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a 32 y/o woman coems to the physician b/c of a 4 month hx of fatigue, cough, and shortness of breath with exertion. she has had 2 episodes of pneumonaie and one episode of severe sinusitis over the past 2 years. she has never smoked. she takes no meds. crackles are heard at the left lung base. an x/r film of the chest shows a left lower lobe infiltrate and scarring of the right base. for this patient with cough select the most appropriate next step in diagnosis?
a) measurement of serum alpha 1 antitrypsin level
b) methacholine challenge test
c) quantitative measurement of serum antibody levels
d) sweat chloride test
e) ventilation-perfusion scans
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Though it is late for CF but still the most appropriate next step will be d) sweat chloride test
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C. wegener granulomatosis
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there is no renal involvement..
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I think it's C. Need to measure (is it anti-GBM antibodies?) antibodies because suspicious of Wegener's: pulmonary involvement (bilateral), sinusitis.
It is not that there is no renal involvement. It's just that the question does not make a mention of the results of urinalysis or U&E's.
It cannot be CF because the age is wrong. CF pts usually die in their 20's without treatment, so she could not have survive 32 years without medical help.
I don't think it's alpha-AT deficiency, which cause emphysematious changes (so you see holes on CXR).
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anti-gbm antibody is in Good pasture's dz.. which is charc by pulm and renal invovlement..
yes radonc, u may be right, they did not mention about uriine that does not mean there is no renal invovement..
so now i think its C... for c-ANCA for wegener's...
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Life expectancy for people with CF depends largely upon access to health care. In 1959, the median age of survival of children with cystic fibrosis was 6 months. In the United States, the life expectancy for infants born in 2006 with CF is 36.8 years, based upon data compiled by the Cystic Fibrosis Foundation.[51] Similarly, in much of the western world people with CF live to a similar age. However, the life expectancy in underdeveloped countries is much less ” the majority of individuals with CF do not live past the age of ten.
The Cystic Fibrosis Foundation also compiles lifestyle information about American adults with CF. In 2004, the foundation reported that 91% had graduated high school and 54% had at least some college education. Employment data revealed 12.6% of adults were disabled and 9.9% were unemployed. Marital information showed that 59% of adults were single and 36% were married or living with a partner. In 2004, 191 American women with CF were pregnant.[52]
