpful 🙂

 

[medInUSA]

just curious what year are you? i am second year

 

[Ypo.]

PE stands for pulmonary embolism.

From http://www.emedicine.com/EMERG/topic490.htm:

"The classic triad of signs and symptoms of PE (hemoptysis, dyspnea, chest pain) are neither sensitive nor specific. They occur in fewer than 20% of patients in whom the diagnosis of PE is made, and most patients with those symptoms are found to have some etiology other than PE to account for them. Of patients who go on to die from massive PE, only 60% have dyspnea, 17% have chest pain, and 3% have hemoptysis. Nonetheless, the presence of any of these classic signs and symptoms is an indication for a complete diagnostic evaluation."

"A rare late finding of pulmonary infarction is the Hampton hump, a triangular or rounded pleural-based infiltrate with the apex pointed toward the hilum, frequently located adjacent to the diaphragm."

I think the point of the question is NOT whether or not the pt has a PE, it is whether his presentation is COMMON for a PE, which according the stats listed above, clearly it is not.

Nice work, Bitsy.

That question was worded poorly.

 

[Bitsy3221]

Thanks!

I am a super-slacking fourth year. 108 days until graduation!😀 😀 😀