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Old 12-15-2012
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Arrow A 20-year-old woman with SOB

A 20-year-old woman with a history of well-controlled asthma presents to her physician with a 4-week history of shortness of breath, chest tightness, wheezing, and irritating cough. She started working at the local cotton mill at about the same time the symptoms developed. On further questioning, the patient reveals that the symptoms are worse when she first enters the mill, especially after being away over the weekend. Although the symptoms do persist throughout the week, they are not as severe as they are on Mondays. She denies fever, chills, sweats, or exposure to sick persons. She also does not smoke. Her only medication is an albuterol inhaler, which she used sparingly until the development of her current symptoms. Her temperature is 36.7įC (98įF), heart rate is 85/min, blood pressure is 120/80 mm Hg, respiratory rate is 14/min, and oxygen saturation is 99% on room air. Physical examination is unremarkable. X-ray of the chest is normal. Which of the following is the most likely diagnosis?

(A) Byssinosis
(B) Community-acquired pneumonia
(C) Exposure to grain dust
(D) Farmerís lung
(E) Influenza
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Old 12-15-2012
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(D) Farmerís lung
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Old 12-17-2012
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Quote:
Originally Posted by aknz View Post
(D) Farmerís lung

Its not farmer`s lung.

(A) Byssinosis is the correct answer due to exposure to cotton.
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Old 12-17-2012
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Default hyper sensibility neumonitis

I think the answer is C cause this patient has premorbic condition (asthma), now exacerbate for the dust in the factory
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Quote:
Originally Posted by aknz View Post
Its not farmer`s lung.

(A) Byssinosis is the correct answer due to exposure to cotton.
Very good
The correct answer is A.
This presentation is classic for cotton dust exposure, or byssinosis, a type of hypersensitivity pneumonitis. Byssinosis affects workers who are exposed to the processing of cotton, flax, and hemp to make cotton cloth, linen, and rope. Those with asthma and chronic bronchitis tend to be susceptible to byssinosis. Eighty percent of workers exposed to cotton dust may show a significant drop in their FEV1 over the course of a Monday shift (hence the term Monday chest tightness). Removal from exposure to the inciting antigen results in subsiding of symptoms within 12 hours to several days and complete resolution of clinical and radiographic findings within several weeks. X-ray of the chest in early byssinosis typically shows no active disease.

Answer C is incorrect. The findings in workers exposed to grain dust are identical to those in cigarette smokers: persistent cough, mucus secretion, wheezing, dyspnea on exertion, reduced FEV1, and reduced FEV1:FVC.

Answer D is incorrect. Farmerís lung occurs when a person is exposed to moldy hay containing spores of actinomycetes. The inhalation of the spores results in a hypersensitivity pneumonitis. The patient with farmerís lung typically presents 4Ė8 hours after exposure, complaining of fever, chills, malaise, cough, and dyspnea with wheezes. To differentiate this condition from influenza or pneumonia, an adequate history documenting exposure to moldy hay is crucial. Nevertheless, the patientís lack of fever, chills, or sweats, and the cyclical nature of the patientís symptoms, makes byssinosis the most likely diagnosis.
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