07-17-2012, 10:03 AM
A 64-year-old woman is evaluated for a 9-month history of progressive exertional dyspnea and nonproductive cough. She is an ex-smoker with a 30-pack-year history. She has no constitutional symptoms or environmental exposures. There is no history of cardiovascular disease. She was recently treated with several courses of oral antibiotics for “bronchitis.” On physical examination, no exanthem or joint abnormalities are apparent. Cardiac examination is normal. Bibasilar, coarse mid to end-inspiratory crackles are noted. Chest radiograph shows increased bibasilar reticular markings in the periphery that were not evident 3 years ago. Pulmonary physiology shows a decreased total lung capacity (TLC), force vital capacity (FVC), and forced expiratory volume in 1 sec (FEV1), an increased FEV1/FVC ratio, and a decreased diffusing capacity for carbon monoxide (DLCO).
Which of the following tests is most likely to provide specific diagnostic and prognostic information?
A Measurement of antinuclear antibodies and rheumatoid factor
B Timed walk test with oximetry (6-minute walk test)
C High-resolution computed tomographic scan (HRCT)
D Gallium scan
E Cardiopulmonary exercise test
Which of the following tests is most likely to provide specific diagnostic and prognostic information?
A Measurement of antinuclear antibodies and rheumatoid factor
B Timed walk test with oximetry (6-minute walk test)
C High-resolution computed tomographic scan (HRCT)
D Gallium scan
E Cardiopulmonary exercise test