A crazy cause for dyspnea

Case presentation An 18-year-old black woman presented with fever, ear pain, and dull discomfort on the right side of the chest that was unchanged with movement or inspiration. She had no other symptoms and had previously been well, aside from mild exercise-induced asthma. Chest radiography was performed, and the images showed air-space opacities in the base of the right lung and the perihilar region of the left lung.

Posteroanterior radiograph of the chest showing air-space opacities in the base of the right lung and the perihilar region of the left lung. Lateral radiograph of the chest

Medical history Exercise-induced asthma. Which had never required glucocorticoid therapy or hospitalization. Pneumothorax at birth eczema

Question 1 Which of the following empirical outpatient treatment regimens are appropriate for community-acquired pneumonia in a generally healthy adult who has not recently taken antibiotics? (choose all answers that are collect)

Initial trestment A 5-day course of azithromycin was prescribed. The patient’s smptoms resolved within 24 hours, and 1 week later CR showed that infiltrates had diminished. The patient returned several months later, reporting a nonproductinve cough and dyspnea on exertion. Frequent coughing spells had forced her to discontinue participation in competitive soccer and in dance. Initially, the dyspnea occurred only with coughing, but it slowly progressed to the point ant which if was limiting her ability to engage in the activity of daily living. Despite the daily use of inhaled abuterol. She had fevers, chills, or night sweats, and her weight was stable. Pulmonary-function test could not be completed because of frequent coughing.

The patient was referred for asthma education, through which potential home triggers (a cat and wall-to-wall carpeting) were identified; poor inhaler technique was noted. She was given a spacer and peak- flow meter. Began using a fluticasone- salmeteral combination inhaler, and started taking loratadine.

QUESTION 2 What was the most accurate interpretation the CR.

Which one of the following should be considered in the differential diagnosis at this point ?

Question 4 Patient resumed taking azithromycin, which resulted in on change in the symptoms or a repeat radiograph. Which of the following addition tests would be most appropriate to order now?

Further testing A sputum culture grew only normal oral flora, and tests for antinuclear antibodies were negative. The correct carbon monoxide diffusing capacity was 36% of the predicted value. Baseline oxygen saturation on treadmill testing was 97%, with desaturation to 85% when the patient was walking at 1.8 mph.

Question 5 Which of the following ventilatory abnormalitis is suggested by the results of the pulmonary-function test.