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Retired NBME Step 2 CK Form 8 Answers
merpaperple
"bronchiectasis would be less likely to lead to diffuse lung changes" - idk about that? You can't even really tell what lung changes there are here without any kind of imaging, and bronchiectasis can also present with wheezing on exam. I picked bronchiectasis but I think looking back the tells were the history of smoking and the "pink puffer" appearance (maybe A1AT given her age), vs in bronchiectasis they would more likely give you some predisposing factor (eg CF, recurrent infection), as well as probably more than one tablespoon of sputum production per day and possibly hemoptysis.
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