 |  nbme , please explain your answer
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| Author | 20 Posts |
nadiabarati
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46. A previously healthy 16-year-old boy is brought to the physician because of fever and cough with right-sided chest pain for 2 weeks. Six months ago, he visited his grandparents in Albania for 2 weeks. He weighs 54 kg (120 lb) and is 173 cm (68 in) tall. He appears thin and pale. His temperature is 38.2 C (100.8 F), pulse is 76/min, and respirations are 36/min. Examination shows shallow respirations with decreased breath sounds at the right lung base. An x-ray film of the chest shows a right pleural effusion and hilar adenopathy.
A
) α1-Antitrypsin deficiency
B
) Cystic fibrosis
C
) Pneumothorax
D
) Pulmonary alveolar proteinosis
E
) Pulmonary aspergillosis
F
) Pulmonary hemorrhage
G
) Pulmonary tuberculosis
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| vanshita
Forum Guru
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G?
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| nadiabarati
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TB in two weeks? Isn't a short time?
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| gilbert
Forum Junior
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Posts: 45
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TB, 6 months.
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| doc_clotaire
Forum Guru
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G ) Pulmonary tuberculosis
Only TB is associated with hilar adenopathy in thoses options
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| ram3
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Posts: 525
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Aspergillus fumigatus is one of the most ubiquitous of the airborne saprophytic fungi. Allergic bronchopulmonary aspergillosis (ABPA) is a syndrome seen in patients with asthma and cystic fibrosis, and is characterized by hypersensitivity to chronic colonization of the airways with A. fumigatus. We report the case of a patient with ABPA presenting with pleural effusion. A 27-year-old male was referred with recurrent right pleural effusion. Past medical history was remarkable for asthma, allergic sinusitis, and recurrent pleurisy. Investigations revealed peripheral eosinophilia with elevated serum immunoglobulin E and bilateral pleural effusions with bilateral upper lobe proximal bronchiectasis. Precipitating serum antibodies to A. fumigatus were positive and the A. fumigatus immediate skin test yielded a positive reaction. A diagnosis of ABPA associated with bilateral pleural effusions was made and the patient was commenced on prednisolone. At review, the patient's symptoms had considerably improved and his pleural effusions had resolved. ABPA may present with diverse atypical syndromes, including paratracheal and hilar adenopathy, obstructive lung collapse, pneumothorax and bronchopleural fistula, and allergic sinusitis. Allergic bronchopulmonary aspergillosis is a rare cause of pleural effusion and must be considered in the differential diagnosis of patients presenting with a pleural effusion, in particular those with a history of asthma.
So I go for pulmonary aspergillosis --E
Edited by Aashi on 06/12/07 - 08:59 PM
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| let thesunshine
Forum Newbie
Topics: 6
Posts: 17
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It is Pulmonary tuberculosis
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| prathapdoctor
Forum Elite
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i would go for G.
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| ashfaque
Forum Newbie
Topics: 0
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G for sure
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| oggn
Forum Elite
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G
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| krsna
Forum Senior
Topics: 1
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my bet wud be on G
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| doyoudig
Forum Guru
Topics: 144
Posts: 613
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agree w/ TB, Weight Loss, Nigh Sweats, Chills, Fever, Hilar adenopathy w/ Pleural Efusion
The info given is overwhemling for TB rather than Aspergillosis
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| robin082006
Forum Hero
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G
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| medicinaeu
Forum Newbie
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Well in the mediterrean country tb whas frequentin the past now not moore, but i will go also fo G.
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| cirus
Forum Guru
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well thats how i solved this q on US world (TB ), The ans was aspergillosis
the explan was that TB has to have a ghon focus &mucoperulent sputum, but it was a little clearer on UW as they said their was an increased serum Eosinphills
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| Ivonne
Find a way or make one
Topics: 58
Posts: 1,618
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I will go for TB
Lymph node involvement (adenitis) is the most frequently involved extrapulmonary site.
Systemic compromised
Trip 6 months ago
Previously healthy
Fever and cough
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| dr in trouble
Forum Guru
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with this explanation, pulmonary TB seems the most accurate answer as for aspergillosis they shud give some clue.
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| elitoki
Forum Guru
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I agree with Ivonne. I think it is TB.
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| ssrpk
Forum Fanatic
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yes, tuberculosis
as for aspergillosis, they have to give something
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| hanwin
Forum Senior
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TB
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