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 68-year-old man undergoes a planned knee replacement surgery and experiences a successful procedure with no complications during anaesthesia. However, a few hours after the surgery, the patient’s oxygen saturation levels begin to drop and eventually reach 92% despite receiving oxygen via a face mask. Additionally, the patient starts coughing up small mucous plugs.
The patient has a medical history of mild COPD treated with tiotropium and hypertension managed with ramipril and amlodipine. He has a smoking history of 15 cigarettes per day for 35 years. There is no relevant family history.
What is the most likely diagnosis?
A 50-year-old man with a history of multiple sclerosis was admitted to the hospital after overdosing on baclofen. He was diagnosed with relapsing and remitting multiple sclerosis 20 years ago and typically uses two sticks to walk. He intermittently self-catheterizes and takes baclofen 20 mg three times a day as his only medication.
The patient’s son found him surrounded by empty packets of baclofen after returning from a night out with friends. Earlier that evening, the patient had an argument with his partner, which was believed to have triggered his actions. According to his partner, there were approximately 20 tablets left in the packet, each containing 10 mg of baclofen. (Severe toxicity is associated with 150 mg of baclofen.)
The patient is a non-smoker and does not drink alcohol. His only other significant medical history is a previous admission 18 months ago for severe community-acquired pneumonia, which required mechanical ventilation.
Upon examination, the patient was drowsy with a respiratory rate of 5/min. He had a Glasgow Coma Scale (GCS) score of 8/15 (eye = 2, verbal = 2, motor = 4), and neurological examination revealed generalized hyporeflexia. His pulse rate was 60/min, and his blood pressure was 95 systolic and 60 diastolic. Examination of his respiratory, cardiovascular, and abdominal systems was unremarkable.
His arterial gases on 50% inspired O2 were as follows:
pH 7.34 (7.36-7.44)
PO2 24.0 kPa (11.3-12.6)
PCO2 7.2 kPa (4.7-6.0)
HCO3 27 mmol/L (20-28)
Base excess 0.3 mmol/L (+/-2)
What is the next step in managing this patient?
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 63-year-old man presents to the respiratory clinic with a mass lesion detected on his chest x-ray by his GP. He has a history of heavy smoking and has been experiencing a persistent cough and weight loss for the past two months. During the consultation, he reports feeling very weak and has difficulty standing up from a chair. The consultant observes some proximal muscle wasting during the physical examination. The patient’s initial investigations reveal a blood pressure of 170/90 mmHg and low potassium levels. The consultant orders a 24-hour urinary cortisol test, in addition to staging CT and bronchoscopy. The cortisol test comes back elevated. What is the most likely underlying pathology?
A 48-year-old male presented to the respiratory outpatient clinic with a complaint of progressive breathlessness on exertion. He enjoyed hiking and had first noticed his symptoms about a year ago when he struggled to keep up with his friends. He denied any cough, sputum production, wheezing, or chest pain. His medical history included a transient ischemic attack (TIA) four months ago, seasonal allergic rhinitis, and high cholesterol. He had never smoked and was prescribed aspirin and simvastatin after his TIA. He admitted to having a poor diet with a lot of saturated fats.
During the physical examination, he was found to be obese with a BMI of 30 and plethoric. His blood pressure was 100/80 mmHg, temperature 36.8°C, pulse 96 beats per minute, and oxygen saturation of 90% on room air. An ejection systolic murmur was heard loudest in the left second intercostal space during auscultation. His ECG showed right axis deviation with right bundle branch block.
The results of his full pulmonary function tests are as follows:
– FVC: 4.30 L (87% predicted)
– FEV1: 3.62 L (84% predicted)
– FEV1/FVC: 84% (99% predicted)
– TLC: 6.90 L (86% predicted)
– RV/TLC: 30.0% (110% predicted)
– DLCO (ml/m/mm Hg): 56 mL/m/mm Hg (163% predicted)
What is the most likely underlying diagnosis?
An 80-year-old woman visits her GP complaining of increasing shortness of breath for the past 4 months. She occasionally experiences a productive cough. Her medical history includes two previous heart attacks treated with percutaneous coronary intervention and hypercholesterolaemia managed with simvastatin. She has a 35 pack-year smoking history and does not consume alcohol.
The GP orders lung function tests which reveal:
Forced expiratory volume in 1 second (FEV1) 0.78L
Forced vital capacity (FVC) 1.68L
Total lung capacity 5.08L
What is the most probable diagnosis?
A 72-year-old woman presents to the rapid access chest clinic with a chronic productive cough, progressive shortness of breath, and reduced exercise tolerance over the past 3 months. She also reports experiencing constant pain in her left shoulder for the past month, which is slightly relieved by paracetamol and codeine. The patient has a medical history of moderate COPD, mechanical back pain, and a 15-year pack history. She drinks 1-2 units of alcohol per day. On examination, there is wasting of the hypothenar eminence of the left hand, but clear bilateral chest sounds with no added sounds and present heart sounds 1 and 2 without murmurs.
What investigation would be most useful to perform following a chest x-ray?
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?
A 36-year-old man residing in long-term care is experiencing increased respiratory effort and drowsiness. He has been diagnosed with pneumonia after a new consolidation was found on his chest x-ray. His care workers reported that he had vomited a few times 4 days ago.
The microbiology laboratory analyzed a sputum sample and found a mixture of Gram-positive cocci and Gram-negative rods visible on microscopy. After 48 hours, growth was observed on both the blood agar plate and the anaerobic agar plate.
What sputum culture finding would indicate that his pneumonia is caused by aspiration?