A 65-year-old man complains of worsening shortness of breath. During examination, the left base has a stony dull percussion note. A chest x-ray reveals opacification in the lower lobe of the left lung. What is the most suitable test for this patient?
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 63-year-old man presents to the Emergency department with worsening dyspnoea, dry cough, and low-grade fever. He has a medical history of hypertension and was hospitalized six months ago for an acute inferior myocardial infarction complicated by left ventricular failure and arrhythmia. His chest x-ray reveals diffuse interstitial pneumonia, and further investigations show an ESR of 110 mm/h, FEV1 of 90%, FVC of 70%, and KCO of 60%. What is the most likely cause of these findings?
A 60-year-old man comes to you with complaints of increasing shortness of breath on exertion over the past year. During the examination, you observe early finger clubbing and bibasal fine crackles on auscultation. You suspect that he may have pulmonary fibrosis.
What is the imaging modality considered the gold standard for diagnosing pulmonary fibrosis?
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?
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?