A 65-year-old asthmatic patient is brought to the emergency department with wheezing and difficulty breathing, but is not yet displaying signs of exhaustion. The patient is receiving ongoing nebulized salbutamol, IV steroids, and high-flow oxygen. The nursing supervisor asks if administering IV magnesium is appropriate at this point. Based on the BTS guidelines, what factors would suggest that IV magnesium is not necessary at this stage?
A 65-year-old man presents with symptoms of weight gain and purplish stripes on his abdomen, along with a history of community-acquired pneumonia. His recent chest x-ray shows resolution of the pneumonia but a suspicious right hilar mass. He has a 40 pack-year smoking history and has been diagnosed with hypertension and borderline diabetes. What type of lung cancer is most likely in this patient?
A 54-year-old woman visits the respiratory clinic due to experiencing breathlessness. Her GP referred her after noticing breathlessness and a chest X-ray showing right pleural effusion. The patient had recently undergone a right-sided wide local excision with axillary clearance for ductal carcinoma in situ.
Upon examination, the patient has reduced breath sounds on one side with dullness on percussion and tracheal deviation away from that area of her chest. A pleural aspirate is taken and appears milky white in color. The two potential diagnoses are chylothorax and pseudochylothorax.
What diagnostic test would be helpful in distinguishing between chylothorax and pseudochylothorax?
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 35-year-old man comes to the Emergency Department complaining of severe cough, shortness of breath, and unexplained weight loss. He has a medical history of asthma and nasal polyps and has visited his GP thrice in the past 6 months for chest infections, for which he was prescribed antibiotics.
What are the expected blood test results for this patient, considering the probable underlying diagnosis?
A 34-year-old HIV-positive man presented to hospital with increasing shortness of breath and cough, as well as slightly worse vision over the last few weeks. He had a prolonged admission 4 months ago for a chest complaint and has been taking prophylactic co-trimoxazole. He is a current smoker with a 10-pack year history. On examination, he appeared unwell with a pulse of 110/min, respiratory rate of 28/min, BP of 95/65 mmHg, and saturations of 91% on air. Auscultation of his chest revealed fine crackles bilaterally, and the CXR showed reticular shadowing throughout both lung fields. His investigations revealed a low haemoglobin level, low white cell count, low CD4+ count, and elevated bilirubin, AST, and ALP levels. His TLCO was 80% predicted. What is the likely diagnosis?
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?
Among these patients with lobar pneumonia, which one has the bleakest prognosis?
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 20-year-old student came to the clinic complaining of sudden onset of left-sided chest pain and difficulty breathing. He had a history of cardiac surgery during childhood and smoked ten cigarettes a day. He denied any use of alcohol or illicit drugs. He had recently returned from a trip to Thailand ten days ago.
During the examination, the patient appeared tall and thin with no signs of clubbing or lymphadenopathy. He did not show any signs of cyanosis, but had a resting tachycardia and an audible click during expiration. What is the most likely underlying diagnosis?