Correct!
4. Pulmonary function testing
Correct!
4. Pulmonary function testing
Repeat chest radiography is unlikely to be of benefit for short-term follow up of a slowly progressive clinical abnormality. Ventilation-perfusion scintigraphy is commonly used for the assessment of acute or chronic thromboembolic disease and occasionally for differential lung function assessment prior to surgical resection. This study could be of some benefit for this patient, given her compliant of slowly progressive shortness of breath, which could be a manifestation of chronic thromboembolic disease; however, ventilation-perfusion scintigraphy is not the best choice among those listed. Flexible fiberoptic bronchoscopy and right heart catheterization could prove useful, but are needlessly invasive at this point of the patient’s evaluation. The most appropriate next step is obtaining pulmonary function testing.
The patient underwent pulmonary function testing, which showed increased residual volume (171% predicted) and a slightly increased total lung capacity (106% predicted). No significant response to bronchodilator inhalation was seen. The diffusion capacity for carbon dioxide was normal. The forced expiratory volume in one second was severely decreased at 34% predicted.
Which of the following is the most appropriate next step for the evaluation of this patient? (Click on the correct answer to proceed to the fourth of seven panels)