A 52 yo woman is sent to you by her primary care physician for evaluation of hypoxia. She has no symptoms except for early fatigue when she attempts to exercise. She is a lifelong nonsmoker and has no significant past medical history except for hypertension. Pulse oximetry on room air at rest is 80%. You order full PFTs which reveal normal spirometry and lung volumes, but DlCO adjusted for Hb is 40% predicted.
Exam reveals mild digital clubbing.
1) What diagnosis driven questions do you ask her about her history?
2) What is the next best step in her evaluation?
Continued in a subsequent post
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