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cases of the month What's the Diagnosis? Case Studies: Each of the numbered items or incomplete statements below is followed by answers or by completions of the statement. Select the one lettered answer or completion that is best in each case.
2. A 69-year-old woman with a history of smoking two packs of cigarettes per day for the past 30 years notes a several-year history of worsening dyspnea with exertion. Pulmonary function testing reveals a reduced ratio of 1-second forced expiratory volume to forced vital capacity (FEV1/FVC), increased lung volumes (residual volume, functional reserve capacity (FRC) and total lung capacity) and reduced carbon monoxide diffusing capacity. Specialized laboratory testing reveals a deficiency in plasma a1-antitrypsin. Which of the following best describes normal tidal inspiration in this patient?
3. A 17-year-old female cross-country runner comes to the emergency department with acute-onset shortness of breath and chest discomfort. A chest radiograph confirms the clinical suspicion of a tension pneumothorax. Her blood pressure on arrival is documented at 88/56mmHg. Which of the following factors is most likely responsible for the hypotension in this setting?
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1. A 45-year-old woman presents for evaluation of a long history of “heartburn,” which is worse at night. She also complains of occasional dysphagia to solids, particularly when eating meat. A radiograph is obtained (see image) and shows circular strictures about 5 cm above the diaphragmatic opening. The most likely cause of these findings is:
