MKSAP: 38-year-old man with a 1-year history of cough

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 38-year-old man is evaluated for a 1-year history of cough with mucoid sputum and a 6-month history of mildly progressive dyspnea. He has a 12-pack-year history of smoking. He has no history of asthma, allergies, skin disease, or liver disease. On physical examination, vital signs are normal. Pulmonary examination discloses decreased breath sounds bilaterally with no wheezing. Laboratory studies, including a complete blood count and complete metabolic panel, are normal. Oxygen saturation is 97% breathing ambient air. The electrocardiogram is normal. CT scan of the chest shows basilar lucency without bronchiectasis. Spirometry reveals an FEV1 of 53% of predicted and an FEV1/FVC ratio of 64%. The DLCO is 67% of predicted. There is no significant improvement in airflow after bronchodilator administration. Which of the following is the most appropriate next step in management? A: α1-Antitrypsin level measurement B: Initiation of an inhaled corticosteroid C: Sweat chloride testing D: Z and S genotyping for α1-antitrypsin alleles Continue reading ... Your patients are rating you online: How to respond. Manage your online reputation: A social media guide. Find out how.
Source: Kevin, M.D. - Medical Weblog - Category: Journals (General) Authors: Tags: Conditions Pulmonology Source Type: blogs