{"id":861,"date":"2016-03-08T15:00:20","date_gmt":"2016-03-08T15:00:20","guid":{"rendered":"http:\/\/hfhpulm.com\/info\/?p=861"},"modified":"2016-03-08T15:03:23","modified_gmt":"2016-03-08T15:03:23","slug":"861","status":"publish","type":"post","link":"https:\/\/hfhpulm.com\/info\/?p=861","title":{"rendered":"Wheezing"},"content":{"rendered":"

You have a 24-year-old female with a history of juvenile rheumatoid arthritis, treated with hydroxychloroquine who sees you in clinic for a new consultation. She reports a history of dyspnea on exertion that has been slowly progressive over the previous six weeks. She is now short of breath with walking 40 steps on flat surface. She has no cough, sputum production, fevers, weight loss, or night sweats. She had worked on a farm and was exposed to mice, birds, ducks and rabbits starting eight weeks ago. There are mild inspiratory and expiratory wheezes on lung examination. PFTs from four years prior were normal but now demonstrate a very severe obstructive ventilatory defect, no significant response to bronchodilators, and air trapping and hyperinflation (TLC-133% and RV-326%).
\nExpiratory (top figure) and Inspiratory (bottom figure) cuts from Chest CT are shown below:<\/p>\n

\"expiratory<\/a> \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \"inspiratory\"<\/a><\/p>\n

 <\/p>\n

What is the most likely diagnosis?
\nAsthma
\nHypersensitivity pneumonitis
\nConstrictive bronchiolitis<\/span>
\nAllergic bronchopulmonary aspergillosis
\nChronic bronchitis <\/span><\/p>\n

 <\/p>\n

 <\/p>\n","protected":false},"excerpt":{"rendered":"

You have a 24-year-old female with a history of juvenile rheumatoid arthritis, treated with hydroxychloroquine who sees you in clinic for a new consultation. She reports a history of dyspnea on exertion that has been slowly progressive over the previous six weeks. She is now short of breath with walking 40 steps on flat surface. […]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_lmt_disableupdate":"","_lmt_disable":"","_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"footnotes":""},"categories":[96],"tags":[],"class_list":["post-861","post","type-post","status-publish","format-standard","hentry","category-curriculum"],"modified_by":"Geneva Tatem","_links":{"self":[{"href":"https:\/\/hfhpulm.com\/info\/index.php?rest_route=\/wp\/v2\/posts\/861","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/hfhpulm.com\/info\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/hfhpulm.com\/info\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/hfhpulm.com\/info\/index.php?rest_route=\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/hfhpulm.com\/info\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=861"}],"version-history":[{"count":10,"href":"https:\/\/hfhpulm.com\/info\/index.php?rest_route=\/wp\/v2\/posts\/861\/revisions"}],"predecessor-version":[{"id":874,"href":"https:\/\/hfhpulm.com\/info\/index.php?rest_route=\/wp\/v2\/posts\/861\/revisions\/874"}],"wp:attachment":[{"href":"https:\/\/hfhpulm.com\/info\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=861"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/hfhpulm.com\/info\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=861"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/hfhpulm.com\/info\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=861"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}