1/ #MedTwitter, we have a new blog post from @zoemarklyon and @StephenieLe11.
Before diving into the blog, let’s warm up with a case that spans the lungs, the skin, and maybe more!
Ready?
Before diving into the blog, let’s warm up with a case that spans the lungs, the skin, and maybe more!
Ready?
2/ A 43 yo woman presents with 9 months of worsening dyspnea on exertion, fatigue & a dry cough. She is hypoxemic to 87% on room air.
Pause and reflect on how you’d approach her dyspnea with the help of our dyspnea schema by @BBroderickMD
Pause and reflect on how you’d approach her dyspnea with the help of our dyspnea schema by @BBroderickMD
3/ She notes swollen hands & skin discoloration, which is especially worse in the cold weather and lasts up to 2 hours. She shows you a picture, which is also shown below. (Image courtesy of @NEJM).
4/ What is the name of this exam finding?
5/ This is Raynaud’s syndrome. Here’s a quick review of how to approach Raynaud’s, including red flag symptoms and associated conditions.
6/ On exam, she has bibasilar, fine, inspiratory crackles, shiny/thickened skin over her hands, with a small ulcer at the tip of her right index finger.
“Have you had these before?”
“A couple times, recently. ”
“Any difficulty swallowing?”
“Have you had these before?”
“A couple times, recently. ”
“Any difficulty swallowing?”
7/ “Yes! Food always gets stuck. It’s frustrating!”
“I’m so sorry. I can’t imagine. I want to find out what’s happening & I’m worried about your oxygen levels. I’d recommend we admit you to the hospital for more tests. Is that okay?”
“Yes. I just want to know what’s going on.”
“I’m so sorry. I can’t imagine. I want to find out what’s happening & I’m worried about your oxygen levels. I’d recommend we admit you to the hospital for more tests. Is that okay?”
“Yes. I just want to know what’s going on.”
8/ She has a normal CBC and BMP, and a clear CXR. Her oxygenation worsens to 84% with ambulation.
What tests would you send next?
What tests would you send next?
9/ CT Chest shows diffuse ground glass opacities. ANA and Anti-Scl-70 Abs return markedly positive. Based on the sclerodactyly, Raynaud’s syndrome, imaging findings, and positive autoantibodies, she is diagnosed with diffuse cutaneous systemic sclerosis.
10/ Given the new diagnosis of systemic sclerosis, would you order PFTs?
11/ PFTs are performed in most patients with systemic sclerosis at the time of diagnosis to determine whether it has affected the lungs and, if so, to what extent.
Her PFTs show:
Good consistency & effort
FEV1/FVC ratio 85% w/ non-scooped flow volume loop
⬇️ FVC & TLC
⬇️ DLCO
Her PFTs show:
Good consistency & effort
FEV1/FVC ratio 85% w/ non-scooped flow volume loop
⬇️ FVC & TLC
⬇️ DLCO
12/ On rounds, your attending asks, “So...how do you interpret these PFTs?”
We know the feeling.
We know the feeling.
13/ Have no fear!
@zoemarklyon and @StephenieLe11 have got your back with their new blog post “How do I interpret Pulmonary Function Tests?”
Check out their post and nail your next PFT interpretation! bit.ly/2Rce8IH
@zoemarklyon and @StephenieLe11 have got your back with their new blog post “How do I interpret Pulmonary Function Tests?”
Check out their post and nail your next PFT interpretation! bit.ly/2Rce8IH
14/ You can find all these schemas, including our new PFT schema on our website - clinicalproblemsolving.com - and the CPSolvers app - bit.ly/2DyidyV
