dreamer
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ans please
A 32- yo F comes to the physician because of a 4 month hx of fatigue, cough, and shortness of breath with exertion. she has has 2 episodes of pneumonia and one episode of severe sinusitis over the past 2 years. she has never smoked. she takes no medication.crackles are heard at the left lung base. an xray fim of the chest shows a left lower lobe infiltrate and scarring of the right base.select the most appropriate next step in dx:
A measurement of serum a1 antitrypsin level
B methacholine challenge test
C quantitative meansurement of serum antibody levels
D sweat chloride test
E ventilation-perfusion lung scans
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| Justice
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A measurement of serum a1 antitrypsin level
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| Drtweetie
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A
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| lakshya_0_7
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plz explain....
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| dreamer
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alpha 1 antitrypsin deficiency: CXR usually shows emphysema, pt may have liver cirrhosis. the q here seems mainly point out recurrent infections plus scarring in lung..... i dont understand, plz explain.
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| elitoki
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http://www.prep4usmle.com/forum/thread/59498
??
A or C?
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| liliaeliz
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yes , thanks in the other Q i pick up d but she has 32 y.o thanks dreamer
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| liliaeliz
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me too dreamer I dont understand
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| radonc
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I was thinking long about this question. Not entirely sure, but I think answer is C.
This pt has Wegener's granulomatosis. Vasculitis affecting sinuses, lower respitaory tracts, and also kidneys. Diagnosis is confirmed by biopsy of affected tissues, but cANCA is positive in 90% of pts with active disease. The above picture does not look like emphysema, caused by alpha1-AT deficiency.
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| dr in trouble
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I dont think it is emphysema, i will go with C too.
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| dr19
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CXR description is not typical of a @1-antitrypsin def. case.
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| MAGY17
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C
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| brooklynmed
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answer is C .....pat. has recurrent sinopulmonary infections indicative of IgA deficiency
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| Vietnamese
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C- He had Wegener Granulomatosis, often along with necroziting nephrositis.
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| Gourdon
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A
http://www.emedicine.com/med/topic108.htm
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