04-29-2009, 05:06 AM
You see a 38-year-old female in follow-up for a recent
episode of sinusitis. The whole illness has been present
for about 6 weeks and has failed 2 weeks of appropriate
antibiotics. She continues to have intermittent
nosebleeds, fatigue, arthralgias, low-grade fevers, and
night sweats. Two new complaints have surfaced: she
has a cough productive of white sputum and she occasionally
expectorates quarter-sized clots of blood. She
denies chest pain, dyspnea, tobacco use, or any history
of cardiac or pulmonary disease.
On examination, she appears in no distress. She is
afebrile, and her respiratory rate is 16, blood pressure
120/74, and pulse 92. Her oxygen saturation is 98%
on room air. There is dried blood in the nares, but the
oropharynx is clear. Cardiac and pulmonary exams are
unremarkable.
Which initial test is most appropriate?
A) Chest x-ray.
B) Sputum cytologic analysis.
C) Bronchoscopy.
D) Chest CT.
E) CBC.
episode of sinusitis. The whole illness has been present
for about 6 weeks and has failed 2 weeks of appropriate
antibiotics. She continues to have intermittent
nosebleeds, fatigue, arthralgias, low-grade fevers, and
night sweats. Two new complaints have surfaced: she
has a cough productive of white sputum and she occasionally
expectorates quarter-sized clots of blood. She
denies chest pain, dyspnea, tobacco use, or any history
of cardiac or pulmonary disease.
On examination, she appears in no distress. She is
afebrile, and her respiratory rate is 16, blood pressure
120/74, and pulse 92. Her oxygen saturation is 98%
on room air. There is dried blood in the nares, but the
oropharynx is clear. Cardiac and pulmonary exams are
unremarkable.
Which initial test is most appropriate?
A) Chest x-ray.
B) Sputum cytologic analysis.
C) Bronchoscopy.
D) Chest CT.
E) CBC.