A 10-year-old boy visits his General Practitioner complaining of feeling unwell for the past two days. He reports having a sore throat, general malaise, and nasal congestion, but no cough or fever. During the examination, his pulse rate is 70 bpm, respiratory rate 18 breaths per minute, and temperature 37.3 °C. The doctor notes tender, swollen anterior cervical lymph nodes. What investigation should the doctor consider requesting?
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 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?
A 10-year-old boy comes to the GP clinic with his father for an asthma check-up. He is currently on Clenil® Modulite® (beclomethasone) 100 μg twice daily as a preventer inhaler, but still needs to use his salbutamol inhaler 2-3 times a day. During the examination, he is able to complete sentences, not using any accessory muscles of respiration, his oxygen saturation is 99%, his chest is clear, and PEFR is 85% of his predicted value. What is the recommended next step in managing this patient according to the latest BTS guidelines?
An 80-year-old woman came to the Emergency Department complaining of severe dyspnoea. A chest X-ray showed an opaque right hemithorax. She had no history of occupational exposure to asbestos. Her husband worked in a shipyard 35 years ago, but he had no lung issues. She has never been a smoker. Upon thorax examination, there was reduced movement on the right side, with absent breath sounds and intercostal fullness.
What is the probable reason for the radiological finding?
A 62-year-old female patient complains of breathlessness and weight loss over the past three months. She is a smoker who consumes 10 cigarettes per day. During the examination, you observe clubbing of the fingers and a few crackles in the chest. What is the probable diagnosis?
A nurse in the Emergency Department presents an electrocardiogram (ECG) to you. The elderly patient is feeling breathless and has long-standing limited mobility. The ECG shows a sinus tachycardia with an S-wave in lead I, Q-wave in lead III and T-wave inversion in lead III.
What is the most likely diagnosis?
A 75-year-old man presents to the Emergency Department with complaints of difficulty breathing. Upon examination, you observe that his trachea is centralized and there is decreased chest expansion on the left side, accompanied by a dull percussion note and diminished breath sounds. What is the diagnosis?
A 32-year-old female with a 10 year history of asthma presents with increasing dyspnoea after returning from a trip to Australia. She has not had a period in three months. On examination, she has a fever of 37.5°C, a pulse rate of 110/min, a blood pressure of 106/74 mmHg, and saturations of 93% on room air. Her respiratory rate is 24/min and auscultation of the chest reveals vesicular breath sounds. Peak flow is 500 L/min and her ECG shows no abnormalities except for a heart rate of 110 bpm. A chest x-ray is normal. What is the most likely diagnosis?
A 25-year-old lady with a history of asthma is brought to the Emergency Department with an acute asthma attack. She has previously been admitted to the intensive therapy unit (ITU) with the same problem. Treatment is commenced with high-flow oxygen and regular nebulisers.
Which of the following is a feature of life-threatening asthma?