Question :

a non -smoking 26 y/o female sees an internist for evaluation for a 5 month HX of cough , wheezing , nasal congestion & wt loss . she repoorts no reflux . she immigrated from Guyana 5 yrs ago & had no significant PMH in her native country . she took no medications until recentky when she was treated with abx , inhaled & systemic steroids  & Albuterol in the ED . despite therapy symptoms have persisted & a leuko riene inhibitor was added with little relief of symptoms . LAbs were noted for a leuckocytosis (28000 ) with with a differential of 58% eosinophils (16000) . ESR was 37 . serum chemistry was unremarkable with negative ANA . PFT’s showed FVC 61 % with FEV 1 65 % with broncho dilator response. FEV1/FVC 85 : TLC 65% . Functional residual capapcity 50 % : residual vol 54 % : DLco 54 % : ABG showed Ph 7.41 : Pco2 : 36 PO2 102: O2 sat 98 % on RA & A-a grad of 5 . Chest X ray reveals a fine interstitial infiltrate. & CT shows a fine nodular pattern in both middle & lower lung fields :

 

Q1 : which of the following diagnostic approach is most appropriate to assess the pt’s condition :

A : perform bronch with BAL :

B : measure serum IgG 4 level:

C perform open lung Biopsy :

D : perform aspergillus ppt

E : test for OVA & parasites stool

Q 2 :

which of the following is the most appropriat treatment ?

A : amphotericin :

B diethyl carbamazapine :

c: Inhaeld steroids :

D : itraconazole :

E : Systemic steroids

 

 

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