MSFinals-5745
You are reviewing a patient who attends the clinic with a respiratory disorder.
Which of the following conditions would be suitable for long-term oxygen therapy (LTOT) for an elderly patient?
Archives: Medical Student Finals
MSFinals-5742
A 40-year-old woman has presented with recurrent respiratory distress over the last 4 years. She has also complained of wheezing at night and coughing up of tenacious sputum, which was occasionally black. Blood reports showed:
Investigation Result Normal value
Haemoglobin 112g/dl 115–155 g/l
White cell count (WCC) 12 × 109/l 4–11 × 109/l
Neutrophil count 6.0 × 109/l 2.5–7.58 × 109/l
Eosinophil count 1.5 × 109/l 0–0.4 × 109/l
Lymphocyte count 4.1 × 109/l 1.0–4.5 × 109/l
Serum immunoglobulin E (IgE) 2800 IU/l 1–87 IU/l
Which of the following is the most likely finding on a chest computerised tomography (CT) scan?
MSFinals-5737
An 80-year-old man comes to the clinic complaining of increasing shortness of breath and dry cough over the past three months. He gets breathless after walking a few hundred metres. He is a non-smoker and takes medication for type II diabetes mellitus. During examination, his pulse is 80/minute and regular, blood pressure (BP) 130/70 mmHg, bilateral clubbing of digits, oxygen saturation (SpO2) in room air is 90%. Auscultation reveals bilateral, fine, late inspiratory crackles, more marked in the mid-zones and at the lung bases. Chest X-ray reveals patchy shadowing at the lung bases. What is the definitive investigation to guide his management?
MSFinals-5746
A 50-year-old man presents with a chronic cough and shortness of breath. He has recently developed a red/purple nodular rash on both shins. He has a history of mild asthma and continues to smoke ten cigarettes per day. On examination, he has mild wheezing and red/purple nodules on both shins. His blood pressure is 135/72 mmHg, and his pulse is 75/min and regular. The following investigations were performed: haemoglobin, white cell count, platelets, erythrocyte sedimentation rate, sodium, potassium, creatinine, and corrected calcium. His chest X-ray shows bilateral hilar lymphadenopathy. What is the most likely underlying diagnosis?
MSFinals-5753
A 58-year-old man presents to the Emergency Department with increasing shortness of breath and cough for the last two days. The patient reports feeling fevers and chills and although he has a chronic cough, this has now become productive of yellow sputum over the last 36 hours. He denies chest pain. His past medical history is significant for chronic obstructive pulmonary disease (COPD) for which he has been prescribed various inhalers that he is not compliant with. He currently smokes 15 cigarettes per day and does not drink alcohol.
His observations and blood tests results are shown below:
Investigation Result Normal value
Temperature 36.9 °C
Blood pressure 143/64 mmHg
Heart rate 77 beats per minute
Respiratory rate 32 breaths per minute
Sp(O2) 90% (room air)
White cell count 14.9 × 109/l 4–11 × 109/l
C-reactive protein 83 mg/l 0–10 mg/l
Urea 5.5 mmol/l 2.5–6.5 mmol/l
Physical examination reveals widespread wheeze throughout his lungs without other added sounds. There is no dullness or hyperresonance on percussion of the chest. His trachea is central.
Which of the following is the most appropriate next investigation?
MSFinals-5752
An 85-year-old man with chronic COPD presents for a review of his home oxygen therapy. The following results are from his arterial blood gas (ABG):
pH 7.37 (normal range 7.35–7.45)
pa(O2) 7.6 (normal range 10–14 kPa)
pa(CO2) 8 (normal range 4.0–6.0 kPa)
HCO3 37 (normal range 22–26 mmol)
base excess +6 (normal range −2 to +2 mmol).
Which of the following best describe this man’s blood gas result?
MSFinals-5748
A 65-year-old man presents with haemoptysis over the last 2 days. He has had a productive cough for 7 years, which has gradually worsened. Over the last few winters, he has been particularly bad and required admission to hospital. Past medical history includes pulmonary tuberculosis (TB) at age 20. On examination, he is cyanotic and clubbed, and has florid crepitations in both lower zones.
What is the most likely diagnosis?
MSFinals-5750
A 32-year-old woman visits her General Practitioner seeking assistance to quit smoking. She has been smoking ten cigarettes daily for the last 14 years and has no significant medical history. However, she is currently in her second trimester of pregnancy. What is the most suitable first-line smoking cessation option for this patient?
MSFinals-5751
A 65-year-old man snores at night and his wife reports it is so loud that he often wakes her up. She notes that her husband sometimes appears to not take a breath for a long time and then gasps for air before continuing to snore. He suffers from daytime headaches and sleepiness. He has a body mass index (BMI) of 40 kg/m2.
What would the most likely arterial blood gas result be if it was measured in this patient?
MSFinals-5747
A 67-year-old man comes to the Chest Clinic after being referred by his GP for a chronic cough. He complains of a dry cough that has been ongoing for 10 months and is accompanied by increasing shortness of breath. Despite multiple rounds of antibiotics, he has not experienced significant improvement. He has never smoked and denies any coughing up of blood. He used to work as a teacher and has not been exposed to any environmental dust or chemicals.
His GP ordered a chest X-ray, which reveals reticular shadowing affecting both lung bases. Upon examination, he has clubbed fingers and fine-end inspiratory crackles. His heart sounds are normal, and he is saturating at 94% on room air with a regular heart rate of 80 bpm and regular respiratory rate of 20. There is no peripheral oedema.
What is the most probable diagnosis?