A 65-year-old lady is admitted with severe pneumonia and, while on the ward, develops a warm, erythematosus, tender and oedematous left leg. A few days later, her breathing, which was improving with antibiotic treatment, suddenly deteriorated.
Which one of the following is the best diagnostic test for this patient?
A 68-year-old man with known bronchial carcinoma presents to hospital with confusion. A computed tomography (CT) scan of the brain was reported as normal: no evidence of metastases. His serum electrolytes were as follows:
Investigation Result Normal value
Sodium (Na+) 114 mmol/l 135–145 mmol/l
Potassium (K+) 3.9 mmol/l 3.5–5.0 mmol/l
Urea 5.2 mmol/l 2.5–6.5 mmol/l
Creatinine 82 μmol/l 50–120 µmol/l
Urinary sodium 54 mmol/l
Which of the subtype of bronchial carcinoma is he most likely to have been diagnosed with?
A 23-year-old man comes to the clinic complaining of sudden onset of difficulty breathing and sharp chest pain that worsens when he inhales. He has no significant medical history and is generally healthy and active. He admits to smoking and drinking occasionally. The patient is diagnosed with a pneumothorax caused by the spontaneous rupture of an apical bulla.
What is the most accurate description of the lung volume and chest wall position in this patient?
A 25-year-old refuse collector arrives at the Emergency Department complaining of sudden breathlessness. He has no prior history of respiratory issues or trauma, but does admit to smoking around ten cigarettes a day since his early teenage years. Upon examination, the doctor suspects a potential spontaneous pneumothorax and proceeds to insert a chest drain for treatment. In terms of the intercostal spaces, which of the following statements is accurate?
A 72-year-old retired boiler maker presents to his General Practitioner with increasing shortness of breath and non-specific dull right-sided chest ache. He has a 35-pack-year history and has recently lost a little weight. On examination, there is evidence of a large right-sided pleural effusion.
Investigations:
Investigation
Result
Normal value
Sodium (Na+) 132 mmol/l 135–145 mmol/l
Potassium (K+) 4.5 mmol/l 3.5–5.0 mmol/l
Creatinine 120 μmol/l 50–120 µmol/l
Haemoglobin 115 g/l 135–175 g/l
Platelets 170 × 109/l 150–400 × 109/l
Chest X-ray: large right-sided pleural effusion.
Pleural tap: pleural effusion contains occasional red blood cells, white blood cells and abnormal-looking cells which look of a sarcomatous type.
Which of the following statements fits best with the underlying condition?
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 70-year-old woman comes to the clinic with left upper-lobe cavitating consolidation and sputum samples confirm the presence of Mycobacterium tuberculosis, which is fully sensitive. There is no prior history of TB treatment. What is the most suitable antibiotic regimen?
A 58-year-old Afro-Caribbean man presents to you with increasing difficulty in breathing and shortness of breath. A chest examination reveals decreased expansion on the right side of the chest, along with decreased breath sounds and stony dullness to percussion. A chest X-ray reveals a pleural effusion which you proceed to tap for diagnostic serum biochemistry, cytology and culture. The cytology and culture results are still awaited, although the serum biochemistry returns back showing the following:
Pleural fluid protein 55 g/dl
Pleural fluid cholesterol 4.5 g/dl
Pleural fluid lactate dehydrogenase (LDH) : serum ratio 0.7
Which of the following might be considered as a diagnosis in this patient?
What is the most effective tool for assessing a patient who is suspected of having occupational asthma?
A 14-year-old boy comes to your clinic complaining of wheezing for the past week. His mother mentions that he had a similar issue a couple of years ago but hasn’t had any problems since. He was treated with inhalers and recovered quickly at that time. The boy is an animal lover and has always had multiple pets, including dogs, cats, birds, and reptiles. He hasn’t acquired any new pets in the last two months. Upon examination, there are no clinical findings. What would be the best next step to take?