#may2020mccqe1
A 40-year-old man who is a new patient is evaluated for a 6-month history of mild shortness of breath, which occurs primarily with exertion, and also occasional wheezing. He has smoked a half pack of cigarettes daily since the age of 18 years. He is otherwise healthy and takes no medications. He works in an automobile repair shop. His father, a cigarette smoker, died of emphysema at the age of 55 years. On physical examination, vital signs are normal. Breath sounds are diminished bilaterally, and there is occasional wheezing posteriorly. Spirometry shows an FEV1 of 58% of predicted and an FEV1/FVC ratio of 65%. Chest radiograph shows bilateral basilar lucency (lung bullae). Which of the following is the most appropriate next step in management?
(A) Measure plasma α1-antitrypsin
(B) Measure sweat chloride
(C) Obtain a flow-volume loop
(D) Obtain high-resolution CT scan of the chest
A 40-year-old man who is a new patient is evaluated for a 6-month history of mild shortness of breath, which occurs primarily with exertion, and also occasional wheezing. He has smoked a half pack of cigarettes daily since the age of 18 years. He is otherwise healthy and takes no medications. He works in an automobile repair shop. His father, a cigarette smoker, died of emphysema at the age of 55 years. On physical examination, vital signs are normal. Breath sounds are diminished bilaterally, and there is occasional wheezing posteriorly. Spirometry shows an FEV1 of 58% of predicted and an FEV1/FVC ratio of 65%. Chest radiograph shows bilateral basilar lucency (lung bullae). Which of the following is the most appropriate next step in management?
(A) Measure plasma α1-antitrypsin
(B) Measure sweat chloride
(C) Obtain a flow-volume loop
(D) Obtain high-resolution CT scan of the chest
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