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?
A 75-year-old woman is referred to the Medical Clinic by her GP due to experiencing shortness of breath. She has been seeing her GP for the past few months regarding increasing shortness of breath during exercise. Despite some investigations, her GP has been unable to determine the cause of her symptoms. She has also been experiencing a dry cough on and off for the past 4 months. During examination, her blood pressure is 135/80 mmHg, pulse is regular at 70 bpm, and her jugular venous pulse is not raised. Although her breathing is noisy, her chest is clear on auscultation. Which investigation would be most useful in identifying the location of any obstruction?
A 30-year-old man presents with left-sided pleuritic chest pain. It had come on suddenly 2 days previously. Initially he thought it was due to lifting heavy weights at the gym. However, since it did not improve and he noticed that he was slightly more breathless than usual, he went to the Emergency Department. He has no significant past medical history. He is a smoker of 15/day. On examination he looked well. He was a tall, thin man and was not short of breath at rest. Examination was unremarkable except for a clicking sound which was synchronous with the heart sounds. CXR was unremarkable.
Which of the following investigations may help with the diagnosis?
A high-resolution thoracic CT of an elderly patient experiencing difficulty breathing reveals scattered ground-glass opacities. Nevertheless, there is significant motion artifact. What is the most effective examination to verify a parenchymal disorder causing restrictive lung disease?
A 19-year-old-female is brought into the emergency room after experiencing a tonic-clonic seizure. Upon examination, she has a Glasgow coma scale of 11 (M4, E3, V4) and her blood pressure is 85/65 mmHg. Her heart rate is 135 bpm and an ECG shows atrial fibrillation. She has a medical history of asthma and is currently taking betamethasone, salbutamol, salmeterol, montelukast, and theophylline. She recently started taking erythromycin for a chest infection and has been consuming 6g of paracetamol per day for the past 3 days to alleviate fever and chest discomfort.
Fluid resuscitation with 0.9% saline is initiated, and a beta blocker is administered to treat the supraventricular tachycardia. The patient is suspected to have theophylline toxicity and is given repeated doses of activated charcoal. However, her condition continues to worsen.
What is the appropriate treatment in this case?
A 65-year-old male presents to the hospital with sudden onset breathlessness and no chest pain. He has recently started taking an ACE inhibitor for hypertension. Upon examination, bilateral crepitations to the mid-zones are noted, along with tachypnea and 90% saturation on room air. Urinalysis is negative, and a chest X-ray reveals acute pulmonary edema. An ECG shows sinus rhythm with a rate of 95. Blood tests show Na+ at 135 mmol/l, K+ at 5.1 mmol/l, urea at 12.6 mmol/l, and creatinine at 188 µmol/l. What diagnostic test will confirm the most likely underlying diagnosis?
A 50-year-old man presents to the emergency department with complaints of fever, headache, epistaxis, diarrhea, and cough for the past 8 days. He has no medical history but drinks 32 units of alcohol per week, keeps parrots, and enjoys open water swimming in rivers. On examination, he has splenomegaly and crackles in both lungs. Blood tests show leukopenia, thrombocytopenia, and elevated CRP. Chest radiography reveals bilateral patchy airspace opacification. Which pathogen is the most likely cause of his illness?
A 32-year-old asthmatic woman presented to the Respiratory Outpatient Clinic with complaints of coughing at night and increased wheezing during tennis, requiring her salbutamol inhaler at least 4 times a week. She had been taking budesonide 200 micrograms two puffs twice a day and smoked 10 cigarettes/day for 2 years. On examination, a mild expiratory wheeze was heard. What is the recommended treatment for this patient?
A 56-year-old man with a history of allergic rhinitis and adult onset asthma presented to the respiratory clinic with worsening breathlessness, wheezing, and abdominal pain over the past six months. Despite being on high dose inhaled corticosteroids, his asthma was no longer well controlled. He was recently admitted for acute coronary syndrome, but his coronary angiogram was normal. On examination, he had a purplish rash on his abdomen and lower extremities, and bilateral polyphonic wheezing was heard on chest auscultation. Laboratory investigations revealed elevated eosinophils, an elevated erythrocyte sedimentation rate, and positive P-ANCA. What is the most likely diagnosis?