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Old 06-26-2011
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Lungs Dry cough and diffuse patchy infiltrates

A 24-year-old woman sees her family physician for a cough. The cough is nonproductive and first appeared 3 days ago. The patient has also felt feverish with a headache and sore throat. Both of her roommates are having similar symptoms. On exam, she has erythematous tympanic membranes and pharyngeal erythema with no exudate. There are fine rhonchi and inspiratory and expiratory wheezes heard on chest exam. A chest radiograph is ordered and shows diffuse patchy infiltrates in both lungs. What is this patientís most likely diagnosis?

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A. Adult-onset asthma
B. Haemophilus influenzae pneumonia
C. Hypersensitivity pneumonitis
D. Mycoplasma pneumonia
E. Viral pneumonia
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Old 06-26-2011
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I choose viral pneumonia. Viral infections have a wide set of manifestations as sore throat, erythema in tympanic membrane and pharyngeal mucosa. They are very contagious as well.
Another strong posibility would be Mycoplasma because it usually has bilateral manifestations in the chest X ray, but viral infections have them as well.
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Old 06-26-2011
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E. Viral pneumonia
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Old 06-27-2011
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Option D (Mycoplasma pneumonia) is correct. This patient has classic Mycoplasma pneumonia, which is the most common cause of community-acquired pneumonia in young adults. Macrolide antibiotics are the treatment of choice.

Option A (Adult-onset asthma) is incorrect. History signs and symptoms of a communicable disease in this case make this an unlikely diagnosis.

Option B (Haemophilus influenzae pneumonia) is incorrect. This would be uncommon in someone in this age group without obvious risk factors.

Option C (Hypersensitivity pneumonitis) is incorrect. This diagnosis shares many of the signs and symptoms of the patient, but has a somewhat different radiologic appearance, usually does not have involvement of the middle ear, and is not infectious. The patientís history suggests this condition is infectious.

Option E (Viral pneumonia) is incorrect. A common and similar disease to Mycoplasma pneumonia, but this patientís chest radiograph makes Mycoplasma a more likely diagnosis.

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Regardless of cause, the morphologic patterns in atypical pneumonias are similar. The process may be patchy, or it may involve whole lobes bilaterally or unilaterally. Macroscopically, the affected areas are red-blue, congested, and subcrepitant. Histologically, the inflammatory reaction is largely confined within the walls of the alveoli (Fig. 13-27). The septa are widened and edematous; they usually contain a mononuclear inflammatory infiltrate of lymphocytes, histiocytes, and, occasionally, plasma cells. In contrast to bacterial pneumonias, alveolar spaces in atypical pneumonias are remarkably free of cellular exudate. In severe cases, however, full-blown diffuse alveolar damage with hyaline membranes may develop. In less severe, uncomplicated cases, subsidence of the disease is followed by reconstitution of the native architecture. Superimposed bacterial infection, as expected, results in a mixed histologic picture.

Clinical Course. The clinical course of primary atypical pneumonia is extremely varied, even among cases caused by a single pathogen. It may masquerade as a severe upper respiratory tract infection or "chest cold" that goes undiagnosed, or it may present as a fulminant, life-threatening infection in immunocompromised patients. More typically, the onset is that of an acute, nonspecific febrile illness characterized by fever, headache, and malaise, and, later, cough with minimal sputum. Chest radiographs usually reveal transient, ill-defined patches, mainly in the lower lobes. Physical findings are characteristically minimal and indistinguishable from bronchopneumonia, although, particularly with Mycoplasma, lobar consolidations may occur. Because the edema and exudation are both in a strategic position to cause an alveolocapillary block, there may be respiratory distress seemingly out of proportion to the physical and radiographic findings.
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Old 06-27-2011
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Default Mycoplasma-atypical pneumonia

A coupld points to add

1) Erythematous tympanic membranes or bullous myringitis in patients older than 2 years, an uncommon but unique sign

2) Various exanthems including erythema multiforme and Stevens-Johnson syndrome
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Infectious-Diseases, Internal-Medicine-, Pulmonology-, Step-2-Questions

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