childhood asthma history...now presenting with wheezing and eosinophhilia - USMLE Forums
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Old 06-25-2012
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Default childhood asthma history...now presenting with wheezing and eosinophhilia

A 56-year-old woman with a history of asthma since childhood
presents to her physician's office because of a cough of 3 to 4
weeks' duration. The patient states that the cough produces
yellowish sputum and is associated with fever and some
difficulty breathing. She recently completed a course of oral
antibiotics without improvement. The patient also reports
generalized weakness, fatigue, anorexia, and night sweats over
the same time period. Her HIV test was negative 2 years ago..
The patient is afebrile with mild respiratory distress. There is
scattered wheezing upon auscultation of the lungs. Laboratory
studies show: WBC 6,000/mm3, differential: neutrophils 47%,
lymphocytes 18%, eosinophils 32%; and hematocrit 39%. Chest
x-ray shows bilateral peripheral infiltrates and a small right
pleural effusion. What is your plan for this patient?
(A) Sputum culture
(B) Bronchoscopy for lavage and transbronchial biopsy
(C) Thoracentesis
(D) High-resolution chest CT scan with contrast
(E) Open lung biopsy
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Old 06-25-2012
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