08-11-2016, 11:52 AM
A 74-year-old man comes to the office because of a 3-month history of worsening productive cough, exercise-induced shortness of breath, and right-sided chest pain that worsens with deep breathing. He rates the chest pain as a 6 on a 10-point scale. He also reports that he has lost 4.5 kg during the past month. He says he previously felt well. Medical history is significant for hypertension and dyslipidemia. Medications include hydrochlorothiazide, propranolol, and atorcastatin. The patient smoked 1 1/2 packes of cigarettes daily for 50 years but quit 4 years ago. He drinks alcoholic beverages occasionally. He worked as a sheet metal contractor, insulating new construction and ripping out old ductwork, until he retired 12 years ago. He is 178 cm tall and weighs 70 kg; BMI is 22 kg/m2. Vital signs are T 37.0 C, pulse 94/min, respirations 16/min, and BP 156/84 mm Hg. Auscultation of the lungs discloses crackles bilaterally and decreased breath sounds at the right base. Examination of the extremities discloses clubbing of the digits. Sputum cytology is shown. Chest x-ray shows pleural thickning that is more prominent on the right than on the left, and a large right pleural effusion. Which of the following is most likely to differentiate malignant from benign causes of this patient's lung disease?
(a picture of sputum cytology shown)
A) Bronchoalveolar lavage
B) High-resolution CT scan of the chest
C) Thoracentesis
D) Thoracoscopic lung and pleural biopsy
E) Transthoracic needle aspiration biopsy
(a picture of sputum cytology shown)
A) Bronchoalveolar lavage
B) High-resolution CT scan of the chest
C) Thoracentesis
D) Thoracoscopic lung and pleural biopsy
E) Transthoracic needle aspiration biopsy