Isolated low TLCO — SCE Respiratory MCQ

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HardRespiratory PhysiologyIsolated low TLCOSCE Respiratory

A 66-year-old woman has unexplained dyspnoea. Spirometry is normal, TLCO is 42% predicted and KCO is reduced. CT chest shows no ILD or emphysema. Echocardiography suggests pulmonary hypertension. What is the most appropriate investigation?

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Correct answer: C — Right-heart catheterisation

The best answer is “Right-heart catheterisation”. Right-heart catheterisation is the investigation that most directly resolves the remaining diagnostic or staging uncertainty at this point in the pathway. The alternatives address different questions, have lower expected yield, or would be premature before this result. The remaining choices—“Peak-flow diary, with clinical reassessment”, “Bronchoscopy with endobronchial biopsy”, “Pleural aspiration, after safety review”, “Methacholine challenge, after specialist assessment”—are credible in related respiratory presentations, but each addresses a different diagnostic, staging or management decision and does not fit the decisive findings and pathway position in this stem.

Reference: NICE NG115 chronic obstructive pulmonary disease: https://www.nice.org.uk/guidance/ng115/chapter/Recommendations