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June 2016 Pulmonary Case of the Month

Katie Murphy, MB BCh BAO1

Henry D. Tazelaar, MD2

Laszlo T. Vaszar, MD3


1Departments of Internal Medicine, 2Laboratory Medicine and Pathology and 3Pulmonary Medicine

Mayo Clinic Arizona

Scottsdale, AZ USA


Pulmonary Case of the Month CME Information

Members of the Arizona, New Mexico, Colorado and California Thoracic Societies and the Mayo Clinic are able to receive 0.25 AMA PRA Category 1 Credits™ for each case they complete. Completion of an evaluation form is required to receive credit and a link is provided on the last panel of the activity. 

0.25 AMA PRA Category 1 Credit(s)™

Estimated time to complete this activity: 0.25 hours

Lead Author(s): Katie Murphy, MB.  All Faculty, CME Planning Committee Members, and the CME Office Reviewers have disclosed that they do not have any relevant financial relationships with commercial interests that would constitute a conflict of interest concerning this CME activity.

Learning Objectives:
As a result of this activity I will be better able to:

  1. Correctly interpret and identify clinical practices supported by the highest quality available evidence.
  2. Will be better able to establsh the optimal evaluation leading to a correct diagnosis for patients with pulmonary, critical care and sleep disorders.
  3. Will improve the translation of the most current clinical information into the delivery of high quality care for patients.
  4. Will integrate new treatment options in discussing available treatment alternatives for patients with pulmonary, critical care and sleep related disorders.

Learning Format: Case-based, interactive online course, including mandatory assessment questions (number of questions varies by case). Please also read the Technical Requirements.

CME Sponsor: University of Arizona College of Medicine at Banner University Medical Center Tucson

Current Approval Period: January 1, 2015-December 31, 2016

Financial Support Received: None


History of Present Illness

A 77-year-old gentleman presented with 6 weeks of:

  • Sinus congestion
  • Bloody nasal discharge
  • Cough with maroon sputum
  • Dyspnea
  • Hearing loss
  • Painful peripheral neuropathy
  • Left median neuropathy and left foot drop
  • Fevers

Past Medical History, Social History and Family History

  • No significant past medical history
  • Retired
  • Does not smoke
  • Family history is noncontributory

Physical Examination

  • Temperature of 37.8º C
  • Bloody nasal discharge
  • Lungs clear to auscultation and percussion
  • Heart with a regular rhythm without murmur
  • Neurologic findings consistent with his complaints

Laboratory Evaluation

  • Elevated white blood cell count with a left shift
  • Na+ 130 mEq/L
  • 10-20 RBCs on urinalysis

Radiographic Evaluation

Initial chest x-day is shown in Figure 1.

Figure 1. Initial PA radiograph of chest.

Which of the following is (are) the next appropriate steps in the evaluation? (Click on the correct answer to proceed to the second of five panels)

  1. Transthoracic echocardiogram
  2. Treat with macrolide antibiotics for outpatient pneumonia
  3. Thoracic CT scan
  4. 1 and 3
  5. All of the above

Cite as: Murphy K, Tazelaar HD, Vaszar LT. June 2016 pulmonary case of the month. Soutwest J Pulm Crit Care. 2016 Jun;12(6):205-11. doi: PDF

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