A 34-year-old woman having vague chest discomfort

Sunday, 25 March 2012

Question NO 34

A 34-year-old woman, a recent immigrant from Eastern Europe, is
seen with complaints of vague chest discomfort after an upper respiratory
tract infection. She is not a smoker and gives a history of BCG vaccination
when she was an infant. Physical examination is normal. PPD is 10-mm
induration and induced sputum for acid-fast bacilli is negative. CXR is
shown







What is the most likely diagnosis?


a. Granuloma
b. Scar carcinoma
c. Coccidioidomycosis
d. Hamartoma



 What is the next step in the management of this patient?


a. MRI of the chest
b. Fiberoptic bronchoscopy
c. Comparison of previous chest radiograph, if available, and repeat chest radiograph
in 3 mo
d. Treatment with four-drug anti-TB chemotherapy

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