Division of Pulmonary & Critical Care Medicine

Posts have been on a brief break but will re-launch on Feb1st.  Posts for both outpatient clinic as well as critical care topics will be uploaded.  Stay tuned.

Your 54-year-old male patient who is a lifelong nonsmoker comes back to your office for followup of a RUL nodule after a recent biopsy you performed revealed stage IV non-small cell lung cancer. His oncologist said that a “signet ring” sign was seen on his biopsy and that he has a gene abnormality seen on […]

A new 35 yo patient is referred to you for evaluation of cough.  She has had 2 weeks of non-productive cough that has been worsening, to the point of her having fits of cough and post-tussive emesis. Her symptoms started she experienced generalized malaise, but no fever or chills.  She denies post-nasal drip, and has […]

A 38-year-old Korean woman who immigrated to California 6 monthsago complains of weight loss, fever, cough, arthralgia,and frequentbouts of hemoptysis for the past 4 months. She has had no perceptible fever. Chest roentgenograms show a 4.0-cm cavity in the right upper lobe with associated infiltrate. There is a BCG scar on her left arm associated […]

Your 25-year-old female patient with a history of asthma returns to clinic again after you sent additional testing.  Her FEV1/FVC of 70% and FEV1 60% predicted are unimproved despite your inhaler therapy. How did you classify her asthma? You performed HRCT of the chest which revealed multiple areas of bronchoarterial ratio >1, thickened bronchial walls, […]

Your 54-year-old male patient is undergoing evaluation for dyspnea. He is a lifelong nonsmoker. A  CT scan was performed by his primary care physician and a 2.5cm RUL lesion with spiculated border is noted, with a 1.4cm satellite nodule in the same lobe of the lung.  There is a 7mm subcarinal lymph node seen, but […]

You’re seeing a 25-year-old female patient with a history of asthma for a new patient evaluation. She is a lifelong nonsmoker, and gives a history of 1-2 tablespoons of sputum production daily.  On review of systems she has a history of intermittent crampy abdominal pain that hasn’t been formally evaluated yet. Results of in-office spirometry […]

You have a 58 yo male patient who is evaluated because of worsening dyspnea, chronic productive cough, and increasing sputum production. He has a 30 pack-year smoking history. Spirometry shows a FEV1/FVC ratio <0.7. FEV1 is 60% of predicted. He enjoys daily walks with his neighbors, but has to walk slower than others because of […]

For the first clinic discussion of the week, the topic is asthma.  I have a clinical scenario for you: Your 23-year-old female patient is evaluated because of a 4-week history of cough, wheezing, and chest tightness. She reports daytime symptoms more than twice weekly, but not daily; she has had nighttime symptoms 3-4 times during […]

As an FYI, we will be posting the weekly outpatient discussion topics as part of the outpatient curriculum. Look here, for the weekly updates, including links to the pertinent articles to be read prior to the discussions.