#may2020mccqe1
A 38-year-old woman with a 4-year history of systemic sclerosis is evaluated for a 6-month history of dry cough and shortness of breath. She has no fever, sputum production, or orthopnea. The clinical manifestations of her systemic sclerosis include arthralgia, gastroesophageal reflux disease, and Raynaud phenomenon. On physical examination, temperature is 36.9°C (98.5°F), blood pressure is 120/76 mm Hg, pulse rate is 88/min, and respiration rate is 18/min. Oxygen saturation by pulse oximetry is 90% on ambient air. Fine bibasilar late inspiratory crackles are heard. Cardiac examination is normal without murmurs or extra sounds. Complete blood count, serum electrolytes, and metabolic panel are normal. Chest x-ray is normal. Results of pulmonary function testing: FEV1, 75% of predicted; FVC, 71% of predicted; FEV1/FVC ratio, 100% of predicted; and diffusing capacity of lung for carbon monoxide (DLCO), 64% of predicted. Antitopoisomerase I antibody testing is positive. Which of the following is the most appropriate next diagnostic test?
(A) Bronchoalveolar lavage
(B) High resolution chest CT
(C) Lung biopsy
(D) Pulmonary artery angiogram
A 38-year-old woman with a 4-year history of systemic sclerosis is evaluated for a 6-month history of dry cough and shortness of breath. She has no fever, sputum production, or orthopnea. The clinical manifestations of her systemic sclerosis include arthralgia, gastroesophageal reflux disease, and Raynaud phenomenon. On physical examination, temperature is 36.9°C (98.5°F), blood pressure is 120/76 mm Hg, pulse rate is 88/min, and respiration rate is 18/min. Oxygen saturation by pulse oximetry is 90% on ambient air. Fine bibasilar late inspiratory crackles are heard. Cardiac examination is normal without murmurs or extra sounds. Complete blood count, serum electrolytes, and metabolic panel are normal. Chest x-ray is normal. Results of pulmonary function testing: FEV1, 75% of predicted; FVC, 71% of predicted; FEV1/FVC ratio, 100% of predicted; and diffusing capacity of lung for carbon monoxide (DLCO), 64% of predicted. Antitopoisomerase I antibody testing is positive. Which of the following is the most appropriate next diagnostic test?
(A) Bronchoalveolar lavage
(B) High resolution chest CT
(C) Lung biopsy
(D) Pulmonary artery angiogram
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