Questions and Answers

This section consist of question and answers for the section

Osteoarthritis, Gout, and Infectious Arthritis

Cervicothoracic complaints can be classified into 3 categories on the basis of etiology: mechanical, neurogenic, and pain secondary to other systemic processes. Mechanical neck complaints are often secondary to trauma, overuse injury, malposture, and osteoarthritis. Neurogenic neck complaints are experienced acutely after trauma or gradually as a result of progressive osteoarthritis with subsequent nerve root impingement. Neck pain secondary to systemic disease often is associated with systemic symptoms such as fever, chills, weight loss, rash, polyarthralgia, or polymyalgia.

Sleep-Related Breathing Disorders

Pulmonary hypertension (PH) is defined by a mean pulmonary artery pressure of at least 25 mm Hg at rest, as measured during right heart catheterization (RHC). The many causes of PH are classified into 5 groups. The clinical presentation of patients with PH is nonspecific: progressive dyspnea, chest pain, lower extremity edema, and fatigue. Typically, a diagnosis of PH is suggested by an increased right ventricular systolic pressure on transthoracic Doppler echocardiography and is confirmed with RHC.

Pulmonary Evaluation

Obstructive lung diseases include chronic obstructive pulmonary disease (COPD) (eg, chronic bronchitis and emphysema), asthma, bronchiectasis, cystic fibrosis, obliterative bronchiolitis, and diffuse panbronchiolitis (eg, bullous lung disease, α‎1-antitrypsin deficiency, and airway stenosis). The 2 most prevalent obstructive lung diseases are COPD and asthma.

Obstructive Lung Diseases

An estimated 1 in 3,000 to 1 in 4,000 persons in the general population have a diagnosis of interstitial lung disease (ILD), and ILDs account for about 15% of all consultations for general pulmonologists. These diseases encompass a group of heterogeneous lung conditions characterized by diffuse involvement of the lung parenchyma and pulmonary interstitium. By convention, infections, pulmonary edema, lung malignancies, and emphysema are excluded, but they should be carefully considered as part of the differential diagnosis.

Cystic Fibrosis, Bronchiectasis, and Pleural Effusion

Effective functioning of the respiratory system requires 1) normal central nervous system control, 2) intact neuromuscular transmission and bellows function, 3) patent airways, and 4) normal gas exchange at the alveolar-capillary level. Respiratory failure may be caused by dysfunction at any of these levels, resulting in failure of oxygenation (hypoxemic respiratory failure) or ventilation (hypercapnic respiratory failure).

Substance Use Disorders, Personality Disorders, and Eating Disorders

Psychosis is a generic term used to describe altered thought and behavior in which the patient is incapable of interpreting his or her situation rationally and accurately. Psychotic symptoms can occur in various medical, neurologic, and psychiatric disorders. Many psychotic reactions seen in medical settings are associated with the use of recreational or prescription drugs. Some of these drug-induced psychotic reactions are nearly indistinguishable from schizophrenia in terms of hallucinations and paranoid delusions.

Seizure Disorders

Brain tumors may manifest with focal progressive neurologic deficits, increased intracranial pressure (causing headache, vomiting, and papilledema), new-onset seizures, or progressive cognitive and behavioral changes. The most common primary brain tumors in adults are meningioma, astrocytoma, oligodendroglioma, and lymphoma.

Renal Parenchymal Diseases

Volume expansion can be general (as in patients with congestive heart failure, cirrhosis, or nephrotic syndrome) or regional (as in patients with regional capillary leak, venous insufficiency, or lymphatic obstruction). Volume depletion is associated primarily with gastrointestinal tract (GI) fluid loss, excessive sweating, and renal sodium loss related to diuretic use or, rarely, renal salt wasting. The cause of a volume disorder can be determined by physical examination.

Sexually Transmitted, Urinary Tract, and Gastrointestinal Tract Infections

Influenza causes annual, seasonal epidemics that lead to tens of thousands of deaths each year in the United States. Two influenza A strains (H3N2 and H1N1) and 1 or 2 influenza B strains typically circulate during winter months and undergo minor antigenic mutations (antigenic drift) resulting in annual seasonal epidemics. Influenza pandemics occur more rarely (every 20-30 years) and are the result of major antigenic changes (antigenic shift) leading to large numbers of infections due to low levels of population immunity. In seasonal epidemics, 80% to 90% of deaths due to influenza occur in persons older than 65 years.