• A 38 year old female amateur astronomer, all the while

Last updated: 7/31/2022

• A 38 year old female amateur astronomer, all the while knowing better, has smoked since she was 18 years old. She has been having trouble for years with the smoke and the light of the cigarette impairing her ability to see the more distant galaxies through her telescope, but she has not been willing to quit yet. • Additionally, she has noticed a mild, occasionally productive cough for the past 3-4 months. The cough is worse whenever she spends the night out in the country taking astrophotos where she is exposed to the smoke of the nearby wild fires. . She finally decides to visit her family physician who, after making appropriate patient-centered inquiries as to how her astrophotography hobby is going, finds that she has been smoking about one pack per day for the past 20 years. . The cough has been present for almost a year. She has had no fever or chills. She does admit to more shortness of breath when she exercises over the past six months. . Her only other past medical history includes hypertension for which she is using lisinopril, metoprolol, and hydrochlorothiazide. At this point, what further investigations do you think would be appropriate? Why? 1. Chest radiograph (CXR) 2. Computed axial tomography (CT) of the chest 3. Complete blood count (CBC) and thyroid stimulating hormone (TSH) level 4. Spirometry 5. A and D