A 27-year-old female patient has come for a follow-up on her asthma management. She reports that her asthma control has deteriorated lately and she is using her Ventolin inhaler once or twice a week. She confirms that she is not taking any other medication for asthma control. She denies any recent sickness, but she does mention that her symptoms worsen in colder temperatures and during physical activity. What would be the most appropriate course of action to take next?
A 35-year-old male construction worker complained of difficulty breathing. He reported that his symptoms disappeared during a recent trip to the beach. He arrived at the hospital in the early morning after using his salbutamol inhaler 10 times. Treatment with a salbutamol nebulizer and steroids resulted in a full recovery. What is the most effective test to determine the cause of his condition?
A 26-year-old woman with a history of recurrent hospital admissions for asthma exacerbations presents to the Emergency department at 8 am with increasing breathlessness. On examination, she appears dyspnoeic and wheezy, with a respiratory rate of 27 breaths per minute, a heart rate of 118 bpm (sinus tachycardia), and a PEFR of 34%. An arterial blood gas is obtained, with the following results: pH 7.52 (7.36-7.44), pO2 8.64 kPa (11.3-12.6), and pCO2 3.1 kPa (4.7-6.0). Based on this information, what is the severity of the patient’s exacerbation?
A 14-year-old boy presents to the outpatient clinic with his parents after experiencing a small amount of hemoptysis. He mentions feeling slightly short of breath. According to his mother, he had frequent chest infections during childhood and has always been the smallest of her children. The patient’s siblings are all healthy, and they have a pet cat at home.
During the examination, the patient appears well and is not experiencing dyspnea. Nasal polyps are present, and coarse crackles are audible throughout both lung fields upon auscultation. The following investigations were conducted:
– Hemoglobin (Hb): 113 g/L (normal range: 130 – 180)
– White blood cell count (WCC): 12.9 ×109/L (normal range: 4 – 11)
– Platelets: 438 ×109/L (normal range: 150 – 400)
– Sodium (Na+): 138 mmol/L (normal range: 137 – 144)
– Potassium (K+): 4.1 mmol/L (normal range: 3.5 – 4.9)
– Urea: 5.3 mmol/L (normal range: 2.5 – 7.5)
– Creatinine: 69 μmol/L (normal range: 60 – 110)
– Bilirubin: 37 μmol/L (normal range: 1 – 22)
– Aspartate aminotransferase (AST): 49 U/L (normal range: 1 – 31)
– Alkaline phosphatase (ALP): 228 U/L (normal range: 45 – 105)
Spirometry results are as follows:
– Forced expiratory volume in one second (FEV1): 1.8 L/min (62% predicted)
– Forced vital capacity (FVC): 3.1 L (83% predicted)
– Carbon monoxide diffusion capacity (Kco): 72% predicted
A chest X-ray reveals patchy haziness throughout both lung fields, with tramlines visible at the bases. The patient weighs 40 kg, and his ECG shows sinus rhythm with no significant findings.
What is the most likely diagnosis?
A 65-year-old woman presents with a history of exertional breathlessness and cough for the past seven months. She has also experienced a reduced appetite and has lost weight. She has no significant medical history. The patient worked as a hairdresser, kept a cat at home, and lived alone. She smoked 20 cigarettes a day. On examination, the patient was found to be clubbed and cyanosed, with a pale appearance. Her pulse rate was 80 beats per minute, and her blood pressure was 138/80 mmHg. Heart sounds were normal, but bilateral fine inspiratory crackles were heard at the lung bases. Investigations revealed an FEV1 of 2.8 L (3.6 predicted), FVC of 3.1 L (4.5 predicted), and diffusion capacity of 5.1 mmol/min/kPa (NR 6.3-11.9). The chest x-ray showed a slight increase in basal lung markings. What is the most likely diagnosis?
A wheezing patient undergoes pulmonary function testing.
The following results are obtained:
FEV1 74% predicted
FVC 68% predicted
TLC 77% predicted
TLCO 46% predicted
KCO 53% predicted
What is the most probable reason for these results?
A 68-year-old retired miner presents to the outpatient clinic with a persistent non-productive cough, exertional dyspnoea, and left-sided chest pain that has been ongoing for two months. He has also experienced poor appetite and weight loss of over one stone in the past four months. The patient retired at the age of 45 after working underground for over thirty years and lives with his wife. He drinks 10 units of alcohol per week and is an ex-smoker of forty cigarettes a day. On examination, he is apyrexial with a regular pulse of 90 beats per minute and blood pressure of 135/75 mmHg. There is no finger clubbing, but chest expansion is reduced on the left with dullness to percussion and diminished breath sounds at the left base and mid-zone. A chest radiograph reveals bilateral calcified pleural plaques and a large left pleural effusion. What investigation is most likely to provide a diagnosis?
A 60-year-old man with a BMI of 37 presents to the respiratory clinic with increasing shortness of breath. He has a 40 pack year history.
Initial investigations reveal:
pH 7.36 (7.36 – 7.44)
pO2 10.6 kPa (11.3 – 12.6)
pCO2 6.7 kPa (4.7 – 6.0)
HCO3 37 mmol/L (20 – 28)
Spirometry shows:
Actual % predicted
FVC (l) 3.63 59
FEV1(l) 3.01 60
FRC (l) 1.46 37
RV (l) 1.08 48
TLC (l) 4.99 61
What is the most likely diagnosis?
A middle-aged patient with a history of heavy alcohol consumption presents with a persistent fever, coughing up blood, green phlegm, and a left-sided effusion. The patient reports feeling unwell with fluctuating fevers for the past week and admits to drinking a significant amount of alcohol and not maintaining a proper diet. You suspect the possibility of an empyema. What test would be most helpful in confirming your suspicion?
A 51-year-old teacher presents to the clinic with complaints of worsening shortness of breath, chronic cough, and wheezing. She is a smoker of 15 cigarettes per day and has a strong odor of cigarettes. On physical examination, coarse wheezing and occasional crackles are heard on auscultation. What is the most helpful factor in determining the appropriate long-term management of her condition?