A 20-Year-Old Man Comes to the Physician Complaining of Cough

question 136

Multiple Choice

A 20-year-old man comes to the physician complaining of cough, dyspnea on exertion, and nighttime awakenings with wheezing.  His symptoms started 1 month ago after painting a room and using ammonia to clean the windows.  He had mild shortness of breath and felt irritation and burning in his throat and nostrils afterwards.  He did not seek further treatment at that time.  He has a history of running marathons but is now limited to running 1 mile before he has to stop due to dyspnea and cough.  He has no past medical history and does not use alcohol, tobacco, or illicit drugs.  
Vital signs and physical examination are normal. 
Office spirometry shows an FEV1 of 82% predicted, FVC 90% predicted, and FEV1/FVC 0.82.  Chest x-ray is unremarkable.
Which of the following would be most helpful to establish the diagnosis?

• A)Bronchoscopy with bronchoalveolar lavage
• B)High-resolution chest CT scan
• C)Methacholine challenge testing
• D)Transthoracic echocardiogram
• E)Video-assisted thoracoscopic biopsy

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Definitions:

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Speculation

The act of forming theories or conjecture without firm evidence.

Cargo System

A traditional system of communal work and social organization, often found in indigenous communities, involving the rotation of community service roles.

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Historical settlements of the Maya civilization, characterized by their advanced architectural, agricultural, and astronomical systems.