A 38-year-old man is admitted to the ICU due to severe breathlessness after experiencing acute pancreatitis for three days. He is receiving facemask oxygen through a non-rebreathing mask at a rate of 15 liters per minute, and a blood gas measurement reveals a PaO2 of 7.3 kPa. A chest x-ray shows hazy shadowing throughout both lung fields, and his temperature is 37.5°C. An ECG shows sinus tachycardia, and the cardiac-specific troponin is normal. Based on these symptoms, what is the most likely diagnosis?
MRCP2-4159
A 29-year-old woman came to the Respiratory Outpatients Department complaining of a persistent cough and shortness of breath that had been worsening over the past 3 years. Despite taking numerous courses of antibiotics, her symptoms persisted. Although she had quit smoking 4 years ago, she had previously smoked 5 cigarettes a day for 5 years. Upon respiratory examination, her chest was hyper-inflated, and a mild wheeze was heard throughout. Lung function tests revealed an FEV1 of 50% predicted, FVC of 80% predicted, TLCO of 68% predicted, KCO of 71% predicted, and an increased RV:TLC ratio. What is the most likely diagnosis?
MRCP2-4170
A 65-year-old man presents to his primary care physician three weeks after experiencing an infective exacerbation of COPD. He is currently feeling well but is worried that this is his second exacerbation this winter. He is currently taking fostair, tiotropium, and salbutamol as needed. He has a mild cough but has attended his recent COPD review.
Upon examination, his chest is clear with no wheezing or crepitations. His JVP is not raised, and there is no edema. His oxygen saturation is 94% in air, and he has a respiratory rate of 22 breaths per minute. He is currently able to do his gardening and walk his dog up to half a mile each day without experiencing breathlessness at night. He has been discharged from chest physio and is performing well.
FEV1 (% predicted) is 40%, and FVC (% predicted) is 80%. A chest x-ray reveals several bullae and a hyperexpanded chest with no consolidation. An ECG shows sinus rhythm and a right bundle branch block.
What additional intervention should be considered for this patient’s current management?
MRCP2-4162
A 27-year-old man presents to the clinic with plans to climb Mount Everest. He is interested in taking medication to prevent acute mountain sickness. He has no medical history and is not on any regular medications.
What medication will you recommend for him?
MRCP2-4165
A 16-year-old girl with stable cystic fibrosis presents to the Emergency Department with a cough productive of purulent sputum tinged with blood, and significantly worse shortness of breath over the past 48 hrs. Her CF is currently well managed and she is Pseudomonas negative. On examination she is pyrexial 38.1°C, BP is 95/55 mmHg; heart rate is 85/min and regular, respiratory rate is 32. There are coarse crackles at the right base, and you also notice a couple of cold sores at the corner of her mouth. O2 saturation on air is 92%. Her BMI is 23.
Which of the following is the most appropriate antibiotic option?
MRCP2-4158
A 45-year-old man presented to the Pulmonary Clinic with a 4-year history of worsening shortness of breath and persistent cough. He has had multiple courses of antibiotics in the past few years. He smoked a pack a day for 20 years. Upon respiratory examination, his chest was hyperinflated and he had a mild wheeze throughout.
Lung function tests: FEV1 60% predicted FVC 75% predicted TLCO 65% predicted KCO 70% predicted RV:TLC No bronchodilator reversibility Increased
Which diagnostic test would be most beneficial in providing a definitive diagnosis?
MRCP2-4168
A 25-year-old male non-smoker visits your respiratory clinic with complaints of more frequent episodes of wheezing and shortness of breath. He has a history of asthma and takes salbutamol after exercising and beclometasone 200 mcg inhaler bd. What would be the most suitable course of action for management?
MRCP2-4142
A 54-year-old man comes to the respiratory clinic for evaluation. He has a history of recurrent coughing episodes lasting for months, which have been worse during winters. He has also noticed a decline in his exercise tolerance over the past two years and experiences shortness of breath more easily. He has no prior medical history and does not take any regular medications. He has a smoking history of 20 pack-years. Spirometry reveals an FEV1/FVC ratio of 63%, with an FEV1 of 74% of predicted. His chest X-ray is normal, and blood tests are unremarkable. During a previous exacerbation, his sputum sample showed growth with pseudomonas. What feature is inconsistent with a COPD diagnosis?
MRCP2-4149
A 58-year-old man was admitted to the hospital with a productive cough. Chest x-ray revealed left basal pneumonia. He was treated with intravenous antibiotics and discharged after successful weaning off oxygen. What follow-up, if any, should be recommended for this patient?
MRCP2-4143
A 57-year-old smoker was referred to the respiratory outpatient clinic by his GP with a history of progressively worsening shortness of breath. His symptoms started several months ago with shortness of breath on extreme exertion but he gradually developed shortness of breath with minimal activity. He also complained of increasing tiredness and a non-productive cough had lost approximately 3 pounds in 6 months. He denied the presence of sputum production, haemoptysis or chest pain, and also denied the presence of both orthopnoea and paroxysmal nocturnal dyspnoea. He had a past medical history comprising ankylosing spondylosis diagnosed 30 years ago as well as hypertension and hypercholesterolaemia. His drug history comprised naproxen 500mg BD, lansoprazole 30 mg OD, felodipine M/R 2.5mg OD and atorvastatin 20 mg OD. He stated that he had been trialled with a course of methotrexate a few years ago for his ankylosing spondylosis and was subsequently stopped.
Examination revealed the presence of a well male with a blood pressure of 146/86 mmHg, heart rate 74 bpm and respiratory rate of 18/min. His oxygen saturations were 93% on air. There was no BCG scar seen on examination of his arm. Examination of his respiratory system revealed the presence of bilateral fine upper zone crackles but nil else and no respiratory distress. Examination of his cardiovascular system revealed no abnormalities including a normal JVP and the absence of pedal oedema, and examination of his gastrointestinal system was likewise unremarkable.
Pulmonary function testing FEV1 2.4 l (predicted value 2.3) FVC 2.6 l (predicted value 4.8) FEV1/FVC ratio 92% TLCO transfer factor 86% of predicted value