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A 28-Year-Old African American Woman Returns to the Physician for Follow-Up

question 358

Multiple Choice

A 28-year-old African American woman returns to the physician for follow-up of persistent symptoms. She has had a low-grade fever, joint pains, a cough, and shortness of breath for one month. Two weeks ago, she was given a 5-day course of azithromycin without improvement of her symptoms. A chest x-ray showed bilateral upper lobe opacities. She was then prescribed a 10-day course of levofloxacin. She has not noticed any improvement and has now developed painful red bumps on her legs.
She has no other medical problems and takes no other medications. She lives in New York and denies recent travel or any sick contacts. She has been in a relationship with a new male partner for the last 2 months. She does not use tobacco, alcohol, or illicit drugs.
Her temperature is 37.2 C (99 F) , blood pressure is 120/70 mm Hg, pulse is 84/min, and respirations are 16/min. The patient's pulse oximetry is 94% on room air. Examination reveals crackles in the upper lungs bilaterally. Tender, erythematous, non-fluctuant nodules are present on the anterior surfaces of both legs. The remainder of the examination is unremarkable.
Repeat chest x-ray shows bilateral upper lobe opacities that are unchanged.
Which of the following is the most likely diagnosis?

Definitions:

Least Functional

Describes the component, system, or person that performs the lowest in terms of functionality or effectiveness.

Vision

The ability to see; the faculty by which the mind receives information about the environment through the light that enters the eye.

20/200

A measure of visual acuity denoting that what the average person can see from 200 feet away, a person with this level of acuity can only see from 20 feet away.

20/600

20/600 refers to a level of visual acuity where an individual can only see at 20 feet what a person with normal vision can see at 600 feet, indicating severe visual impairment.