USMLE Forum Archives - USMLE Step 3 - A 49-year-old woman
A 49-year-old woman
meduploader - 05-07-09 14:19
A 49-year-old woman has a 3-week history of a persistent cough that is generally dry but is occasionally mildly productive. Over-the-counter antitussive agents have been ineffective. The patient received a heart transplant 5 years ago for refractory congestive heart failure. She experienced several rejection episodes during the first post-transplant year but has been doing well since then. Current medications are mycophenolate mofetil, sirolimus, and prednisone, 5 mg daily. She has no other medical problems, is a lifelong nonsmoker, and has received pneumococcal polysaccharide vaccine and annual influenza immunizations.
On physical examination, temperature is 37.4 °C (99.3 °F), pulse rate is 86/min, respiration rate is 17/min, and blood pressure is 133/75 mm Hg. No crackles or rhonchi are heard, and the remainder of the examination is normal. Hemoglobin is 12.0 g/dL, the leukocyte count is 8300/μL with a normal differential, and the platelet count is 155,000/μL. A chest radiograph shows stable mild cardiomegaly and very mild cardiovascular congestion.
Which of the following is the most likely diagnosis?
meduploader - 05-07-09 14:19
A 49-year-old woman has a 3-week history of a persistent cough that is generally dry but is occasionally mildly productive. Over-the-counter antitussive agents have been ineffective. The patient received a heart transplant 5 years ago for refractory congestive heart failure. She experienced several rejection episodes during the first post-transplant year but has been doing well since then. Current medications are mycophenolate mofetil, sirolimus, and prednisone, 5 mg daily. She has no other medical problems, is a lifelong nonsmoker, and has received pneumococcal polysaccharide vaccine and annual influenza immunizations.
On physical examination, temperature is 37.4 °C (99.3 °F), pulse rate is 86/min, respiration rate is 17/min, and blood pressure is 133/75 mm Hg. No crackles or rhonchi are heard, and the remainder of the examination is normal. Hemoglobin is 12.0 g/dL, the leukocyte count is 8300/μL with a normal differential, and the platelet count is 155,000/μL. A chest radiograph shows stable mild cardiomegaly and very mild cardiovascular congestion.
Which of the following is the most likely diagnosis?
The correct answer and explanation will be available after you answer.
Page 1
#6
Re: A 49-year-old woman zkadhem - 07-14-09 14:43 "Although Pneumocystis jiroveci (formerly Pneumocystis carinii) pneumonia may be possible, the timing is incompatible, as this infection usually develops from the second month to the end of the first year post transplant. Exceptions occur in patients with organ rejection (and consequently with increased immunosuppression) and in lung transplant recipients."
This is good information, thank you meduploader.
#16
Re: A 49-year-old woman babbu5508 - 08-30-10 00:37 My answer is: a.
3-week history of a persistent cough that is generally dry but is occasionally mildly productive. Over-the-counter antitussive agents have been ineffective.
Page 1