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A 34 year old female who works in a pet shop presents with a few days history of fever, chills, unproductive cough
and shortness of breath. She is also complaining of a sore throat, nose bleeds and severe headache. She is also
photophobic. On examination there is a few bibasal crackles. There is evidence of splenomegaly. You notice a few
salmon coloured, blanching, papules on her cheeks. Which of the following is the most likely diagnosis?
Your answer was Q Fever which is incorrect
Psittacosis correct answer
Q Fever
Acute form of Extrinsic Allergic Alveolitis
Chronic form of Extrinsic Allergic Alveolitis
Legionella
Explanation:
The history and clinical findings are characteristic of Chlamydophila psittaci infection. It is a zoonosis and
infects psittacine birds such as parrots, parakeets and cockatoos. This patient is a pet shop keeper and thus
is at risk. It usually presents with pneumonia symptoms however pharyngitis, epistaxis, headache and
photophobia are common features. Horder spots, a facial malar rash, which is described can occur and
resembles rose spots in typhoid. Splenomegaly is found in up to 70%. Often the chest findings are milder
than what the CXR shows. Doxycycline or tetracycline is the treatment of choice. In the acute form of extrinsic
allergic alveolitis a flu like illlness predominates and symptoms occur 4 to 6 hours after exposure of a typical
allergen and splenomegaly and Horder spots are not found. In the chronic form weight loss and shortness of
breath predominate. In Q fever due to coxiella burnetti there is exposure to farm yard animals. In Legionella
GI symptoms and deranged LFTs occur.
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Question category: Respiratory
A 48 year old farmer presents to his GP. He states that often in the evening
following his morning duties of milking the cows and forking hay he feels unwell
with a fever, cough, chest tightness and shortness of breath. This then
resolves and he feels well again by the morning. On examination he has
bibasal inspiratory crackles. A CXR shows diffuse micronodular interstitial
shadowing. Which of the following is the most likely diagnosis?
Acute form of Extrinsic Allergic Alveolitis
Tuberculosis
Occupational Asthma
Viral Pneumonia
Chronic form of Extrinsic Allergic Alveolitis
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