ccssa q form 2

ccssa q form 2

usmle6789
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Posted 01/21/05 - 11:11 AM: Subject: ccssa q form 2	#1
a 32 yr old woman comes becos of a 4 month h/o fatigue ,cough, SOB with exertion. She had 2 episodes of pneumonia and 1 episodes of severe sinusitis over the past 2 years. Never smoked. She takes no meds. Crackles heard at left lung base. X-ray shows a left lower lobe infiltrate and scarring of the right base. most next step in diagnosis? 1] mechanism of serum alfa 1 antitrypsin level 2] methacholine challenge test 3] quantitative measurement of serum serum antibody levels 4] sweat chloride test 5] ventilation-perfusion lung scans what is the diagnosis here? My answer is 3 .

tamriko
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ELM
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Posted 01/21/05 - 03:13 PM:	#3
Bibasilar lesions---> onset in third/forth decade??? to me it's 1.
ELM

mikyro
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Posted 01/22/05 - 05:44 AM:	#4
seems like alfa1-AT defic. I would go with 1.
the same miky - always ready to help my patients and friends as well

drk1980
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Posted 07/25/06 - 04:50 AM:	#5
Is there any correlation between alpha1 antitrypsin deficiency and her episodes of pneumonia/sinusitis ?

vnty
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Posted 07/25/06 - 05:21 AM:	#6
How about common variable immunodeficiency? I go with C

mazinger
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frank100
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Posted 07/25/06 - 08:17 PM:	#8
in that case first, I would study her for any immunodeficiency such as: HIV, an immunoglobulin deficency, etc.. in that case (c) is a good option.

shadia
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drhyd
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Posted 07/26/06 - 06:01 PM:	#10
Well i dont know tha answer but i can say without seeing anything we can rule out methacholine challenge test and perfusion scan. If we think option 1. ther should be emphysematic chnages panlobular, not just one side that to lower as in this case.Scarring , i think its due to previous infection. CF- may be he should ahve ahistory since childhood, not in this age and he should have malabsorption .( I may be worng saying it starts in child hood, iam not sure. But i choose definitely C as my asnwer because, common variable deficiency 1. starts in 2nd 3rd decades 2.B cell- so commonly infected with strep, h.influenza-- common causes for pneumonia and also sinusitis. These are the two imp thing which make me chose answer C correct me if iam wrong for not chosing CF as it do not start in adults( CF pt should have history since childhood) please correct me if iam wrong. thank u drhyd

frank100
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Posted 07/26/06 - 07:03 PM:	#11
great clinical approach rdhyd!!!

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