AANP Family Nurse Practitioner (FNP) Certification ExamAssessmentHard
A 22-year-old female presents with a 3-month history of a persistent, productive cough with thick, purulent sputum, recurrent respiratory infections, and occasional hemoptysis. She reports a history of frequent childhood pneumonias. On physical examination, crackles and wheezes are heard in the lower lung fields. Which of the following is the most appropriate diagnostic test to confirm the suspected diagnosis?
- AChest X-ray
- BSpirometry
- CHigh-resolution computed tomography (HRCT) of the chest
- DBronchoscopy with bronchoalveolar lavage
Show answer & explanationAnswer & explanation
Correct answer: C. High-resolution computed tomography (HRCT) of the chest
The patient's chronic productive cough with purulent sputum, recurrent respiratory infections, hemoptysis, and history of childhood pneumonias strongly suggest bronchiectasis. High-resolution computed tomography (HRCT) of the chest is the gold standard for diagnosing bronchiectasis, as it can clearly visualize the characteristic bronchial dilation and wall thickening.
Why the other options are wrong
- A. A chest X-ray may show non-specific findings (e.g., 'tram tracks') but is often insufficient for definitive diagnosis.
- B. Spirometry can show obstructive or restrictive patterns but is not diagnostic for bronchiectasis.
- D. Bronchoscopy is an invasive procedure useful for identifying the cause of bronchiectasis (e.g., foreign body, tumor) or for obtaining samples, but not the primary diagnostic tool for the condition itself.
Bronchiectasis Diagnosis
Bronchiectasis is a chronic lung condition characterized by irreversible dilation and destruction of the bronchial walls, leading to impaired mucociliary clearance, chronic productive cough, and recurrent respiratory infections.
- Often associated with underlying conditions like cystic fibrosis, immune deficiencies, or severe infections.
- Persistent productive cough with purulent sputum is a hallmark symptom.
- High-resolution computed tomography (HRCT) is the diagnostic imaging modality of choice.
Memory trick: Bronchiectasis: Bad Airways, Constant Cough, HRCT Confirms!