Dry cough and diffuse patchy infiltrates - USMLE Forums
USMLE Forums Logo
USMLE Forums         Your Reliable USMLE Online Community     Members     Posts
Home
USMLE Articles
USMLE News
USMLE Polls
USMLE Books
USMLE Apps
Go Back   USMLE Forums > USMLE Step 2 CK Forum

USMLE Step 2 CK Forum USMLE Step 2 CK Discussion Forum: Let's talk about anything related to USMLE Step 2 CK exam


Reply
 
Thread Tools Search this Thread Display Modes
  #1  
Old 06-26-2011
USMLE-Syndrome's Avatar
USMLE Forums Master
 
Steps History: ---
Posts: 1,203
Threads: 180
Thanked 1,251 Times in 441 Posts
Reputation: 1265
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?

Answer Choices
A. Adult-onset asthma
B. Haemophilus influenzae pneumonia
C. Hypersensitivity pneumonitis
D. Mycoplasma pneumonia
E. Viral pneumonia
Reply With Quote Quick reply to this message



  #2  
Old 06-26-2011
Sadalssud's Avatar
USMLE Forums Addict
 
Steps History: 1 + CK
Posts: 132
Threads: 4
Thanked 107 Times in 62 Posts
Reputation: 117
Default

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.
Reply With Quote Quick reply to this message
  #3  
Old 06-26-2011
USMLE Forums Addict
 
Steps History: 1+CK+CS
Posts: 112
Threads: 20
Thanked 128 Times in 39 Posts
Reputation: 143
Default

E. Viral pneumonia
Reply With Quote Quick reply to this message
  #4  
Old 06-27-2011
USMLE-Syndrome's Avatar
USMLE Forums Master
 
Steps History: ---
Posts: 1,203
Threads: 180
Thanked 1,251 Times in 441 Posts
Reputation: 1265
Default

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.

High-yield Hit 1
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.
Reply With Quote Quick reply to this message
The above post was thanked by:
Sadalssud (06-27-2011)
  #5  
Old 06-27-2011
1TA2B's Avatar
USMLE Forums Guru
 
Steps History: CK Only
Posts: 475
Threads: 39
Thanked 351 Times in 169 Posts
Reputation: 374
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
__________________
Skill+Hardwork+Preparation=Success
To view links or images in signatures your post count must be 10 or greater. You currently have 0 posts.

Reply With Quote Quick reply to this message
The above post was thanked by:
Sadalssud (06-27-2011)



Reply

Tags
Infectious-Diseases, Internal-Medicine-, Pulmonology-, Step-2-Questions

Quick Reply
Message:
Options

Register Now

In order to be able to post messages on the USMLE Forums forums, you must first register.
Please enter your desired user name, your email address and other required details in the form below.
User Name:
Password
Please enter a password for your user account. Note that passwords are case-sensitive.
Password:
Confirm Password:
Email Address
Please enter a valid email address for yourself.
Email Address:
Medical School
Choose "---" if you don't want to tell. AMG for US & Canadian medical schools. IMG for all other medical schools.
USMLE Steps History
What steps finished! Example: 1+CK+CS+3 = Passed Step 1, Step 2 CK, Step 2 CS, and Step 3.

Choose "---" if you don't want to tell.

Favorite USMLE Books
What USMLE books you really think are useful. Leave blank if you don't want to tell.
Location
Where you live. Leave blank if you don't want to tell.

Log-in

Human Verification

In order to verify that you are a human and not a spam bot, please enter the answer into the following box below based on the instructions contained in the graphic.



Thread Tools Search this Thread
Search this Thread:

Advanced Search
Display Modes


Similar Threads
Thread Thread Starter Forum Replies Last Post
The number one cause of chronic cough! aghammoud85 USMLE Step 2 CK Forum 3 06-15-2011 05:22 AM
Malaise, Diffuse Red Rash, Fever, ...etc Yallah USMLE Step 1 Forum 5 06-26-2010 09:42 AM
yallow white patchy areas on colon wall Seetal USMLE Step 1 Forum 3 04-08-2010 11:45 AM
Fever and Cough Sarah-cali USMLE Step 1 Forum 7 03-07-2010 05:01 PM
Heart Failure + Cough Farazdaq USMLE Step 2 CK Forum 3 03-02-2010 06:49 PM

RSS Feed
Find Us on Facebook
vBulletin Security provided by vBSecurity v2.2.2 (Pro) - vBulletin Mods & Addons Copyright © 2017 DragonByte Technologies Ltd.

USMLE® & other trade marks belong to their respective owners, read full disclaimer
USMLE Forums created under Creative Commons 3.0 License. (2009-2014)