MKSAP: 70-year-old man with night sweats, weight loss, and cough
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 70-year-old man is evaluated for a 3-month history of night sweats, weight loss, and increasing cough. He is a retired miner, and his medical history is significant for a diagnosis of pulmonary silicosis made 15 years ago based on exposure history and characteristic chest radiographic findings. He is a lifelong nonsmoker.
On physical examination, temperature is 37.9 °C (100.2 °F), blood pressure is 120/65 mm Hg, pulse rate is 84/min, and respiration rate is 22/min. Pulmonary examination reveals diffuse inspiratory crackles throughout all lung zones, unchanged from previous examinations.
Pulmonary function tests demonstrate mild obstruction with no change from 1 year ago. Chest radiograph shows multiple small nodules that appear throughout all lung zones but are upper-lobe predominant. There is no significant change in comparison with previous imaging studies.
Which of the following is the most appropriate next step in management?
A: High-resolution CT of the chest
B: Lung biopsy
C: Prednisone
D: Tuberculosis testing
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Source: Kevin, M.D. - Medical Weblog - Category: Family Physicians Tags: Conditions Infectious disease Pulmonology Source Type: blogs
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