Author Archives: Tony Breu

Why does it take weeks for the radiographic evidence of pneumonia to clear? Early in medical training, many of us are told that it takes weeks for the radiographic infiltrate to resolve after a bout of pneumonia. This is the sort of statement many accept without question. But it is worth wondering what is inContinue reading “Episode 71 – Slow to Resolve”

Why does an upper GIB increase the BUN/Cr ratio? The idea that something other than kidney injury might lead to elevations in BUN was first identified in 1912 in infants with cholera. The entity was called extrarenal azotemia. In retrospect, these were likely instances of prerenal azotemia, but the clinicians could not identify renal abnormalitiesContinue reading “Episode 70 – Blood meal”

How does alpha-1 antitrypsin deficiency affect the liver? Pulmonologists frequently test for alpha-1 antitrypsin deficiency in patients with emphysema, especially those with early onset emphysema, emphysema associated with lighter smoking histories, or those with lower lobe-predominant bronchiectasis. The mechanism by which having alpha-1 antitrypsin deficiency might predispose to emphysema is clear. But it was lessContinue reading “Episode 69 – Including Liver Disease”

Should I consider atrial fibrillation a risk factor for pulmonary embolism? Most of us have probably learned that a pulmonary embolism can cause right heart strain and lead to atrial fibrillation. But why can’t the reverse be true? Why isn’t atrial fibrillation considered a risk factor for pulmonary embolism? If the right atria is beatingContinue reading “Episode 68 – A fib about PE”

Why do steroids reduce cerebral edema? Steroids are used a lot in medicine. They are prescribed to treat exacerbations of chronic obstructive pulmonary disease and asthma, as part of initiation and maintenance therapy of autoimmune diseases, and to treat airway swelling, gout, and many others. We also use steroids to treat cerebral edema related toContinue reading “Episode 67 – Crossing a Barrier”