Pulmonary and Critical Care Medicine Q 18

A 42-year-old man is evaluated in the office for follow-up of progressive dyspnea of 2 years' duration. He first noted dyspnea with exercise but now has symptoms when walking up a flight of stairs. He has intermittent wheezing but no coughing or nocturnal respiratory symptoms. At the time of his initial evaluation 2 years ago, pulmonary function tests demonstrated moderate airflow obstruction. He has a 1-pack-year smoking history but has not smoked in 20 years. He has no environmental exposures. His father and uncle both have emphysema without a history of smoking. He takes no medications.

On physical examination, vital signs are normal. Oxygen saturation is 94% breathing ambient air. Examination reveals no clubbing or jugular venous distention, extra cardiac sounds, edema, pulmonary crackles, or wheezing.

A chest radiograph shows hyperinflation and diaphragmatic flattening.

Which of the following is the most appropriate test to perform next?

A α1-Antitrypsin level

B Exhaled nitric oxide test

C High-resolution CT scan of the chest

D Vascular endothelial growth factor-D

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