Quiz 18 Context:
A 60-year-old female presents for evaluation of exercise related dyspnea and chronic dry cough. The symptoms have been present and progressive for several months. There have been no associated fevers or chills. The patient reports a previous history of smoking. There is no history of environmental exposure, cardiac disease, connective tissue disease, or exposure to medications or drugs with these adverse effects. A recent evaluation found no infectious or cardiac explanation for these symptoms.
Physical examination reveals a patient in no distress. Vital signs are normal. The exam is notable for dry rales at the bases of the lung fields as well as clubbing.
A previously obtained chest radiograph was abnormal; as a result a CT of the chest is obtained and shown above.
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The history, exam, and chest CT are most consistent with which of the following?
- Pericardial effusion
- Pneumonia, community acquired
- Idiopathic pulmonary fibrosis