The previous question:

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?
Your answer was Chronic form of Extrinsic Allergic Alveolitis which is incorrect
Acute form of Extrinsic Allergic Alveolitis correct answer
Chronic form of Extrinsic Allergic Alveolitis
Occupational Asthma
Tuberculosis
Viral Pneumonia
Explanation:
The history, clinical findings and Xray are indicative of extrinsic allergic alveolitis. This is a diffuse
granulomatous inflammation in lung parenchyma and airways following repeated exposure to organic
antigens. In the acute form there is a flu like illness with fever, chest tightness, cough and dyspnoea 4 to 6
hours after exposure. In the chronic form there is typically fatigue, upper lobe fibrosis and dyspnoea on
exertion. Causes include farmers lung due to mouldy hay exposure as in this case, birds fanciers lung and
numerous others. A CXR may reveal reticulonodular shadowing in sub acute form and upper lobe fibrosis is
typical of the chronic form. Hugh resolution CT and antigen specific IgG antibodies are useful for the
diagnosis. In occupational asthma you would expect wheeze but not generally fever or malaise.
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Question category: Respiratory
A 28 year old female with asthma which is normally well controlled presents
with worsening wheeze. She states this is associated with a productive cough
and on occasion the sputum has been blood stained. This is also associated
with malaise and severe headache. This has occurred on several occasions
over the last few months. Her family owns a farm. As her father died recently
she has been helping out on the farm. Bloods reveal an eosinophilia and
raised IgE. A CXR shows evidence of pulmonary infiltrates. Which of the
following is the most likely diagnosis?
Aspergilloma
Wegener's Granulomatosis
Tropical pulmonary eosinophilia
Allergic Bronchopulmonary Aspergillosis
Invasive aspergillosis
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