Rosh Internal Medicine Boost Practice Exam

A 20-year-old woman with cystic fibrosis describes chronic cough with foul-smelling sputum and chest X-ray findings of airway dilatation. What is the likely diagnosis?

1. Asthma

2. Bronchiectasis

3. Chronic bronchitis

4. Emphysema

The correct answer is: Bronchiectasis

The scenario described aligns closely with bronchiectasis, particularly in the context of cystic fibrosis. In cystic fibrosis, the abnormal mucus production leads to recurrent infections and inflammation, which often results in damage to the airways. This damage causes the airways to become dilated and thickened, which is characteristic of bronchiectasis. The chronic cough and foul-smelling sputum further support this diagnosis, as the sputum can become infected due to stagnant mucus in the dilated airways, resulting in a characteristic malodorous quality. Bronchiectasis is specifically characterized by the abnormal and permanent enlargement of the airways, and the chest X-ray findings of airway dilatation are a clear indicator of this condition. The patient’s young age, along with the history of cystic fibrosis, strongly correlates with this diagnosis compared to other respiratory conditions that may present with similar symptoms. For instance, asthma typically presents with wheezing and reversible airway obstruction rather than significant structural changes in the airways like those seen in bronchiectasis. Chronic bronchitis might also present with productive cough, but it is often seen in older populations and can be related to smoking or environmental pollutants rather than cystic fibrosis. Emphysema primarily involves the destruction of