As requested, below is the recap from our High-Yield Pulmonary Concepts webinar on 12/14/2014. Thanks for joining, and congrats to VTCSOM, Icahn SOM, and Netter SOM for their excellent performance! Click above to like/follow us for strategy tips, daily code switches (check out #S1Mcodeswitch), and future Webinar invites!

 

HIGH-YIELD ONE-LINERS

  • ARDS- Middle-aged alcoholic male with SOB, severe abd pain, bilateral infiltrates on CXR (i.e., severe pancreatitis with ARDS as a complication, common question)
  • Asthma- Young male with SOB, nonproductive cough, URI sx, diffuse wheezes, hyperinflation on CXR (infection as trigger for asthma exacerbation seen commonly, many times the patient will be a young child)
  • Atelectasis- Elderly female with SOB one day after cholecystectomy, decreased R-sided breath sounds
  • Bronchiectasis- Young male with SOB, productive cough with occasional hemoptysis, recent pseudomonas pneumonia (bronchiectasis secondary to cystic fibrosis; sometimes they'll include hx of diabetes, frequent URIs/PNAs, or infertility).
  • Emphysema- Middle-aged female smoker with SOB, nonproductive cough, bilateral expiratory wheezes, hyperinflation on CXR
  • Pleural effusion- Elderly female with SOB, L-sided pleuritic pain, hx of breast cancer, L-sided dullness to percussion (i.e., malignant effusions)
  • Pneumonia- Middle-aged alcoholic male with SOB, productive cough, fever, recently found down (aspiration PNA)
  • Pneumothorax- Young male with SOB, L pleuritic pain, decreased L-sided breath sounds (frequently tall males)
  • Pulmonary edema- Elderly female with SOB, JVD, bibasilar crackles (i.e., hx of CHF)
  • Pulmonary embolism- Middle-aged female smoker with SOB, L-sided pleuritic pain, normal CXR (commonly they'll use females given the probability that they may be on OCPs - which increases DVT rate if they're smokers; pregnant females with this presentation +/- unilateral leg swelling is also quite common)

 

COMMON CODE SWITCHES

  • Bat wing edema- perihilar pulmonary edema on CXR
  • Dahl’s sign- hyperpigmented calluses above knees (chronic tripoding in COPD)
  • Hamman’s crunch- mediastinal crunch synchronous with heartbeat (subQ air seen in Boerhaave syndrome)
  • Hampton’s hump- wedge-shaped infiltrate abutting the pleura on CXR (seen in pulmonary embolism/infarction)
  • Homan’s sign- calf tenderness with dorsiflexion (painful compression of calf seen in DVT)
  • Kerley B lines- small transverse lines along lateral lung margins (thickening of interlobular septa seen in pulmonary edema)
  • Kussmaul Respirations- deep labored respirations in acidosis
  • Obstructive pattern- low FEV1, low FVC, low FEV1/FVC (seen in COPD)
  • Pulsus paradoxus- large decrease in systolic blood pressure and pulse wave amplitude during inspiration (seen in COPD, cardiac tamponade)
  • Restrictive pattern- low FEV1, low FVC, normal (or high) FEV1/FVC (seen in ILD, obesity hypoventilation, kyphosis)