Internal-Medicine

258 12: Diseases of the Respiratory System
Careful physical examination can be very useful
in diagnosing many common pulmonary disorders.
Atelectasis and large pleural effusions both can
present with decreased fremitus, dullness or flatness
to percussion, and absent breath sounds. In
atelectasis, tracheal shift, if present, is toward the
affected side, and the opposite for a large pleural
effusion. Asthma’s most typical manifestations are
prolonged expiration and diffuse wheezing.
However, impaired expansion, decreased fremitus,
hyperresonance, and low diaphragms can also be
found. A complete pneumothorax results in absent
fremitus, hyperresonance or tympany, and absent
breath sounds. Lobar pneumonia is characterized
by consolidation with increased fremitus, dullness,
and auscultatory findings of bronchial breathing,
bronchophony, pectoriloquy, and crackles. (Kasper,
p. 1496)
58. (A) Hypercalcemia may be due to metastatic
destruction of bone, ectopic formation of
parathyroid hormone, or formation of other
osteolytic substances. (Kasper, pp. 506–507)
59. (D) Combination chemotherapy has produced
promising results in lung cancer, particularly of
the small cell anaplastic type. Alkylating agents
and anthracyclines are active among other
agents. (Kasper, pp. 506–507)
60. (A, B, C, E) Early stage non-small cell lung
cancer can be cured by surgery. However, 70%
present with disseminated disease. (Kasper,
pp. 506–507)
61. (D) The most commonly encountered syndromes
are SIADH, Cushing’s syndrome, and
gynecomastia. (Kasper, pp. 506–507)
62. (A) Pancoast’s syndrome (or superior sulcus
syndrome) is found in apical lung tumors, usually
epidermoid. Shoulder pain secondary to
involvement of the eighth cervical and first
and second thoracic nerves is characteristic.
Horner syndrome frequently coexists. (Kasper,
pp. 506–507)