AANP Family Nurse Practitioner (FNP) Certification ExamAssessmentHard
A 22-year-old female presents with a 3-week history of worsening productive cough with thick, purulent sputum, occasional hemoptysis, and recurrent fevers. She reports a history of recurrent respiratory infections since childhood. On examination, crackles and rhonchi are heard bilaterally. Clubbing of the digits is noted. Her chest X-ray shows dilated and thickened bronchi with 'tram track' opacities. What is the most appropriate next diagnostic step?
- ABronchoscopy with bronchoalveolar lavage
- BAlpha-1 antitrypsin level
- CSpirometry
- DHigh-resolution computed tomography (HRCT) of the chest
Show answer & explanationAnswer & explanation
Correct answer: D. High-resolution computed tomography (HRCT) of the chest
The patient's history of recurrent infections, chronic productive cough with purulent sputum, hemoptysis, clubbing, and characteristic chest X-ray findings ('tram track' opacities suggesting dilated airways) are highly indicative of bronchiectasis. HRCT of the chest is the gold standard for diagnosing bronchiectasis, as it provides detailed imaging of the bronchial tree and can confirm the presence and extent of bronchial dilation and wall thickening.
Why the other options are wrong
- A. Bronchoscopy with lavage can identify pathogens or rule out obstruction but is usually performed after HRCT has confirmed bronchiectasis and specific etiology is being sought.
- B. Alpha-1 antitrypsin deficiency can cause bronchiectasis, but it's a specific cause. HRCT is needed first to confirm the diagnosis of bronchiectasis itself, before investigating specific etiologies.
- C. Spirometry assesses lung function and would likely show an obstructive pattern, but it is not diagnostic of the structural changes of bronchiectasis.
Bronchiectasis Diagnosis
Bronchiectasis is a chronic lung condition characterized by permanent abnormal dilation of the bronchi. HRCT of the chest is the gold standard for diagnosis.
- Chronic productive cough, purulent sputum, recurrent infections.
- Clubbing, crackles, rhonchi.
- HRCT shows bronchial dilation and wall thickening ('tram tracks').
Memory trick: Chronic Cough? Look for the Dilation!