A 32-year-old postal worker with asthma visits his GP for his annual asthma review. He reports experiencing breathlessness during his morning postal round for the past few months. Despite a normal examination, the GP advises him to conduct peak flow monitoring. The results show a best PEFR of 650 L/min and an average of 439 L/min, with a predicted PEFR of 660 L/min. What is the most likely interpretation of these PEFR results?
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?
A 35-year-old male presents with recurrent dyspnoea and cough. He has a medical history of asthma and has been hospitalized in the past due to asthma and two recent cases of pneumonia. On examination, he has bilateral wheeze and a mild fever. His sputum is thick and sticky. Blood tests reveal an ESR of 72 mm/hr (1-10) and elevated IgE levels. What is the most probable diagnosis?
A 50-year-old man visits the Respiratory Outpatients Department complaining of a dry cough and increasing breathlessness. During the examination, the doctor observes finger clubbing, central cyanosis, and fine end-inspiratory crackles upon auscultation. The chest X-ray shows reticular shadows and peripheral honeycombing, while respiratory function tests indicate a restrictive pattern with reduced lung volumes but a normal forced expiratory volume in 1 second (FEV1): forced vital capacity (FVC) ratio. The patient’s pulmonary fibrosis is attributed to which of the following medications?
A 28-year-old female patient presents to your clinic seeking help to quit smoking. Despite several attempts in the past, she has been unsuccessful. She has a medical history of bipolar disorder and well-managed epilepsy, for which she takes lamotrigine. She currently smokes 15 cigarettes per day and is especially interested in the health benefits of quitting smoking since she has recently found out that she is pregnant. As her physician, you decide to prescribe a suitable medication to assist her in her efforts. What would be the most appropriate treatment option?
A 38-year-old woman presents to the Emergency department with a two-week history of palpitations and breathlessness. She has a past medical history of diabetes mellitus, which is well controlled on metformin 850 mg bd, and longstanding hypertension for which she has been on therapy for several years. Her current medications include captopril 50 mg bd, furosemide 40 mg od, and nifedipine 20 mg bd. She recently consulted her GP with symptoms of breathlessness, and he increased the dose of furosemide to 80 mg od.
On examination, the patient is overweight and appears distressed. She is afebrile, with a pulse of 120, regular, and a blood pressure of 145/95 mmHg. Heart sounds 1 and 2 are normal without added sounds or murmurs. Respiratory rate is 28/minute, and the chest is clear to auscultation. The rest of the examination is normal.
Investigations:
– Hb: 134 g/L (normal range: 115-165)
– WBC: 8.9 ×109/L (normal range: 4-11)
– Platelets: 199 ×109/L (normal range: 150-400)
– Sodium: 139 mmol/L (normal range: 137-144)
– Potassium: 4.4 mmol/L (normal range: 3.5-4.9)
– Urea: 5.8 mmol/L (normal range: 2.5-7.5)
– Creatinine: 110 µmol/L (normal range: 60-110)
– Glucose: 5.9 mmol/L (normal range: 3.0-6.0)
– Arterial blood gases on air:
– pH: 7.6 (normal range: 7.36-7.44)
– O2 saturation: 99%
– PaO2: 112 mmHg/15 kPa (normal range: 75-100)
– PaCO2: 13.7 mmHg/1.8 kPa (normal range: 35-45)
– Standard bicarbonate: 20 mmol/L (normal range: 20-28)
– Base excess: -7.0 mmol/L (normal range: ±2)
What is the appropriate treatment for this patient?
A 78-year-old man with known alcohol dependence presents to the Emergency Department with a few weeks of productive cough, weight loss, fever and haemoptysis. He is a heavy smoker, consuming 30 cigarettes per day. On a chest X-ray, multiple nodules 1-3 mm in size are visible throughout both lung fields. What is the best treatment option to effectively address the underlying cause of this man’s symptoms?
A 65-year-old man with chronic obstructive pulmonary disease (COPD) continues to be breathless at rest despite maximal inhaler therapy, pulmonary rehabilitation and home oxygen therapy. He has been reviewed for lung volume reduction surgery but was deemed unsuitable. He is referred for consideration of lung transplantation.
His FEV1 is 30% predicted, he has not smoked for 12 years, and his past medical history includes bowel cancer, for which he underwent partial colectomy and adjunctive chemotherapy six years previously without evidence of recurrence on surveillance, and pulmonary tuberculosis age 37, which was fully sensitive and treated with six months of anti-tuberculous therapy. The patient’s body mass index (BMI) is 29 kg/m2.
What feature in this patient’s history would make him ineligible for listing for lung transplantation at this time?
A 29-year-old woman comes to the Emergency Department complaining of right-sided chest pain. She reports experiencing fever and shortness of breath for the past week. Upon examination, there are reduced breath sounds on the right side, and a chest X-ray reveals a right pleural effusion without loculation. The patient consents to a thoracentesis to obtain a sample of the pleural fluid.
What is the optimal location for needle insertion?
What is the most effective method for diagnosing sleep apnoea syndrome?