Correct!
5. More than one of the above
More than one answer listed is correct- it is appropriate to check for titers suggesting coccidioidomycosis infection given that the patient resides in an endemic region. Obtaining prior imaging for comparison is always an expedient choice when confronted with abnormalities at imaging, particularly in the context of a possible indeterminate solitary pulmonary nodule in an adult patient. Pulmonary function testing is also a reasonable procedure to perform when an adult patient presents with respiratory complaints. However, 18FDG – PET scan is premature at this point. It is usually more rewarding to obtain chest CT for characterization of pulmonary opacities, as well as first determine if prior imaging or medical records can clarify the nature of a potentially indeterminate focal lung opacity, before obtaining expensive, advanced non-invasive tissue characterization procedures.
The patient was empirically treated with broad-spectrum antibiotics for several weeks, but without improvement. Pulmonary function testing showed an FEV1 of 1.57L (80% predicted), DLCO = 133% of predicted, and normal oxygenation at rest and with exercise. No prior imaging for comparison could be located, and testing for coccioidomycosis infection was unrevealing.
Which of the following represents the most appropriate step in this patient’s management? (Click on the correct answer to be directed to the fourth of sixteen pages)