11th January 2024

A 32-year-old Caucasian female presented to A&E with a several-month history of feeling fatigued.

A 32-year-old Caucasian female presented to A&E with a several-month history of feeling fatigued. She feels like she cannot run as far as she used to when she goes for her usual jogs; she describes shortness of breath and coughing fits, which are non-productive; her joints have also been aching, affecting her running further. Over the last couple of days, she has also been having chest pains, which are worse on inspiration. On examination, she looks flushed, which she believes is due to running in sunny weather the other day. There are no other rashes. Observations are normal apart from tachycardia with HR of 102. Investigations are as follows:

Hb 110

WCC 8

Plts 100

CRP 18

ESR 55

Creatinine 100, eGFR 45

Urine dip: ++ erythrocytes, + leukocytes, + protein

CXR: normal

Which additional investigations are most likely to help establish her diagnosis?

Select the SINGLE most appropriate option from the list below. Select ONE option only.