TABLE IV-114 Risk Factors for Active Tuberculosis Among Persons Who Have Been Infected With Tubercle Bacilli 12 page

V-83. The answer is B.(Chap. 248) Abdominal aortic aneurysms (AAAs) affect 1-2% of men older than age 50. Most AAAs are asymptomatic and are found incidentally on physical examination. The predisposing factors for AAA are the same as those for other cardiovascular disease, with over 90% being associated with atherosclerotic disease. Most AAAs are located infrarenally, and recent data suggest that an uncomplicated infrarenal AAA may be treated with endovascular stenting instead of the usual surgical grafting. Indications for proceeding to surgery include any patient with symptoms or an aneurysm that is growing rapidly. Serial ultrasonography or CT imaging is imperative, and all aneurysms larger than 5.5 cm warrant intervention because of the high mortality associated with repair of ruptured aortic aneurysms. The rupture rate of an AAA is directly related to size, with the 5-year risk of rupture being 1-2% with aneurysms less than 5 cm and 20-40% with aneurysms greater than 5 cm. The mortality of patients undergoing elective repair is 1-2% and is greater than 50% for the emergent treatment of a ruptured AAA. Preoperative cardiac evaluation before elective repair is imperative, as coexisting coronary artery disease is common.

V-84. The answer is E.(Chap. 248) Aortitis and ascending aortic aneurysms are commonly caused by cystic medial necrosis and mesoaortitis that result in damage to the elastic fibers of the aortic wall with thinning and weakening. Many infectious, inflammatory, and inherited conditions have been associated with this finding, including syphilis, tuberculosis, mycotic aneurysm, Takayasu's arteritis, giant cell arteritis, rheumatoid arthritis, and the spondyloarthropathies (ankylosing spondylitis, psoriatic arthritis, Reiter's syndrome, Behcet's disease). In addition, it can be seen with the genetic disorders Marfan's syndrome and Ehlers-Danlos syndrome.

V-85. The answer is E.(Chap. 248) Descending aortic aneurysms are most commonly associated with atherosclerosis. The average growth rate is approximately 0.1-0.2 cm yearly. The risk of rupture and subsequent management are related to the size of the aneurysm as well as symptoms related to the aneurysm However, most thoracic aortic aneurysms are asymptomatic. When symptoms do occur, they are frequently related to mechanical complications of the aneurysm causing compression of adjacent structures. This includes the trachea and esophagus, and symptoms can include cough, chest pain, hoarseness, and dysphagia. The risk of rupture is approximately 2-3% yearly for aneurysms less than 4 cm and increases to 7% per year once the size is greater than 6 cm Management of descending aortic aneurysms includes blood pressure control. Beta blockers are recommended because they decrease the contractility of the heart and thus decrease aortic wall stress, potentially slowing aneurysmal growth. Individuals with thoracic aortic aneurysms should be monitored with chest imaging at least yearly, or more frequently if new symptoms develop. This can include CT angiography, MRI, or transesophageal echocardiography. Operative repair is indicated if the aneurysm expands by more than 1 cm in a year or reaches a diameter of more than 5.5-6.0 cm Endovascular stenting for the treatment of thoracic aortic aneurysms is a relatively new procedure with limited long-term results available. The largest study to date included more than 400 patients with a variety of indications for thoracic endovascular stents. In 249 patients, the indication for stent was thoracic aortic aneurysm This study showed an initial success rate of 87.1%, with a 30-day mortality rate of 10%. However, if the procedure was done emergently, the mortality rate at 30 days was 28%. At 1 year, data were available on only 96 of the original 249 patients with degenerative thoracic aneurysms. In these individuals, 80% continued to have satisfactory outcomes with stenting and 14% showed growth of the aneurysm (LJ Leurs, J Vase Surg 40:670, 2004). Ongoing studies with long-term follow-up are needed before endovascular stenting can be recommended for the treatment of thoracic aortic aneurysms, although in individuals who are not candidates for surgery, stenting should be considered.

V-86. The answer is C.(Chap. 249) The patient presents with classic signs of arterial occlusion with limb pain, physical examination showing pallor, and a pulseless, cold leg. She has no risk factors for central or peripheral atherosclerotic disease; thus angiogram would simply confirm the diagnosis of arterial occlusion, not demonstrate her predisposing condition. In the absence of fever or systemic symptoms, vasculitis and endocarditis are unlikely sources of arterial embolization. She likely had a paradoxical embolism in the context of an atrial septal defect, which was the source of her childhood murmur. Because many of these patients develop pulmonary hypertension with time, she is now at risk for a paradoxical embolism Although in this context, arterial emboli frequently originate from venous thrombus, the thrombi cannot produce a paradoxical embolism in the absence of right-to-left shunt, such as in a large patent foramen ovale or an atrial septal defect.

SECTION VI

Disorders of the Respiratory System

QUESTION

DIRECTIONS: Choose the one best response to each question.

VI-1. Which of the following statements regarding auscultation of the chest is TRUE?

A. Absence of breath sounds in a hemithorax is almost always associated with a pneumothorax.

B. An astute clinician should be able to differentiate “wet” from “dry” crackles.

C. “Cardiac asthma” refers to wheezing associated with alveolar edema in congestive heart failure.

D. Rhonchi are a manifestation of obstruction of mediumsized airways.

E. The presence of egophony can be used to distinguish pulmonary fibrosis from alveolar filling.

VI-2. A 72-year-old male with a long history of tobacco use is seen in the clinic for 3 weeks of progressive dyspnea on exertion. He has had a mild nonproductive cough and anorexia but denies fevers, chills, or sweats. On physical examination, he has normal vital signs and normal oxygen saturation on room air. Jugular venous pressure is normal, and cardiac examination shows decreased heart sounds but no other abnormality. The trachea is midline, and there is no associated lymphadenopathy. On pulmonary examination, the patient has dullness over the left lower lung field, decreased tactile fremitus, decreased breath sounds, and no voice transmission. The right lung examination is normal. After obtaining chest plain film, appropriate initial management at this point would include which of the following?

A. Intravenous antibiotics

B. Thoracentesis

C. Bronchoscopy

D. Deep suctioning

E. Bronchodilator therapy

VI-3. At what lung volume does the outward recoil of the chest wall equal the inward elastic recoil of the lung?

A. Expiratory reserve volume

B. Functional residual capacity

C. Residual volume

D. Tidal volume

E. Total lung capacity

VI-4. A 65-year-old man is evaluated for progressive dyspnea on exertion that has occurred over the course of the past 3 months. His medical history is significant for an episode of necrotizing pancreatitis that resulted in multiorgan failure and acute respiratory distress syndrome. He required mechanical

ventilation for 6 weeks prior to his recovery. He also has a history of 30 pack-years of tobacco, quitting 15 years previously. He is not known to have chronic obstructive pulmonary disease. On physical examination, a low-pitched inspiratory and expiratory wheeze is heard that is loudest over the mid-chest area. On pulmonary function testing, the forced expiratory volume in 1 second is 2.5 L (78% predicted), forced vital capacity is 4.00 L (94% predicted), and the FEV₁/FVC ratio is 62.5%. The flow volume curve is shown in Figure VI-4. What is the most likely cause of the patient’s symptoms?

FIGURE VI-4

A. Aspirated foreign body

B. Chronic obstructive pulmonary disease

C. Idiopathic pulmonary fibrosis

D. Subglottic stenosis

E. Unilateral vocal cord paralysis

VI-5. A 32-year-old woman presents to the emergency department in her 36th week of pregnancy complaining of acute dyspnea. She has had an uncomplicated pregnancy and has no other medical problems. She is taking no medications other than prenatal vitamins. On examination, she appears dyspneic. Her vital signs are as follows: blood pressure 128/78, heart rate 126 beats/min, respiratory rate 28 breaths/min, and oxygen saturation is 96% on room air. She is afebrile. Her lung and cardiac examinations are normal. There is trace bilateral pitting pedal edema. A chest x-ray performed with abdominal shielding is normal, and the ECG demonstrates sinus tachycardia. An arterial blood gas is performed. The pH is 7.52, PaCO₂ is 26 mmHg, and PaO₂ is 85 mmHg. What is the next best step in the diagnosis and management of this patient?

A. Initiate therapy with amoxicillin for acute bronchitis.

B. Perform a CT pulmonary angiogram.

C. Perform an echocardiogram.

D. Reassure the patient that dyspnea is normal during this stage of pregnancy and no abnormalities
are seen on testing.

E. Treat with clonazepam for a panic attack.

VI-6. Match each of the following pulmonary function test results with the respiratory disorder for which

they are the most likely findings.

A. Increased total lung capacity (TLC), decreased vital capacity (VC), decreased FEV₁/FVC ratio

B. Decreased TLC, decreased VC, decreased residual volume (RV), increased FEV₁/FVC ratio,
normal maximum inspiratory pressure (MIP)

C. Decreased TLC, increased RV, normal FEV₁/FVC ratio, decreased MIP

D. Normal TLC, normal RV, normal FEV₁/FVC ratio, normal MIP

1. Myasthenia gravis

2. Idiopathic pulmonary fibrosis

3. Familial pulmonary hypertension

4. Chronic obstructive pulmonary disease

VI-7. A 78-year-old woman is admitted to the medical intensive care unit with multilobar pneumonia. On initial presentation to the emergency room, her initial oxygen saturation was 60% on room air and only increased to 82% on a non-rebreather face mask. She was in marked respiratory distress and intubated in the emergency room. Upon admission to the intensive care unit, she was sedated and paralyzed. The ventilator is set in the assist-control mode with a respiratory rate of 24, tidal volume of 6 mL/kg, FiO₂

of 1.0, and positive end-expiratory pressure of 12 cmH₂O. An arterial blood gas measurement is

performed on these settings; the results are pH 7.20, PCO₂ of 32 mmHg, and PO₂ of 54 mmHg. What is

the cause of the hypoxemia?

A. Hypoventilation alone

B. Hypoventilation and ventilation-perfusion mismatch

C. Shunt

D. Ventilation-perfusion mismatch

VI-8. A 65-year-old man is evaluated for progressive dyspnea on exertion and dry cough that have worsened over the course of 6 months. He has not had dyspnea at rest and denies wheezing. He has not experienced chest pain. He has a history of coronary artery disease and atrial fibrillation, and underwent coronary artery bypass surgery 12 years ago. His medications include metoprolol, aspirin, warfarin, and enalapril. He previously smoked one pack of cigarettes daily for 40 years, quitting 5 years previously. His vital signs are blood pressure 122/68, heart rate 68 beats/min, respiratory rate 18 breaths/min, and oxygen saturation 92% on room air. His chest examination demonstrates bibasilar crackles present about one-third of the way up bilaterally. No wheezing is heard. He has an irregularly irregular rhythm with a II/VI holosystolic murmur at the apex. The jugular venous pressure is not elevated. No edema is present, but clubbing is noted. Pulmonary function testing reveals a forced expiratory volume in 1 second 65% predicted, forced vital capacity of 67% predicted, FEV₁/FVC ratio of 74%, total lung capacity 68% predicted, and diffusion capacity for carbon monoxide of 62% predicted. Which test is most likely to determine the etiology of the patient’s dyspnea?

A. Bronchoscopy with transbronchial lung biopsy

B. CT pulmonary angiography

C. Echocardiography

D. High-resolution CT scan of the chest

E. Nuclear medicine stress test

VI-9. A 24-year-old woman is seen for a complaint of shortness of breath and wheezing. She reports the symptoms to be worse when she has exercised outdoors and is around cats. She has had allergic rhinitis in the spring and summer for many years and suffered from eczema as a child. On physical examination, she is noted to have expiratory wheezing. Her pulmonary function tests demonstrate a forced expiratory volume in 1 second (FEV₁) of 2.67 (79% predicted), forced vital capacity of 3.81 L (97% predicted), and an FEV₁/FVC ratio of 70% (predicted value 86%). Following administration of albuterol, the FEV₁ increases to 3.0 L (12.4%). Which of the following statements regarding the patient’s disease process is TRUE?

A. Confirmation of the diagnosis will require methacholine challenge testing.

B. Mortality due to the disease has been increasing over the past decade.

C. The most common risk factor in individuals with the disorder is genetic predisposition.

D. The prevalence of the disorder has not changed in the last several decades.

E. The severity of the disease does not vary significantly within a given patient with the disease.

VI-10. A 38-year-old woman is brought to the emergency room for status asthmaticus. She rapidly deteriorates and dies of her disease. All of the following pathologic findings would likely be seen in this individual EXCEPT:

A. Infiltration of the airway mucosa with eosinophils and activated T-lymphocytes

B. Infiltration of the alveolar spaces with eosinophils and neutrophils

C. Occlusion of the airway lumen by mucous plugs

D. Thickening and edema of the airway wall

E. Thickening of the basement membrane of the airways with subepithelial collagen deposition

VI-11. A 25-year-old woman is seen for follow-up of persistent asthma symptoms despite treatment with inhaled fluticasone 88 μg twice daily for the past 3 months. According to the National Asthma Education and Prevention Program guidelines endorsed by the National Institutes of Health, which of the following changes in therapy can be considered?

A. Addition of a leukotriene antagonist.

B. Addition of a long-acting beta-agonist.

C. Addition of low-dose theophylline.

D. Increase the dosage of inhaled corticosteroid.

E. Any of the above can be considered.

VI-12. Which of the following patients is appropriately diagnosed with asthma?

A. A 24-year-old woman treated with inhaled corticosteroids for cough and wheezing that has
persisted for 6 weeks following a viral upper respiratory infection.

B. A 26-year-old man who coughs and occasionally wheezes following exercise in cold weather.

C. A 34-year-old woman evaluated for chronic cough with an FEV₁/FVC ratio of 68% with an

FEV₁ that increases from 1.68 L (52% predicted) to 1.98 L (61% predicted) after albuterol (18% change in FEV₁).

D. A 44-year-old man who works as a technician caring for the mice in a medical research
laboratory complains of wheezing, shortness of breath, and cough that are most severe at the end of
the week.

E. A 60-year-old man who has smoked two packs of cigarettes per day for 40 years who has
dyspnea and cough, and airway hyperreactivity in response to methacholine.

VI-13. A 40-year-old woman with moderate persistent asthma has been under good control for 3 months and is currently using her albuterol MDI for symptomatic control once weekly. She awakens at night twice monthly with asthma symptoms, but continues to exercise regularly without difficulties. Her other medications include fluticasone inhaled 88 μg/puff twice daily and salmeterol 50 μg twice daily. Her FEV₁ is currently at 83% of her personal best. Which action is most appropriate at the present time?

A. Add montelukast 10 mg once daily, as the current albuterol usage suggests poor asthma control.

B. Decrease the fluticasone to 44 μg/puff twice daily.

C. Discontinue the fluticasone.

D. Discontinue the salmeterol.

E. Do nothing, as the current albuterol usage suggests poor asthma control.

VI-14. You are considering omalizumab therapy for a patient with severe persistent asthma who is requiring oral prednisone at 5–10 mg daily in addition to high-dose inhaled corticosteroids, long-acting bronchodilators, and montelukast to control her symptoms. Which of the following is necessary prior to initiating omalizumab?

A. Discontinuation of oral prednisone

B. Demonstrated elevation in immunoglobulin E levels to greater than 1000 IU/L

C. Normalization of FEV₁ or peak expiratory flow rates

D. Presence of sensitivity to a perennial aeroallergen

E. Switch oral prednisone to intravenous prednisolone

VI-15. A 76-year-old woman is evaluated for acute onset of shortness of breath and dry cough for the past 2 days. She also has had a fever to as high as 102.5°F (39.2°C). Her past medical history includes hypothyroidism and diabetes mellitus. She currently is taking metformin 1000 mg twice daily. Her levothyroxine dose was increased to 100 μg daily 1 month ago, and she was prescribed nitrofurantoin 100 mg twice daily 3 days ago for a urinary tract infection. Her vital signs show a blood pressure of 115/82, heart rate of 96 beats per minute, respiratory rate of 24 breaths per minute, temperature of 101.3°F (38.5°C), and oxygen saturation of 94% on room air. There is dullness to percussion and decreased breath sounds at the right lung base. Crackles are heard bilaterally as well. A chest radiograph shows a moderate right-sided pleural effusion, and patchy bilateral lung infiltrates are seen. The patient is admitted to the hospital. A thoracentesis is performed demonstrating an exudative effusion. The fluid has a white cell count of 3500/mm³ with a differential of 60% polymorphonuclear cells, 30% eosinophils, and 10% lymphocytes. A bronchoscopy is performed that shows a differential of 50% polymorphonuclear cells, 15% eosinophils, and 35% alveolar macrophages. Which of the following would be the most important next step in the treatment of this patient?

A. Await pleural fluid cultures before making a treatment recommendation.

B. Decrease levothyroxine dose.

C. Discontinue nitrofurantoin.

D. Increase levothyroxine dose.

E. Initiate treatment with high-dose steroid therapy (methylprednisolone 1 g daily).

VI-16. A 34-year-old female seeks evaluation for a complaint of cough and dyspnea on exertion that has gradually worsened over 3 months. The patient has no past history of pulmonary complaints and has never had asthma. She started working in a pet store approximately 6 months ago. Her duties there include cleaning the reptile and bird cages. She reports occasional low-grade fevers but has had no wheezing. The cough is dry and nonproductive. Before 3 months ago the patient had no limitation of exercise tolerance, but now she reports that she gets dyspneic climbing two flights of stairs. On physical examination the patient appears well. She has an oxygen saturation of 95% on room air at rest but desaturates to 89% with ambulation. Temperature is 37.7°C (99.8°F). The pulmonary examination is unremarkable. No clubbing or cyanosis is present. The patient has a normal chest radiogram. A high-resolution chest CT shows diffuse ground-glass infiltrates in the lower lobes with the presence of centrilobular nodules. A trans-bronchial biopsy shows an interstitial alveolar infiltrate of plasma cells, lymphocytes, and occasional eosinophils. There are also several loose noncaseating granulomas. All cultures are negative for bacterial, viral, and fungal pathogens. What is the diagnosis?

A. Aspergillosis

B. Hypersensitivity pneumonitis

C. Nonspecific interstitial pneumonitis related to collagen vascular disease

D. Psittacosis

E. Sarcoidosis

VI-17. What treatment do you recommend for the patient in question VI-16?

A. Amphotericin

B. Doxycycline

C. Glucocorticoids

D. Glucocorticoids plus azathioprine

E. Glucocorticoids plus removal of antigen

VI-18. A 75-year-old man is evaluated for a new left-sided pleural effusion and shortness of breath. He worked as an insulation worker at a shipyard for more than 30 years and did not wear protective respiratory equipment. He has a 50 pack-year history of tobacco with known moderate COPD (FEV₁

55% predicted) and prior history of myocardial infarction 10 years previously. His current medications include aspirin, atenolol, benazepril, tiotropium, and albuterol. His physical examination is consistent with a left-sided effusion with dullness to percussion and decreased breath sounds occurring over one-half of the hemithorax. On chest x-ray, there is a moderate left-sided pleural effusion with bilateral pleural calcifications and left apical pleural thickening. No lung mass is seen. A chest CT confirms the findings on chest x-ray and also fails to show a mass. There is compressive atelectasis of the left lower lobe. A thoracentesis is performed that demonstrates an exudative effusion with 65% lymphocytes, 25% mesothelial cells, and 10% neutrophils. Cytology does not demonstrate any malignancy. Which of the

following statements regarding the most likely cause of the patient’s effusion is TRUE?

A. Cigarette smoking increases the likelihood of developing the condition.

B. Death in this disease is usually related to diffuse metastatic disease.

C. Exposure to the causative agent can be as little as 1–2 years, and latency to expression of
disease may be as great as 40 years.

D. Repeated pleural fluid cytology will most likely lead to a definitive diagnosis.

E. Therapy with a combination of surgical resection and adjuvant chemotherapy significantly
improves long-term survival.

VI-19. Chronic silicosis is related to an increased risk of which of the following conditions?

A. Infection with invasive Aspergillus

B. Infection with Mycobacterium tuberculosis

C. Lung cancer

D. Rheumatoid arthritis

E. All of the above

VI-20. All of the following occupational lung diseases are correctly matched with their exposure EXCEPT:

A. Berylliosis—High-technology electronics

B. Byssinosis—Cotton milling

C. Farmer’s lung—Moldy hay

D. Progressive massive fibrosis—Shipyard workers

E. Metal fume fever—Welding

VI-21. A 45-year-old male is evaluated in the clinic for asthma. His symptoms began 2 years ago and are characterized by an episodic cough and wheezing that responded initially to inhaled bronchodilators and inhaled corticosteroids but now require nearly constant prednisone tapers. He notes that the symptoms are worst on weekdays but cannot pinpoint specific triggers. His medications are an albuterol MDI, a fluticasone MDI, and prednisone 10 mg po daily. The patient has no habits and works as a textile worker. Physical examination is notable for mild diffuse polyphonic expiratory wheezing but no other abnormality. Which of the following is the most appropriate next step?

A. Exercise physiology testing

B. Measurement of FEV₁ before and after work

C. Methacholine challenge testing

D. Skin testing for allergies

E. Sputum culture for Aspergillus fumigatus

VI-22. A 53-year-old male is seen in the emergency department with sudden-onset fever, chills, malaise, and shortness of breath, but no wheezing. He has no significant past medical history and is a farmer. Of note, he worked earlier in the day stacking hay. PA and lateral chest radiography show bilateral upper lobe infiltrates. Which organism is most likely to be responsible for this presentation?

A. Nocardia asteroides

B. Histoplasma capsulatum

C. Cryptococcus neoformans

D. Actinomyces

E. Aspergillus fumigatus

VI-23. All of the following conditions are associated with an increased risk of methicillin-resistant Staphylococcus aureus as a cause of health care–associated pneumonia EXCEPT:

A. Antibiotic therapy in the preceding 3 months

B. Chronic dialysis

C. Home wound care

D. Hospitalization for more than 2 days in the preceding 3 months

E. Nursing home residence

VI-24. Which of the following statements regarding the diagnosis of community-acquired pneumonia is TRUE?

A. Directed therapy specific to the causative organism is more effective than empirical therapy in
hospitalized patients who are not in intensive care.

B. Five percent to 15% of patients hospitalized with community-acquired pneumonia will have
positive blood cultures.

C. In patients who have bacteremia caused by Streptococcus pneumoniae, sputum cultures are
positive in more than 80% of cases.

D. Polymerase chain reaction tests for identification of Legionella pneumophila and Mycoplasma
pneumoniae are widely available and should be utilized for diagnosis in patients hospitalized with
community-acquired pneumonia.

E. The etiology of community-acquired pneumonia is typically identified in about 70% of cases.

VI-25. A 55-year-old man presents to his primary care physician with a 2-day history of cough and fever. His cough is productive of thick, dark green sputum. His past medical history is significant for hypercholesterolemia treated with rosuvastatin. He does not smoke cigarettes and is generally quite healthy, exercising several times weekly. He has no ill contacts and cannot recall the last time he was treated with any antibiotics. On presentation, his vital signs are as follows: temperature 102.1°F (38.9°C), blood pressure 132/78, heart rate 87 beats/min, respiratory rate 20 breaths/min, and oxygen saturation 95% on room air. Crackles are present in the right lung base with egophony. A chest radiograph demonstrates segmental consolidation of the right lower lobe with air bronchograms. What is the most appropriate approach to the ongoing care of this patient?

A. Obtain a sputum culture and await results prior to initiating treatment.

B. Perform a chest CT to rule out postobstructive pneumonia.

C. Refer to the emergency department for admission and treatment with intravenous antibiotics.

D. Treat with doxycycline 100 mg twice daily.

E. Treat with moxifloxacin 400 mg daily.

VI-26. A 65-year-old woman is admitted to the intensive care unit for management of septic shock

associated with an infected hemodialysis catheter. She was initially intubated on hospital day 1 for acute respiratory distress syndrome. She has slowly been improving such that her FIO₂ was weaned to

0.40, and she was no longer febrile or requiring vasopressors. On hospital day 7, she develops a new fever to 39.4°C (102.9°F) with increased thick, yellow-green sputum from her endotracheal tube. You suspect the patient has ventilator-associated pneumonia. What is the best way to make a definitive diagnosis in this patient?

A. Endotracheal aspirate yielding a new organism typical of a ventilator-associated pneumonia.

B. Presence of a new infiltrate on chest radiograph.

C. Quantitative cultures from an endotracheal aspirate yielding more than 10⁶ organisms typical of
ventilator-associated pneumonia.

D. Quantitative culture from a protected brush specimen yielding more than 10³ organisms typical
of ventilator-associated pneumonia.

E. There is no single set of criteria that is reliably diagnostic of pneumonia in a ventilated patient.

VI-27. Which of the following associations correctly pairs clinical scenarios and community-acquired pneumonia (CAP) pathogens?

A. Aspiration pneumonia: Streptococcus pyogenes

B. Heavy alcohol use: Atypical pathogens and Staphylococcus aureus

C. Poor dental hygiene: Chlamydia pneumoniae, Klebsiella pneumoniae

D. Structural lung disease: Pseudomonas aeruginosa, S. aureus

E. Travel to southwestern United States: Aspergillus spp.

VI-28. Which of the following is the most common cause of diffuse bronchiectasis worldwide?

A. Cystic fibrosis

B. Immunoglobulin deficiency

Date: 2016-04-22; view: 1350