A 20-Year-Old Man with Known Cystic Fibrosis Is Evaluated for Productive

question 598

Multiple Choice

A 20-year-old man with known cystic fibrosis is evaluated for productive cough, dyspnea, and malaise that have progressively worsened over the last 3 months.  He describes daily brownish sputum production and episodes of wheezing/chest tightness partially relieved by albuterol inhaler.  One month ago, he was hospitalized and treated with intravenous antibiotics.  He received saline nebulizer, azithromycin, inhaled tobramycin, and chest physiotherapy.  The patient has no other medical problems.  His medications include dornase alfa, pancrelipase, hypertonic saline therapy, and a short-acting albuterol inhaler as needed.
His temperature is 36.6° C (98° F) and BMI is 20 kg/m².  Examination shows pale conjunctivae.  There are bilateral scattered rhonchi and wheezes with prolonged expiration on auscultation.
Laboratory results are as follows:

Chest x-ray shows new bilateral patchy upper-lobe infiltrates compared to prior x-rays.
Which of the following is the most likely diagnosis?

• A)Allergic bronchopulmonary aspergillosis
• B)Atypical mycobacterial infection
• C)Churg-Strauss syndrome
• D)Drug-induced eosinophilic pneumonia
• E)Sarcoidosis

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Definitions:

Trait Approach

A perspective in leadership theory that suggests certain personality traits and characteristics are linked to being an effective leader.

Situations

Contexts or scenarios that can have an impact on events, decisions, and outcomes.

High Subjectivity

A state or condition where personal opinions, feelings, and biases heavily influence judgment or analysis.

Leadership Emergence

The process by which individuals become recognized as leaders by their peers or within organizations, often through their actions and qualities.