Clinic · Week 0
The referral
A year of slowly progressive exertional dyspnea, now at one flight of stairs. Chronic morning cough, small volumes of white sputum. Fifty pack-years, quit two years ago.
History
- Orthopnea or PND?
- Sleeps flat; no nocturnal dyspnea.
- Chest pain?
- None.
- Occupational exposures?
- Office work; no asbestos, birds, or dusts.
- Wheeze?
- Occasional, with colds.
Examination
- Respiratory: Prolonged expiratory phase, scattered wheeze, no crackles.
- Cardiac: JVP normal, no edema, normal heart sounds.
Which single investigation will most efficiently separate the leading explanations for her dyspnea?