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  • There is a diffuse bronchial pattern in the lungs with thickening of bronchial walls.
  • There is also a diffuse interstitial pattern with indistinct vessel margins.
  • There is a focal alveolar pattern with air bronchograms in the right middle lung lobe with lobar consolidation.
  • There are faint pleural fissure lines present.
  • There is an incidental small, metal foreign body in the stomach.
  • There is diffuse bronchial disease that is complicated by probable hematogenous bronchopneumonia that could be viral or bacterial in nature. Fungal disease is unlikely in a patient of this age. Other less likely rule-outs are ciliary dyskinesia or PIE.
  • Bronchoscopy with BAL or trans-tracheal wash is recommended.

Outcome: The patient was diagnosed with Bordetella and Mycoplasma pneumonia.

Successful candidates recognized and described all components of pulmonary disease and realized there was a complicating factor to the underlying bronchial disease. Unsuccessful candidates did not recognize the bronchial pattern or came to inappropriate conclusions such as aspiration pneumonia or pleural disease.