A 29-year-old female with a history of cystic fibrosis comes to the respiratory clinic for evaluation. Her primary care physician sent a sputum sample before the appointment due to her worsening cough and difficulty breathing. Which microbe is linked to the poorest prognosis?
A 56-year-old man has been experiencing increasing shortness of breath and orthopnoea over the past few years. He finally went to his GP after a severe episode of breathlessness while wading in the sea on holiday. He also reported morning headaches and an increasing tendency to fall asleep during the day. On examination, reduced breath sounds and percussion note bi-basally were noted. What is the most probable diagnosis based on the given information and test results?
A 67-year-old man is brought to the hospital after being found unconscious in his home. He is drowsy but can be awakened and complains of a severe headache and nausea.
On examination, his temperature is 36.5°C, but he appears flushed. His neck is supple, and there is no palpable lymphadenopathy. His blood pressure is 110/65 mmHg, and his heart sounds normal with no murmurs or added sounds. His chest is clear to auscultation, and the rest of the examination is unremarkable.
His daughter reported that her father, usually a skilled woodworker, had appeared clumsy lately and had been confused at times when talking on the telephone.
Investigations show:
– Haemoglobin 158 g/L (130-180)
– White cell count 10.1 ×109/L (4-11)
– Platelets 401 ×109/L (150-400)
– Serum sodium 140 mmol/L (137-144)
– Serum potassium 4.4 mmol/L (3.5-4.9)
– Serum urea 5.8 mmol/L (2.5-7.5)
– Serum creatinine 110 µmol/L (60-110)
– Serum glucose 4.5 mmol/L (3.0-6.0)
– CSF opening pressure 150 mmH2O (50-180)
– CSF cell count <3 mL-1 (≤5)
– CSF protein 0.4 g/L (0.15-0.45)
– CSF glucose 3.3 mmol/L (3.3-4.4)
– Arterial blood gases breathing air:
– PaO2 11.6 kPa (11.3-12.6)
– PaCO2 4.3 kPa (4.7-6.0)
– HCO3 20 mmol/L (20-28)
– pH 7.33 (7.36-7.44)
Based on the information available, what investigation would you like to perform?
A drowsy 25-year-old student presents to the Emergency department accompanied by a friend. The patient lives alone in a one bedroom apartment and has been experiencing difficulty concentrating in lectures. She is a smoker, consuming 20 cigarettes a day, and has no significant medical history or current medication use. Upon examination, the patient appears flushed with a bounding pulse of 120 beats per minute and a blood pressure of 180/100 mmHg. She had also vomited. Initial investigations reveal normal oxygen saturations, but abnormal values for haemoglobin, white cell count, platelets, serum sodium, serum potassium, and serum urea. The drug screen is negative and the chest x-ray is normal. Arterial blood gases on air show low pO2 and normal pH and pCO2 levels. What diagnostic test would confirm the patient’s diagnosis?
A 35-year-old pregnant woman presents to the emergency department in a confused and agitated state after experiencing a seizure. She had woken up an hour earlier to find her husband dead in bed next to her, and an ultrasound confirmed that her 26-week-old fetus had also passed away. The patient reports that both she and her husband had been experiencing flu-like symptoms for the past week, and had recently moved into an old house they were renovating. The day before, they had painted their bedroom and eaten reheated Chinese food for dinner. The patient has a history of well-controlled asthma and had quit smoking when she became pregnant, but had recently been experiencing headaches. On examination, she is tachypneic with a respiratory rate of 24 breaths per minute, blood pressure of 90/60 mmHg, pulse of 120 beats per minute, and oxygen saturations of 98% on air. There is no visible rash or purpura on her body, and her heart and abdominal exams are normal. What is the most likely cause of this tragic event?
A 50-year-old ex-shipyard laborer presents with progressive shortness of breath. Pulmonary function tests reveal the following results:
Test Predicted Actual
FEV (L) 4.2 3.3
FVC (L) 4.7 3.8
TLCO (mmol/min/kPa) 9.8 6.5
KCO (mmol/min/kPa/L) 1.8 2.1
What is the probable diagnosis?
A 75-year-old woman presents with a one stone weight loss and lethargy over the past four months. She has a persistent cough and has been coughing up blood. She used to smoke 20 cigarettes a day but quit four months ago when her symptoms began. She had a history of pulmonary tuberculosis 15 years ago but is unsure of the treatment she received. Her lab results show a low white cell count, positive Aspergillus fumigatus precipitins, and a solid lesion on her left lung apex. What is the most likely diagnosis?
A 50-year-old man receiving treatment for acute leukaemia visits the haematology clinic with symptoms of cough, wheeze, occasional haemoptysis and fever. The chest x-ray reveals the air crescent sign, and a positive galactomannan test is conducted. What is the probable diagnosis, and what treatment should be initiated?
A 59-year-old man from South Africa presented to the respiratory outpatient clinic complaining of severe breathlessness. He had recently relocated to the United Kingdom to live with his children after working in the mining region of Pretoria. His breathlessness had started two years ago and had gradually worsened over time. He had an MRC dyspnoea score of IV and could only walk 100 yards before needing to stop. He had no history of cough, sputum or wheeze, and had never been diagnosed with a respiratory condition in the past. He was a lifelong non-smoker.
Upon examination, the patient was clubbed and visibly breathless at rest. His pulse was regular at 100 beats per minute, and his blood pressure was 140/80 mmHg. The jugular venous pulse was not elevated. Auscultation of his heart revealed normal heart sounds with no added sounds or audible murmurs. Examination of his respiratory system revealed symmetrically diminished breath sounds at his lung bases with fine end inspiratory crepitations. Abdominal examination was normal.
The chest radiograph showed irregular reticular shadowing affecting the periphery of the lower lobes, as well as multiple pleural plaques and areas of pleural thickening. His full pulmonary function tests revealed a FVC of 2.5 (40% predicted), FEV1 of 2.4 (44% predicted), FEV1/FVC of 96 (113% predicted), TLC of 4.5 (56% predicted), FRC of 1.6 (54% predicted), RV of 1.4 (70% predicted), and KCO of 2.30 (51% predicted).
What is the most likely cause of this patient’s symptoms?
A 50 year old patient undergoing R-CHOP chemotherapy for Non-Hodgkins Lymphoma presents with a persistent cough, fevers up to 39.4 degrees, and rigors. Despite two courses of antibiotics prescribed by their GP, the patient’s symptoms have not improved. They were admitted to the Medical Assessment Unit after experiencing blood-stained sputum during a particularly severe coughing episode.
The following investigations were conducted:
Hb: 10.4 g/dl
Platelets: 460 * 109/l
WBC: 16.4 * 109/l
Neutrophils: 13.5 * 109/l
Lymphocytes: 2.7 * 109/l
Na+: 134 mmol/l
K+: 4.2 mmol/l
Urea: 7.4 mmol/l
Creatinine: 106 µmol/l
Chest X-Ray: Cavitating lesion in the right upper zone. No evidence of pleural effusion. No other focal consolidation.
CT Thorax: Cavitating lesion with halo sign.
Broncho-alveolar lavage induced sputum: Hyphae seen on silver staining.
What is the most likely diagnosis?