AANP Family Nurse Practitioner (FNP) Certification ExamAssessmentMedium
A 45-year-old male presents with a 3-month history of a persistent, productive cough with thick, purulent sputum, often worse in the mornings. He reports recurrent respiratory infections since childhood. Physical examination reveals crackles and wheezes, and clubbing of the digits. Which of the following diagnostic studies is most likely to confirm the suspected diagnosis?
- ASpirometry with bronchodilator responsiveness
- BChest X-ray
- CHigh-resolution computed tomography (HRCT) of the chest
- DAlpha-1 antitrypsin level
Show answer & explanationAnswer & explanation
Correct answer: C. High-resolution computed tomography (HRCT) of the chest
The patient's history of chronic productive cough, recurrent infections, and physical exam findings (crackles, wheezes, clubbing) are highly suggestive of bronchiectasis. HRCT of the chest is the gold standard for diagnosing bronchiectasis, as it can visualize bronchial wall thickening and dilation.
Why the other options are wrong
- A. Spirometry would assess lung function and may show obstructive patterns but cannot confirm the structural changes of bronchiectasis.
- B. Chest X-ray may show non-specific findings but is not sensitive or specific enough to definitively diagnose bronchiectasis.
- D. Alpha-1 antitrypsin deficiency can cause bronchiectasis, but measuring its level is for identifying an underlying cause, not for initial diagnosis of bronchiectasis itself.
Bronchiectasis Diagnosis
The process of identifying permanent, abnormal dilation of the bronchi due to chronic inflammation and infection.
- Chronic productive cough with purulent sputum.
- Recurrent respiratory infections.
- HRCT of the chest is the gold standard for diagnosis.
Memory trick: Bronchiectasis: 'B' for 'Big' airways on 'Best' (HRCT) scan.