A 34-year-old woman having vague chest discomfort

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

A 40-year-old male smoker presents with a history of chronic cough

Question NO 33

 A 40-year-old male smoker presents with a history of chronic cough. He
has had symptoms of an upper respiratory illness for a few months since
visiting family in Arizona. Physical exam is normal. CXR is shown below in

The next step in management should be



a. Complete pulmonary function tests
b. Fiberoptic bronchoscopy
c. Percutaneous needle biopsy
d. Observation and repeat CXR in 6 to 8 mo