An older woman presents to the Emergency Department with probable community acquired pneumonia (CAP). The consultant asks you to refer to the CURB-65 score to determine the next management plan.
Which of the following statements is part of the CURB-65 score?
A 68-year-old woman with a long history of rheumatoid arthritis presents to her general practitioner complaining of a chronic cough, weight loss and haemoptysis. She smokes ten cigarettes a day. You understand that she has begun anti-tumour necrosis factor (TNF) antibody treatment around 9 months earlier. On examination, her rheumatoid appears quiescent at present.
Investigations:
Investigation Result Normal value
Chest X-ray Calcified hilar lymph nodes,
possible left upper lobe fibrosis
Haemoglobin 109 g/l 115–155 g/l
White cell count (WCC) 11.1 × 109/l 4–11 × 109/l
Platelets 295 × 109/l 150–400 × 109/l
Erythrocyte sedimentation rate (ESR) 61 mm/h 0–10mm in the 1st hour
C-reactive protein (CRP) 55 mg/l 0–10 mg/l
Sodium (Na+) 140 mmol/l 135–145 mmol/l
Potassium (K+) 4.9 mmol/l 3.5–5.0 mmol/l
Creatinine 100 μmol/l 50–120 µmol/l
Which of the following diagnoses fits best with this clinical picture?
A 54-year-old woman presents to the Emergency Department with sudden chest pain and difficulty breathing. She has a history of factor V Leiden mutation and has smoked 20 packs of cigarettes per year. Upon examination, the patient has a fever of 38.0 °C, blood pressure of 134/82 mmHg, heart rate of 101 bpm, respiratory rate of 28 breaths/minute, and oxygen saturation of 90% on room air. Both lungs are clear upon auscultation. Cardiac examination reveals a loud P2 and a new systolic murmur at the left lower sternal border. The patient also has a swollen and red right lower extremity. An electrocardiogram (ECG) taken in the Emergency Department was normal, and troponins were within the normal range.
Which of the following chest X-ray findings is consistent with the most likely underlying pathology in this patient?
A 35-year-old man has just returned from a trip to Kenya. He has been experiencing a productive cough with blood-stained sputum, fever, and general malaise for the past week. Upon testing his sputum, he is diagnosed with tuberculosis and is prescribed isoniazid, rifampicin, pyrazinamide, and ethambutol for the initial phase of treatment. What drugs will he take during the continuation phase, which will last for four months after the initial two-month phase?
A 70-year-old woman comes to the clinic with left upper-lobe cavitating consolidation and sputum samples confirm the presence of Mycobacterium tuberculosis, which is fully sensitive. There is no prior history of TB treatment. What is the most suitable antibiotic regimen?
A 58-year-old Afro-Caribbean man presents to you with increasing difficulty in breathing and shortness of breath. A chest examination reveals decreased expansion on the right side of the chest, along with decreased breath sounds and stony dullness to percussion. A chest X-ray reveals a pleural effusion which you proceed to tap for diagnostic serum biochemistry, cytology and culture. The cytology and culture results are still awaited, although the serum biochemistry returns back showing the following:
Pleural fluid protein 55 g/dl
Pleural fluid cholesterol 4.5 g/dl
Pleural fluid lactate dehydrogenase (LDH) : serum ratio 0.7
Which of the following might be considered as a diagnosis in this patient?
A 29-year-old electrician was referred to the hospital by his doctor. He had visited his GP a week ago, complaining of malaise, headache, and myalgia for three days. Despite being prescribed amoxicillin/clavulanic acid, his symptoms persisted and he developed a dry cough and fever. At the time of referral, he was experiencing mild dyspnea, a global headache, myalgia, and arthralgia. On examination, he appeared unwell, had a fever of 39°C, and had a maculopapular rash on his upper body. Fine crackles were audible in the left mid-zone of his chest, and mild neck stiffness was noted.
The following investigations were conducted: Hb 84 g/L (130-180), WBC 8 ×109/L (4-11), Platelets 210 ×109/L (150-400), Reticulocytes 8% (0.5-2.4), Na 129 mmol/L (137-144), K 4.2 mmol/L (3.5-4.9), Urea 5.0 mmol/L (2.5-7.5), Creatinine 110 µmol/L (60-110), Bilirubin 89 µmol/L (1-22), Alk phos 130 U/L (45-105), AST 54 U/L (1-31), and GGT 48 U/L (<50). A chest x-ray revealed patchy consolidation in both mid-zones. What is the most likely cause of his abnormal blood count?
What is the most effective tool for assessing a patient who is suspected of having occupational asthma?
A 14-year-old boy comes to your clinic complaining of wheezing for the past week. His mother mentions that he had a similar issue a couple of years ago but hasn’t had any problems since. He was treated with inhalers and recovered quickly at that time. The boy is an animal lover and has always had multiple pets, including dogs, cats, birds, and reptiles. He hasn’t acquired any new pets in the last two months. Upon examination, there are no clinical findings. What would be the best next step to take?
A 72-year-old retired boiler maker presents to his General Practitioner with increasing shortness of breath and non-specific dull right-sided chest ache. He has a 35-pack-year history and has recently lost a little weight. On examination, there is evidence of a large right-sided pleural effusion.
Investigations:
Investigation
Result
Normal value
Sodium (Na+) 132 mmol/l 135–145 mmol/l
Potassium (K+) 4.5 mmol/l 3.5–5.0 mmol/l
Creatinine 120 μmol/l 50–120 µmol/l
Haemoglobin 115 g/l 135–175 g/l
Platelets 170 × 109/l 150–400 × 109/l
Chest X-ray: large right-sided pleural effusion.
Pleural tap: pleural effusion contains occasional red blood cells, white blood cells and abnormal-looking cells which look of a sarcomatous type.
Which of the following statements fits best with the underlying condition?