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In Between

Step 1: View clinicals

A 42 year old man presents with exertional dyspnea for 10 years, which rapidly progressed over the last 7 months to the point that it is now present even at rest. He also experienced a nonproductive cough and generalized weakness during the same time. His medical history is unremarkable, he is not on any drugs, and he does not smoke. He worked as a stonecutter for a 10 year period, until 7 years ago. His full blood count is normal, but the ESR is 45mm in the 1st hour.

Step 2: Order all relevant investigations

Tuberculin Test

The tuberculin test is negative

Chest X-Ray

There are mottled opacities and large nodular masses in both lungs, with the right upper and mid zones particularly affected.

HRCT Chest

There are bilateral fibrotic masses, with pulmonary thickening. The fibrosis is predominantly in the upper and mid zones; the nodules are larger on the right side.

Lung Function Tests

The lung function tests demonstrate a mixed obstructive and restrictive pattern.

Step 3: Select appropriate management

Oxygen stat
Antibiotics stat
Influenza Vaccine

Score: ★★☆