Rosh Internal Medicine Boost Practice Exam

Which test is most likely to confirm the diagnosis for a patient with progressive dyspnea and a productive cough, particularly in a mason?

1. Chest X-ray

2. Complete blood count with differential

3. Pulmonary function test

4. Tuberculin skin test

The correct answer is: Chest X-ray

In the context of a mason presenting with progressive dyspnea and a productive cough, a chest X-ray is the most appropriate test to confirm the diagnosis. This is particularly relevant for conditions associated with occupational exposure, such as pneumoconiosis, which is common among those who work with silica or asbestos. A chest X-ray can reveal changes in the lungs, such as the presence of nodules, infiltrates, or signs of fibrosis, which can indicate lung diseases related to long-term inhalation of mineral dust. Given the occupational history of the mason, the chest X-ray can help identify conditions like silicosis, asbestosis, or other forms of pneumoconiosis that may be causing the respiratory symptoms. While other tests such as a complete blood count may provide supportive information about the patient's overall health or possible infections, and pulmonary function tests may help assess the respiratory impact of any lung disease, these tests are not definitive in confirming a diagnosis related to the exposure history. The tuberculin skin test is more specific for tuberculosis and less relevant as a first-line test in this scenario, particularly following the occupational exposure context. Thus, the chest X-ray stands out as the most direct method for diagnosing underlying pulmonary conditions associated with the patient's symptoms and