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?
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?
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 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 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 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 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?
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 20-year-old male presents to the Emergency department with left-sided chest pain and difficulty breathing that started during a football game.
Which diagnostic test is most likely to provide a conclusive diagnosis?
What is the most effective method for diagnosing sleep apnoea syndrome?