Medical Journal

Take the FREE American Heart Association Learn and Live Quiz
and you will find a list of resources to help you to live a longer, healthier life. CLICK HERE


ISSN 1930-6741

Medical Quiz Analysis

 77 year old man presents with small digital gangrenous skin lesions, (these lesions were found to be small vessel vasculitis).

he is hypotensive and mild short of breath. He is not  confused and mental status is good. He has splinter hemorrhages in the nail beds (vasculitis sign)

 and Cardiologist diagnoses him as Endocarditis starts him on Intravenous antibiotics including Penicillin and Gentamycin.       (Excellent choice as initially thought to be Endocarditis treating with Pen & Gentamycin is standard)

                                                                                  Patient is also  noted to be anemic and Hemoglobin is 9 grams BUN and Creatinine are proportionately elevated at 30 and 2.4, suggestion of dehydration versus renal disease with anemia

 blood gases show increased A-a gradient and PO2 of 55 on 50% aerosol mask. almost any lung disease can elevate A-a gradient shunt , embolism or COPD

CT chest is done shows infiltrates with solid mass like sub pleural consolidations bilaterally. Suspicious for pneumonia and tumor. this is interesting is this all due to cancer patient with atypical pneumonia or is it a rheumatologic disease

 ESR was greater than 115, Hemoglobin 9 gm this favors rheumatologic disease

Na is 125.Anion gap was Normal .Is it SIADH or rheumatologic disease or lung cancer hard to say

Pulmonologist diagnoses him as sepsis syndrome with Gagrenosa pyoderma and Cefepime with vancomycin is given and patient is monitored in the ICU. Infectious cause is Possible Pulmonologist is just playing safe like the cardiologist

 Patient is started on moderate dose steroids. Pulmonologist is probably playing safe for rheumatologic condition associated with the disease.

Nephrologists starts working up for vasculitis and Wegner's granulomatosis and aggressively hydrates the patient. He is right on the money it is Wagner's granulomatosis.

Rheumatologist starts the work up and suggests patient be transferred to a tertiary care Hospital. He wants plasma-pherisis and kidney biopsy and lung biopsy to be done.

Patient is anticoagulated and on oxygen face mask and starts having hemoptysis, he is intubated placed on the ventilator and Bronchoscopy is done.

Tests done show P-ANCA and C-ANCA test to be positive.

Bronchoscopy shows alveolar hemorrhage.

   Diagnosis  is Wagner's granulomatosis


Contributors :         A. Acosta MD, R. Kaul MD, P. Wawrzynski MD, Z. Iqbal MD, M. Islam MD

Lupus information :   Lupus site (SLE)- information on lupus




Medical Abbreviations
Search By Abbreviation
Search By Definition


Health News from Medical News Today


Medical News from Send2Press Newswire

This webpage uses Javascript to display some content.

Please enable Javascript in your browser and reload this page.

Bonus Online Content
The following web sites are sites which doctors prefer most:
Lung cancer is perhaps one of the most common types of cancer diagnosed today. The lungs, of course, are a pair of cone-shaped organs situated inside the chest, they absorb oxygen into the body and emit carbon dioxide. There is a confirmed link between smoking and lung cancer. This web site, run by Dr. Ramesh Kaul, MD., FCCP., M.S., is dedicated to informing the public about Lung Cancer Care as well as providing helpful tips and insight and a forum to discuss both concerns and prevention.

National Library of Medicine: MedlinePlus
MedlinePlus contains links to information on hundreds of health conditions and issues. The site also includes a medical dictionary, an encyclopedia with pictures and diagrams, and links to physician directories.

FDA Center For Drug Evaluation And Research
Click on for information on approved prescription drugs and some over-the-counter medications.

WebMd is full of information to help you manage your health. The site's quizzes and calculators are a fun way to test your medical knowledge. Get diet tips, information on drugs and herbs, and check out special sections on men's and women's health.
The renowned Mayo Clinic offers a one-stop health resource Web site. Use the site's Health Decision Guides to make decisions about prevention and treatment. Learn more about complementary and alternative medicine, sports medicine and senior health in the Healthy Living Centers.

Centers for Disease Control
Stay up to date on the latest public health news and get the CDC's recommendations on travelers' health, vaccines and immunizations, and protecting your health in case of a disaster.

Medscape delivers news and research specifically tailored to your medical interests. The site requires a free registration.

The American Lung Association
The mission of the American Lung Association® is to prevent lung disease and promote lung health. The American Lung Association® is the oldest voluntary health organization in the United States, with a National Office and constituent and affiliate associations around the country. Founded in 1904 to fight tuberculosis, the American Lung Association® today fights lung disease in all its forms, with special emphasis on asthma, tobacco control and environmental health. The American Lung Association® is funded by contributions from the public, along with gifts and grants from corporations, foundations and government agencies. The American Lung Association® achieves its many successes through the work of thousands of committed volunteers and dedicated staff members.

Home | Columns | Specials | Cover Story | Send E-mail to | Archive


Copyright 2005 All rights reserved. makes absolutely no representation as to the content, accuracy, or completeness of the information contained on this web site or the linked web sites and does not necessarily endorse any of the information contained therein. All readers and/or patients should verify all of the information and data before ever administering any type of drug, therapy or treatment discussed herein. Neither the web designers, editors nor the publisher accepts any responsibility for the accuracy of the information or the consequences from the use or misuse of the information contained herein. Information on this web site is provided for informational purposes only and is not a substitute for professional medical advice. You should not use the information on this web site for diagnosing or treating a medical or health condition. You should carefully read all product packaging. If you have or suspect you have a medical problem, promptly contact your professional healthcare provider. Statements and information regarding supplements have not been evaluated or approved by the Food and Drug Administration. Please consult your healthcare provider before beginning any course of supplementation or treatment.