06-14-2011, 01:51 PM
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 xray
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
© Thoracentesis
(D) High-resolution chest CT scan with contrast
(E) Open lung biopsy
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 xray
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
© Thoracentesis
(D) High-resolution chest CT scan with contrast
(E) Open lung biopsy