nbme-2-3-45 - goforward

[ArchivalUser]

For each patient with cough, select the most appropriate next step in diagnosis.


A) Measurement of serum a1-antitrypsin level

B) Methacholine challenge test

C) Quantitative measurement of serum antibody levels

D) Sweat chloride test

E) Ventilation-perfusion lung scans


45. A 32-year-old woman comes to the physician because of
a 4-month history of fatigue, cough, and shortness of breath with
exertion. She has had two episodes of pneumonia and one episode of severe
sinusitis over the past 2 years. She has never smoked. She takes no
medications. Crackles are heard at the left lung base. An x-ray
film of the chest shows a left lower lobe infiltrate and scarring of the right
base.

i am not agree with answer key... it is not definitely CF... first CF would not present so late at age 32, second CF would also cause some GI disturbances...

in my opinion it is Common Variable Immune Defficiency... and anwer should be C...

what do you think?

[ArchivalUser]

http://www.usmleforum.com/showthread.php?tid=505818

[ArchivalUser]

ccccc

[ArchivalUser]

Ya the answer is c is right.. same q is given in UW.

[ArchivalUser]

1.Diagnosis of CVID is a diagnosis of exclusion..meaning u have to exclude the other causes of recurrent causes of pneumonia and B/L lower lobe involvement as this patient has ,,as a cause of his symptoms ?
2.could it be reasonable we R/O other causes i.e. CF before labelling it CVID.

[ArchivalUser]

The diagnosis of CF is being made earlier and earlier, usually in infancy. However, about 15% of those with CF are diagnosed later in life (even adulthood). Symptoms involve the lungs and digestive organs and vary in severity.

[ArchivalUser]

A diagnosis of exclusion (per exclusionem) is a medical condition whose presence cannot be established with complete confidence from examination or testing. Diagnosis is therefore by elimination of other reasonable possibilities...
http://en.wikipedia.org/wiki/Diagnosis_of_exclusion