#february2020mccqe1
A 60-year-old woman is evaluated for a 2-month history of progressive exertional dyspnea, low-grade fever, and cough. She has never smoked and has worked all her life as a homemaker. Medical history includes 10-year history of hypertension and a 3-month history of atrial fibrillation. Her medications are hydrochlorothiazide, atenolol, amiodarone, and warfarin. On physical examination, temperature is 37.8°C (100.0°F), blood pressure is 138/78 mm Hg, pulse rate is 92/min, respiration rate is 24/min. Oxygen saturation on pulse oximetry is 94% on ambient air. No evidence of jugular venous distention is seen. Heart sounds are normal without extra cardiac sounds or murmur. Bilateral crackles at the lung bases are noted. No clubbing is noted.
Hemoglobin is 11 mg/dL (110 g/L), leukocyte count is 12,800/μL (12.8 × 109/L) with 9% eosinophils. Chest x-ray shows diffuse interstitial infiltrates with basilar predominance. Which of the following is the most likely diagnosis?
(A) Acute eosinophilic pneumonitis
(B) Asbestosis
(C) Drug-induced lung toxicity
(D) Heart failure
A 60-year-old woman is evaluated for a 2-month history of progressive exertional dyspnea, low-grade fever, and cough. She has never smoked and has worked all her life as a homemaker. Medical history includes 10-year history of hypertension and a 3-month history of atrial fibrillation. Her medications are hydrochlorothiazide, atenolol, amiodarone, and warfarin. On physical examination, temperature is 37.8°C (100.0°F), blood pressure is 138/78 mm Hg, pulse rate is 92/min, respiration rate is 24/min. Oxygen saturation on pulse oximetry is 94% on ambient air. No evidence of jugular venous distention is seen. Heart sounds are normal without extra cardiac sounds or murmur. Bilateral crackles at the lung bases are noted. No clubbing is noted.
Hemoglobin is 11 mg/dL (110 g/L), leukocyte count is 12,800/μL (12.8 × 109/L) with 9% eosinophils. Chest x-ray shows diffuse interstitial infiltrates with basilar predominance. Which of the following is the most likely diagnosis?
(A) Acute eosinophilic pneumonitis
(B) Asbestosis
(C) Drug-induced lung toxicity
(D) Heart failure
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