🏥 USMLE Exam Prep

A 62-year-old male with a 40 pack-year smoking history presents with a chronic cough, hemoptysis, and a 15-lb weight loss over 3 months. Chest X-ray reveals a cavitary lesion in the right upper lobe. Which of the following is the most appropriate next diagnostic step?

A Start empiric broad-spectrum antibiotics
B Order a high-resolution CT scan of the chest
C Perform a bronchoalveolar lavage with acid-fast bacilli smear and culture
D Initiate corticosteroids for presumed sarcoidosis

✓ Correct Answer: Option C

Given the patient's symptoms (chronic cough, hemoptysis, weight loss, cavitary lesion), tuberculosis is a strong consideration. Bronchoalveolar lavage with AFB smear and culture is crucial for diagnosis before starting antitubercular therapy. CT would further characterize, but direct sampling is needed.

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