A 23-year-old man presents to rheumatology clinic with chronic lower back pain and early morning stiffness. He has a history of asthma and regularly uses steroid inhalers, experiencing multiple exacerbations annually. He is scheduled to see a respiratory physician for better management of his symptoms. During clinical examination, Schober’s sign is observed. Pelvic X-rays reveal sacroiliitis, leading to a diagnosis of ankylosing spondylitis. The patient expresses concern about using NSAIDs to manage his symptoms. What factor may indicate NSAID-sensitive asthma?
MRCP2-4339
A 29-year-old female presents with acute asthma. She complains of worsening breathlessness and wheeze over the last 24 hours.
She has a history of previous hospital admissions with asthma but has never been to critical care. The patient has been given salbutamol, ipratropium, hydrocortisone, and magnesium. However, she is unable to complete sentences in one breath and cannot perform a peak flow test. She appears exhausted.
An arterial blood gas test is performed, and her PaCO2 is 7.5 kPa. What degree of clinical severity does this patient meet?
MRCP2-4340
You are requested to assess a patient with acute respiratory failure caused by H1N1 influenza virus infection. The treatment plan involves utilizing non-invasive ventilation (NIV). What is the most crucial statement regarding NIV in this scenario?
MRCP2-4341
A 65-year-old man is admitted with an infective exacerbation of COPD. He normally has a productive cough but has been bringing up large quantities of sputum and estimates about 1 cup of yellow sputum with streaks of blood being produced a day.
He takes steroid nose drops and had endoscopic surgery for recurrent sinusitis 5 years ago. He lives alone independently and drives a car. He can usually walk 50-100 metres on the flat.
He arrives to the emergency department in extremis. There is accessory muscle use and widespread coarse crepitations in both lungs. His heart sounds are normal with no signs of cardiac failure. He is started on antibiotics, steroids, aminophylline and back to back nebulisers. He continues to produce lots of phlegm and the nurses suction to clear a yellow mucoid substance from his mouth. He responds to commands, his eyes open to voice. and he is talking in normal words but his thoughts are incoherent. He is started on non invasive ventilation and tolerates the mask. He continues to cough producing a 20ml plug of sputum with dried clot whilst given his first nebuliser. The respiratory registrar decides that NIV should be stopped.
What is the contraindication to non invasive ventilation in this case?
MRCP2-4342
A 45-year-old woman complains of excessive daytime sleepiness, which is affecting her job performance. She also reports morning headaches and her partner complains of loud snoring. She is a moderate smoker and drinks about six glasses of wine per night. Her exercise tolerance is limited to walking short distances before feeling breathless. Upon examination, her BMI is 35 kg/m2. An arterial blood gas taken at 10 pm shows: PaO2 9.5 kPa 10.5–13.5 kPa PaCO2 8.0 kPa 4.6–6.0 kPa A repeat arterial blood gas the next morning shows: PaO2 9.9 kPa 10.5–13.5 kPa PaCO2 8.2 kPa 4.6–6.0 kPa What is the most likely diagnosis for this patient?
MRCP2-4343
A 42-year-old woman presents to the endocrine clinic with a 2-year history of constant fatigue. She works as a nurse and has had difficulty staying awake during her shifts. She also experiences difficulty concentrating during the day and has frequent morning headaches. Her husband reports that she is restless at night and snores loudly, occasionally having episodes of choking. She has also noticed a decrease in her libido. She is a smoker of 20 cigarettes per day and drinks 2 glasses of wine every night. She takes an inhaler for asthma and has had a chronic cough with sputum for several years.
During the examination, she was found to be clinically obese with a BMI of 33 and had early pitting ankle edema. Her heart sounds were normal, but there was some scattered wheezing in the chest. What would be the most practical investigation to establish the diagnosis?
MRCP2-4344
A 56-year-old accountant has been referred by his doctor due to complaints of constant fatigue. He has a history of depression and is currently taking antidepressant medication as prescribed by his GP. Recently, he had to resign from his job as he found it difficult to drive long distances and almost got into a car accident due to sudden swerving. He has gained 3 stone in weight over the past three years, which he attributes to his depression. During his check-up, his blood pressure was found to be high at 170/100 mmHg. What investigation is most likely to provide an explanation for his symptoms?
MRCP2-4345
A 56-year-old man has been referred to a medical professional by his GP due to constant fatigue. The patient has a history of depression and is currently taking antidepressant medication. He recently quit his job as a sales representative due to feeling too tired to drive long distances, and had a near-accident while driving. The patient has gained 3 stone in weight over the past three years and has elevated blood pressure at 170/100 mmHg. What is the probable diagnosis?
MRCP2-4346
A 26-year-old male employed in a plastic factory complained of experiencing difficulty in breathing. He had just come back from a two-week vacation in Spain where he was in good health. At 2:00 AM, he arrived at the Emergency department after using his salbutamol inhaler eight times. However, he recuperated fully after receiving treatment with a salbutamol nebulizer and steroids. What condition is he most likely suffering from?
MRCP2-4327
A 25-year-old male presents to the Emergency department complaining of chest pain and difficulty breathing. Upon examination, a significant right-sided pneumothorax is identified and promptly treated with chest tube drainage. Interestingly, this patient had a similar episode six months prior, which was also treated successfully with chest tube drainage. He has no history of smoking or any other significant medical conditions. After 24 hours, his lung has fully re-expanded and he is in stable condition. What is the next appropriate step in managing this patient?