A 72-year-old man comes to the clinic with symptoms of a respiratory tract infection, including cough, shortness of breath, confusion, and diarrhea. He has recently returned from a long-term stay at a hotel in Spain. During the examination, you note a temperature of 39.2°C and signs of consolidation in the right lower lobe. Blood tests reveal an elevated white count and a sodium level of 128. What is the most appropriate statement regarding this man’s pneumonia?
A 16-year-old secretary presents to you with an increased dry cough and an intermittently wheezy chest at night, eight weeks after seeing the respiratory nurse at the surgery. She reports no fevers and no difficulties in breathing. Currently, she is taking Fostair (Beclomethasone diproprionate 100 mcg/Formetorol fumarate 6 mcg) combination inhaler, 1 puff twice daily, and salbutamol as needed for shortness of breath. Previously, she was using Clenil (Beclomethasone 100 mcg), but feels that the new inhaler has helped slightly since her last appointment with the nurse. According to the latest SIGN/BTS guidance, what would be the next step in managing her asthma?
A 59-year-old presents with a complaint of breathlessness that has been ongoing for six months. The patient recently underwent spirometry testing with the practice nurse and the post bronchodilator results are as follows:
Despite receiving a short acting muscarinic antagonist from a colleague, the patient reports persistent breathlessness. Based on NICE guidance, what would be the most suitable course of action?
A 58-year-old complains of breathlessness for four months.
She has recently seen the practice nurse for spirometry testing and these are her post bronchodilator results:
FEV1/FVC ratio 0.60
FEV1 (% predicted) 65%
What is the most appropriate initial management for this patient?
A 68-year-old woman with a recent diagnosis of chronic obstructive pulmonary disease (COPD) is seen.
Her spirometry shows an FEV1 of 42% predicted with an FEV1:FVC ratio of 64%. Her current treatment consists of a short-acting beta agonist (SABA) used as required which was started when a clinical diagnosis was made two to three months ago prior to her having had the spirometry performed. A chest x Ray was normal and she gave up cigarettes a few weeks ago. Her home peak flow measurments show a 30% diurnal variation.
On reviewing her symptoms she needs to use the SABA at least four times a day and despite this still feels persistently breathless. In addition, she tells you that over the last few years she gets attacks of ‘bronchitis’ two to three times a year. You can see from her notes that she has received at least two courses of antibiotics each year for the last three years for acute episodes of productive cough and shortness of breath.
Which of the following is the next most appropriate step in her pharmacological management?
A 68-year-old gentleman presents for review. His notes indicate that he was recently treated with furosemide for heart failure after presenting with gradually increasing shortness of breath and bibasal crepitations. Despite taking the medication for the last week, he reports feeling no better and has marked exertional breathlessness. On examination, he is centrally cyanosed with finger clubbing and fine bibasal inspiratory crepitations. There is no evidence of peripheral edema. What is the most likely diagnosis?
A 72-year old woman with a recent diagnosis of chronic obstructive pulmonary disease (COPD) is seen.
Her spirometry shows an FEV1 of 42% predicted with an FEV1: FVC ratio of 64%. Her current treatment consists of a short-acting beta agonist (SABA) used as required which was started when a clinical diagnosis was made following the spirometry.
On reviewing her symptoms she needs to use the SABA at least four times a day and despite this still feels persistently breathless. In addition, she tells you that over the last few years she gets attacks of ‘bronchitis’ requiring antibiotics two to three times a year.
According to NICE guidance, which of the following is the next most appropriate step in her pharmacological management?
A 28-year-old woman presents with a two week history of feeling unwell, characterised by one week of catarrhal illness, followed by a dry hacking cough, which is now paroxysmal, and she has vomited twice after coughing.
On examination, she is afebrile, and her chest sounds clear. She was previously well, but she is unsure of her vaccination history as she lived abroad as a child.
She lives with her husband and two children, aged 18 months and 8. The children have not been immunised against pertussis. You suspect she may have pertussis.
While awaiting confirmation, who should be offered antibiotics?
A 42-year-old man with known asthma visits your clinic with a complaint of worsening wheezing over the past few hours. He seldom attends asthma clinic and you observe that his previous best peak flow readings were 400 L/min. What is the threshold that indicates acute severe asthma in this patient?
A 25-year-old female develops a wheeze and extensive rash whilst eating a Chinese take-away chicken satay.
On examination, she has extensive wheeze and stridor, with urticaria covering her upper and lower limbs and trunk. Her BP is 80/45 mmHg.
What is the likely diagnosis?