Correct!
5. All of the above

Sputum stains and cultures, spirometry and thoracic CT scan may all be useful in evaluating dyspnea. In this case the least useful would probably be sputum stains and cultures all of which were negative. 

Spirometry was performed with the forced vital capacity 2.3 L and the forced expiratory volume in 1 second 0.55 L which was unchanged compared to her most recent previous spirometry. The flow volume loop is shown in Figure 1.

Figure 1. Flow-volume loop consistent with severe lower airway obstruction.

Her thoracic CT scan is shown in Figure 2.

Figure 2. Representative images from initial thoracic CT scan. A-C: axial view in lung windows. D &E: coronal view in lung windows.

Which of the following should be done next? (Click on the correct answer to be directed to the third of four pages)

  1. Antibiotics and prednisone for an exacerbation of COPD
  2. Bronchoscopy
  3. Pulmonary CT angiogram
  4. 1 and 3
  5. All of the above

Home/Pulmonary