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?

The correct answer to the question "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?" is Option C: Perform a bronchoalveolar lavage with acid-fast bacilli smear and culture.

The other options — A) Start empiric broad-spectrum antibiotics, B) Order a high-resolution CT scan of the chest, D) Initiate corticosteroids for presumed sarcoidosis — are incorrect for this USMLE Exam Prep question. As explained above: 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 diagno…