A 35-year-old call centre operator with a 6-year history of sarcoidosis presents with worsening shortness of breath during his visit to Respiratory Outpatients. This is his fifth episode of this nature since his diagnosis. In the past, he has responded well to tapered doses of oral steroids. What initial test would be most useful in evaluating his current pulmonary condition before prescribing steroids?
The blood gases with pH 7.38, pO2 6.2 kPa, pCO2 9.2 kPa, and HCO3– 44 mmol/l are indicative of a respiratory condition. Which respiratory condition is most likely responsible for these blood gas values?
A 72-year-old woman is discovered outside in the early hours of the morning after falling to the ground. She is confused and uncertain of what happened and is admitted to the hospital. An abbreviated mental test (AMT) is conducted, and she scores 4/10. During the examination, crackles are heard at the base of her left lung.
Blood tests reveal:
Investigation Result Normal value
C-reactive protein (CRP) 89 mg/l < 10 mg/l
White cell count (WCC) 15 × 109/l 4–11 × 109/l
Neutrophils 11.4 × 109/l 5–7.58 × 109/l
The remainder of her blood tests, including full blood count (FBC), urea and electrolytes (U&Es), and liver function test (LFT), were normal.
Observations:
Investigation Result Normal value
Respiratory rate 32 breaths/min 12–18 breaths/min
Oxygen saturation 90% on air
Heart rate (HR) 88 beats/min 60–100 beats/min
Blood pressure (BP) 105/68 mmHg Hypertension: >120/80 mmHg*
Hypotension: <90/60 mmHg*
Temperature 39.1°C 1–37.2°C
*Normal ranges should be based on the individual’s clinical picture. The values are provided as estimates.
Based on her CURB 65 score, what is the most appropriate management for this patient?
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?
A 35-year-old male patient presented to the Emergency department with sudden onset chest pain and shortness of breath that had been ongoing for six hours. The symptoms appeared out of nowhere while he was watching TV, and lying flat made the breathlessness worse. The patient denied any recent history of infection, cough, fever, leg pain, swelling, or travel.
Upon examination, the patient was apyrexial and showed no signs of cyanosis. Respiratory examination revealed reduced breath sounds and hyperresonance in the right lung.
What is the most likely diagnosis?
A 54-year-old man who is a long-term cigarette smoker presents with nocturnal dry cough of 4 weeks’ duration. He has recently gone through a stressful life situation due to divorce and bankruptcy. He mentions a history of atopic diseases in his family. His symptom improves with omeprazole, one tablet daily taken in the morning.
What is the most likely diagnosis?
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?
An 80-year-old known alcoholic is brought by ambulance after being found unconscious on the road on a Sunday afternoon. He has a superficial laceration in the right frontal region. He is admitted for observation over the bank holiday weekend. Admission chest X-ray is normal. Before discharge on Tuesday morning, he is noted to be febrile and dyspnoeic. Blood tests reveal neutrophilia and elevated C-reactive protein (CRP) levels. A chest X-ray demonstrates consolidation in the right lower zone of the lung.
What is the most likely diagnosis for this patient?
A 40-year-old patient visits his GP complaining of a dry cough that has persisted for 3 months. He has been smoking 20 cigarettes daily for the past 12 years and has no other medical history. Upon examination, no abnormalities are found, and his vital signs, including pulse rate, respiratory rate, blood pressure, temperature, and oxygen saturation, are all normal. Spirometry results reveal a forced expiratory volume in 1 second (FEV1) of 3.6 litres (predicted = 3.55 litres) and a forced vital capacity of 4.8 litres (predicted 4.72 litres). What is the most probable diagnosis?
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?