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Question 1
Correct
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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?Your Answer: The lung collapses inward and the chest wall expands outward
Explanation:Understanding Pneumothorax: Causes and Management
Pneumothorax is a common thoracic disease characterized by the presence of air in the pleural space. It can be spontaneous, traumatic, secondary, or iatrogenic. When air enters the pleural space, it causes the lung to collapse inward and the chest wall to expand outward. In cases of tension pneumothorax, immediate medical attention is required to decompress the pleural space with a wide-bore needle. For non-tension pneumothorax, management depends on the patient’s symptoms. If the pneumothorax is larger than 2 cm and the patient is breathless, aspiration with a large-bore cannula and oxygen therapy may be necessary. If the pneumothorax is small and the patient is asymptomatic, they can be discharged with an outpatient appointment in 6 weeks. However, if the pneumothorax is larger than 2 cm or the patient remains breathless after decompression, a chest drain will need to be inserted. It is important to understand the causes and management of pneumothorax to ensure prompt and effective treatment.
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This question is part of the following fields:
- Respiratory
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Question 2
Incorrect
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A 70-year-old man with a medical history of hyperlipidaemia and hypertension arrives at the Emergency Department complaining of cough and difficulty breathing that has been getting worse over the past 24 hours. Upon examination, he is not running a fever, has a blood pressure of 100/60 mmHg, a heart rate of 110 bpm, and an oxygen saturation level of 95% on room air. During chest auscultation, the patient displays fine crackles in both lung bases. Additionally, a new audible systolic murmur is detected at the apex.
What is the most likely cause of the patient's pulmonary symptoms?Your Answer: Pleural effusion
Correct Answer: Pulmonary oedema
Explanation:Differential Diagnosis for a Patient with Pulmonary Oedema
The patient in question is likely suffering from flash pulmonary oedema, which can be caused by mitral valve regurgitation due to mitral valve disease. This is supported by the patient’s advanced age, hypertension, hyperlipidaemia, and the presence of a new systolic murmur at the apex. The backup of blood into the left atrium and pulmonary vasculature can lead to transudation of fluid into the pulmonary alveolar space, causing pulmonary oedema.
While pericardial effusion could also lead to pulmonary congestion, it would likely manifest with Beck’s triad of distant heart sounds, hypotension, and distended neck veins. Pleural effusion, on the other hand, would result in quieter sounds on auscultation and dullness to percussion. Lobar pneumonia would be accompanied by a fever and crackles on auscultation, but would not explain the new systolic murmur. Finally, left ventricular outflow tract obstruction, such as aortic stenosis, would cause a different type of murmur at the right upper sternal border, which is not present in this case.
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This question is part of the following fields:
- Respiratory
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Question 3
Correct
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A 65-year-old man presents to the Emergency Department with sudden breathlessness and haemoptysis. He had just returned from a trip to Thailand and had been complaining of pain in his left leg. His oxygen saturation is 88% on room air, blood pressure is 95/70 mmHg, and heart rate is 120 bpm. He has a history of hypertension managed with lifestyle measures only and used to work as a construction worker. While receiving initial management, the patient suddenly becomes unresponsive, stops breathing, and has no pulse. Despite prolonged resuscitation efforts, the patient is declared dead after 40 minutes. Which vessel is most likely to be affected, leading to this patient's death?
Your Answer: Pulmonary artery
Explanation:Differentiating Thrombosis in Varicose Veins: Symptoms and Diagnosis
Pulmonary artery thrombosis is a serious condition that can cause sudden-onset breathlessness, haemoptysis, pleuritic chest pain, and cough. It is usually caused by a deep vein thrombosis that travels to the pulmonary artery. Computed tomography pulmonary angiogram (CTPA) is the preferred imaging modality for diagnosis.
Pulmonary vein thrombosis is a rare condition that is typically associated with lobectomy, metastatic carcinoma, coagulopathies, and lung transplantation. Patients usually present with gradual onset dyspnoea, lethargy, and peripheral oedema.
Azygos vein thrombosis is a rare occurrence that is usually associated with azygos vein aneurysms and hepatobiliary pathologies. It is rarely fatal.
Brachiocephalic vein thrombosis is usually accompanied by arm swelling, pain, and limitation of movement. It is less likely to progress to a pulmonary embolus than lower limb deep vein thrombosis.
Coronary artery thrombus resulting in myocardial infarction (MI) is characterised by cardiac chest pain, hypotension, and sweating. Haemoptysis is not a feature of MI. Electrocardiographic changes and serum troponin and cardiac enzyme levels are typically seen in MI, but not in pulmonary embolism.
In summary, the symptoms and diagnosis of thrombosis vary depending on the affected vein. It is important to consider the patient’s medical history and perform appropriate imaging and laboratory tests for accurate diagnosis and treatment.
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This question is part of the following fields:
- Respiratory
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Question 4
Incorrect
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A 30-year-old woman with asthma presented with rapidly developing asthma and wheezing. She was admitted, and during her treatment, she coughed out tubular gelatinous materials. A chest X-ray showed collapse of the lingular lobe.
What is this clinical spectrum better known as?Your Answer: Lofgren syndrome
Correct Answer: Plastic bronchitis
Explanation:Respiratory Conditions: Plastic Bronchitis, Loeffler Syndrome, Lofgren Syndrome, Cardiac Asthma, and Croup
Plastic Bronchitis: Gelatinous or rigid casts form in the airways, leading to coughing. It is associated with asthma, bronchiectasis, cystic fibrosis, and respiratory infections. Treatment involves bronchial washing, sputum induction, and preventing infections. Bronchoscopy may be necessary for therapeutic removal of the casts.
Loeffler Syndrome: Accumulation of eosinophils in the lungs due to parasitic larvae passage. Charcot-Leyden crystals may be present in the sputum.
Lofgren Syndrome: Acute presentation of sarcoidosis with hilar lymphadenopathy and erythema nodosum. Usually self-resolving.
Cardiac Asthma: Old term for acute pulmonary edema, causing peribronchial fluid collection and wheezing. Pink frothy sputum is produced.
Croup: Acute pharyngeal infection in children aged 6 months to 3 years, presenting with stridor.
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This question is part of the following fields:
- Respiratory
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Question 5
Incorrect
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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?
Your Answer: Spironolactone
Correct Answer: Bleomycin
Explanation:Drug-Induced Pulmonary Fibrosis: Causes and Investigations
Pulmonary fibrosis is a condition characterized by scarring of the lungs, which can be caused by various diseases and drugs. One drug that has been linked to pulmonary fibrosis is bleomycin, while other causes include pneumoconiosis, occupational lung diseases, and certain medications. To aid in diagnosis, chest X-rays, high-resolution computed tomography (CT), and lung function tests may be performed. Treatment involves addressing the underlying cause. However, drugs such as aspirin, ramipril, spironolactone, and simvastatin have not been associated with pulmonary fibrosis. It is important to be aware of the potential risks of certain medications and to monitor for any adverse effects.
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This question is part of the following fields:
- Respiratory
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Question 6
Incorrect
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An 80-year-old man comes to the Emergency Department complaining of difficulty breathing. His vital signs show a pulse rate of 105 bpm, a respiratory rate of 30 breaths per minute, and SpO2 saturations of 80% on pulse oximetry. He has a history of COPD for the past 10 years. Upon examination, there is reduced air entry bilaterally and coarse crackles. What would be the most crucial investigation to conduct next?
Your Answer: Chest X-ray
Correct Answer: Arterial blood gas (ABG)
Explanation:Importance of Different Investigations in Assessing Acute Respiratory Failure
When a patient presents with acute respiratory failure, it is important to conduct various investigations to determine the underlying cause and severity of the condition. Among the different investigations, arterial blood gas (ABG) is the most important as it helps assess the partial pressures of oxygen and carbon dioxide, as well as the patient’s pH level. This information can help classify respiratory failure into type I or II and identify potential causes of respiratory deterioration. In patients with a history of COPD, ABG can also determine if they are retaining carbon dioxide, which affects their target oxygen saturations.
While a chest X-ray may be considered to assess for underlying pathology, it is not the most important investigation. A D-dimer may be used to rule out pulmonary embolism, and an electrocardiogram (ECG) may be done to assess for cardiac causes of respiratory failure. However, ABG should be prioritized before these investigations.
Pulmonary function tests may be required after initial assessment of oxygen saturations to predict potential respiratory failure based on the peak expiratory flow rate. Overall, a combination of these investigations can help diagnose and manage acute respiratory failure effectively.
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This question is part of the following fields:
- Respiratory
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Question 7
Incorrect
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A 50-year-old man in the United Kingdom presents with fever and cough. He smells strongly of alcohol and has no fixed abode. His heart rate was 123 bpm, blood pressure 93/75 mmHg, oxygen saturations 92% and respiratory rate 45 breaths per minute. Further history from him reveals no recent travel history and no contact with anyone with a history of foreign travel.
Chest X-ray revealed consolidation of the right upper zone.
Which of the following drugs is the most prudent choice in his treatment?Your Answer: Isoniazid, rifampicin, pyrazinamide, ethambutol
Correct Answer: Meropenem
Explanation:Understanding Klebsiella Pneumoniae Infection and Treatment Options
Klebsiella pneumoniae (KP) is a common organism implicated in various infections such as pneumonia, urinary tract infection, intra-abdominal abscesses, or bacteraemia. Patients with underlying conditions like alcoholism, diabetes, or chronic lung disease are at higher risk of contracting KP. The new hypervirulent strains with capsular serotypes K1 or K2 are increasingly being seen. In suspected cases of Klebsiella infection, treatment is best started with carbapenems. However, strains possessing carbapenemases are also being discovered, and Polymyxin B or E or tigecycline are now used as the last line of treatment. This article provides an overview of KP infection, radiological findings, and treatment options.
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This question is part of the following fields:
- Respiratory
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Question 8
Incorrect
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A 25-year-old man has suffered a left-sided pneumothorax. A chest drain has been inserted through the left fifth intercostal space at the mid-axillary line.
As well as the intercostal muscles, which other muscle is likely to have been pierced?Your Answer: Latissimus dorsi
Correct Answer: Serratus anterior
Explanation:Muscles and Chest Drains: Understanding the Anatomy
The human body is a complex system of muscles, bones, and organs that work together to keep us alive and functioning. When it comes to chest drains, understanding the anatomy of the surrounding muscles is crucial for successful placement and management. Let’s take a closer look at some of the key muscles involved.
Serratus Anterior
The serratus anterior muscle is located on the lateral chest and plays a vital role in protracting the scapula and contributing to rotation. It is likely to be pierced with most chest drains due to its position, with its lower four segments attaching to the fifth to eighth ribs anterior to the mid-axillary line.Latissimus Dorsi
The latissimus dorsi muscle is a back muscle involved in adduction, medial rotation, and extension of the shoulder. It is not pierced by a chest drain.External Oblique
The external oblique muscle is located in the anterior abdomen and is not involved with a chest drain.Pectoralis Major
The pectoralis major muscle is situated in the anterior chest and is not affected by a chest drain, as it does not overlie the fifth intercostal space at the mid-axillary line. It flexes, extends, medially rotates, and adducts the shoulder.Pectoralis Minor
The pectoralis minor muscle lies inferior to the pectoralis major on the anterior chest. It is a small muscle and is not usually pierced with a chest drain, as it does not overlie the fifth intercostal space at the mid-clavicular line.In conclusion, understanding the anatomy of the muscles surrounding the chest is essential for successful chest drain placement and management. Knowing which muscles are likely to be pierced and which are not can help healthcare professionals provide the best possible care for their patients.
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This question is part of the following fields:
- Respiratory
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Question 9
Correct
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A 55-year-old smoker is referred by his General Practitioner (GP) for diagnostic spirometry after presenting with worsening respiratory symptoms suggestive of chronic obstructive pulmonary disease (COPD).
Regarding spirometry, which of the following statements is accurate?Your Answer: FEV1 is a good marker of disease severity in COPD
Explanation:Common Misconceptions about Pulmonary Function Tests
Pulmonary function tests (PFTs) are a group of tests that measure how well the lungs are functioning. However, there are several misconceptions about PFTs that can lead to confusion and misinterpretation of results. Here are some common misconceptions about PFTs:
FEV1 is the only marker of disease severity in COPD: While FEV1 is a good marker of COPD disease severity, it should not be the only factor considered. Other factors such as symptoms, exacerbation history, and quality of life should also be taken into account.
Peak flow is helpful in the diagnosis of COPD: Peak flow is not a reliable tool for diagnosing COPD. It is primarily used in monitoring asthma and can be affected by factors such as age, gender, and height.
Residual volume can be measured by spirometer: Residual volume cannot be measured by spirometer alone. It requires additional tests such as gas dilution or body plethysmography.
Vital capacity increases with age: Vital capacity actually decreases with age due to changes in lung elasticity and muscle strength.
Peak flow measures the calibre of small airways: Peak flow is a measure of the large and medium airways, not the small airways.
By understanding these common misconceptions, healthcare professionals can better interpret PFT results and provide more accurate diagnoses and treatment plans for patients.
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This question is part of the following fields:
- Respiratory
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Question 10
Incorrect
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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?
Your Answer: Bupropion
Correct Answer: Behavioural therapy
Explanation:Smoking Cessation Options for Pregnant Women: A Review of Medications and Therapies
When it comes to quitting smoking during pregnancy or postpartum, behavioural therapy is the recommended first-line approach by the National Institute for Health and Care Excellence (NICE). Smoking cessation clinics can provide support for women who wish to quit smoking. Clonidine, a medication used for high blood pressure and drug withdrawal, has some effect on smoking cessation but is not licensed or recommended for this use by NICE. Bupropion, which reduces cravings and withdrawal effects, is contraindicated during pregnancy and breastfeeding. Nicotine replacement therapy can be used in pregnancy, but women should be informed of the risks and benefits and only used if behavioural support is ineffective. Varenicline, a medication that reduces cravings and the pleasurable effects of tobacco products, is contraindicated during pregnancy and breastfeeding due to its toxicity in studies. It is important for healthcare providers to discuss the available options with pregnant women and provide individualized recommendations for smoking cessation.
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This question is part of the following fields:
- Respiratory
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Question 11
Incorrect
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A 28-year-old man with a history of cystic fibrosis is experiencing deteriorating respiratory symptoms and is subsequently diagnosed with aspergillus infection. What is a common pulmonary manifestation of Aspergillus infection?
Your Answer: Prominent mediastinal lymphadenopathy
Correct Answer: Allergic asthma
Explanation:Pulmonary Manifestations of Aspergillosis
Aspergillosis is a fungal infection caused by Aspergillus. It can affect various organs in the body, including the lungs. The pulmonary manifestations of aspergillosis include allergic reactions, bronchocentric granulomatosis, necrotising aspergillosis, extrinsic allergic alveolitis, aspergilloma, and bronchial stump infection.
Allergic reactions can manifest as allergic asthma or allergic bronchopulmonary aspergillosis (ABPA). Patients may experience recurrent wheezing, fever, and transient opacities on chest X-ray. In later stages, bronchiectasis may develop.
Bronchocentric granulomatosis is characterised by granuloma of bronchial mucosa with eosinophilic infiltrates. Chest X-ray shows a focal upper lobe lesion, and there may be haemoptysis.
Necrotising aspergillosis is usually found in immunocompromised patients. Chest X-ray shows spreading infiltrates, and there is invasion of blood vessels.
Extrinsic allergic alveolitis, also known as hypersensitivity pneumonitis, may occur in certain professions like malt workers. Four to 8 hours after exposure, there is an allergic reaction characterised by fever, chill, malaise, and dyspnoea. Serum IgE concentrations are normal.
Aspergilloma is saprophytic colonisation in pre-existing cavities. Haemoptysis is the most frequent symptom. Chest X-ray shows Monod’s sign, and gravitational change of position of the mass can be demonstrated.
Bronchial stump infection is usually found in post-surgery cases when silk suture is used. If nylon suture is used, this problem is eliminated. This can also occur in lung transplants at the site of anastomosis of bronchi.
Understanding the Pulmonary Manifestations of Aspergillosis
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This question is part of the following fields:
- Respiratory
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Question 12
Incorrect
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A 63-year-old man who used to work as a stonemason presents to the clinic with complaints of shortness of breath on minimal exercise and a dry cough. He has been experiencing progressive shortness of breath over the past year. He is a smoker, consuming 20-30 cigarettes per day, and has occasional wheezing. On examination, he is clubbed and bilateral late-inspiratory crackles can be heard at both lung bases. A chest X-ray shows upper lobe nodular opacities. His test results show a haemoglobin level of 125 g/l (normal range: 135-175 g/l), a WCC of 4.6 × 109/l (normal range: 4-11 × 109/l), platelets of 189 × 109/l (normal range: 150-410 × 109/l), a sodium level of 139 mmol/l (normal range: 135-145 mmol/l), a potassium level of 4.9 mmol/l (normal range: 3.5-5.0 mmol/l), a creatinine level of 135 μmol/l (normal range: 50-120 μmol/l), an FVC of 2.1 litres (normal range: >4.05 litres), and an FEV1 of 1.82 litres (normal range: >3.15 litres). Based on these findings, what is the most likely diagnosis?
Your Answer: Chronic obstructive pulmonary disease (COPD)
Correct Answer: Occupational interstitial lung disease
Explanation:Possible Occupational Lung Diseases and Differential Diagnosis
This patient’s history of working as a stonemason suggests a potential occupational exposure to silica dust, which can lead to silicosis. The restrictive lung defect seen in pulmonary function tests supports this diagnosis, which can be confirmed by high-resolution computerised tomography. Smoking cessation is crucial in slowing the progression of lung function decline.
Idiopathic pulmonary fibrosis is another possible diagnosis, but the occupational exposure makes silicosis more likely. Occupational asthma, caused by specific workplace stimuli, is also a consideration, especially for those in certain occupations such as paint sprayers, food processors, welders, and animal handlers.
Chronic obstructive pulmonary disease (COPD) is unlikely due to the restrictive spirometry results, as it is characterised by an obstructive pattern. Non-occupational asthma is also less likely given the patient’s age, chest X-ray findings, and restrictive lung defect.
In summary, the patient’s occupational history and pulmonary function tests suggest a potential diagnosis of silicosis, with other possible occupational lung diseases and differential diagnoses to consider.
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This question is part of the following fields:
- Respiratory
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Question 13
Correct
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A 50-year-old woman is brought to the Emergency Department after falling down the stairs at home. She complains of ‘rib pain’ and is moved to the resus room from triage, as she was unable to complete full sentences due to shortness of breath. Sats on room air were 92%. You are asked to see her urgently as the nursing staff are concerned about her deterioration.
On examination, she appears distressed; blood pressure is 85/45, heart rate 115 bpm, respiratory rate 38 and sats 87% on air. Her left chest does not appear to be moving very well, and there are no audible breath sounds on the left on auscultation.
What is the most appropriate next step in immediate management of this patient?Your Answer: Needle thoracocentesis of left chest
Explanation:Needle Thoracocentesis for Tension Pneumothorax
Explanation:
In cases of traumatic chest pain, it is important to keep an open mind regarding other injuries. However, if a patient rapidly deteriorates with signs of shock, hypoxia, reduced chest expansion, and no breath sounds audible on the affected side of the chest, a tension pneumothorax should be suspected. This is an immediately life-threatening condition that requires immediate intervention.There is no time to wait for confirmation on a chest X-ray or to set up a chest drain. Instead, needle thoracocentesis should be performed on the affected side of the chest. A large-bore cannula is inserted in the second intercostal space, mid-clavicular line, on the affected side. This can provide rapid relief and should be followed up with the insertion of a chest drain.
It is important to note that there is no role for respiratory consultation or nebulisers in this scenario. Rapid intervention is key to preventing cardiac arrest and improving patient outcomes.
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This question is part of the following fields:
- Respiratory
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Question 14
Correct
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A 5-year-old girl comes to her general practice clinic with her mother. She has been experiencing nasal congestion, sneezing, and a sore throat for the past few days. During the examination, her pulse rate is 80 bpm, respiratory rate is 20 breaths per minute, and temperature is 36.9 °C. She has no significant medical history. What is the probable diagnosis?
Your Answer: Common cold
Explanation:Possible Diagnosis for a Young Girl with Respiratory Symptoms
A young girl is experiencing respiratory symptoms, including sore throat, sneezing, and nasal congestion. Here are some possible diagnoses to consider:
1. Common cold: This is a common viral infection that can cause mild fever, especially in children.
2. Hay fever: This is an allergic reaction to specific allergens, such as pollen, that can cause similar symptoms to the common cold, but with a chronic and fluctuating course.
3. Infectious mononucleosis: This is a viral infection that can cause fatigue, fever, laryngitis, and a rash, but is less likely in this case.
4. influenzae: This is a seasonal viral infection that can cause more severe symptoms, such as high fever, headache, and muscle aches.
5. Meningitis: This is a serious bacterial infection that can cause non-specific respiratory symptoms, but also tachycardia, hypotension, high fever, photophobia, neck stiffness, and petechial rash, which are not mentioned here.
Possible Diagnoses for a Young Girl with Respiratory Symptoms
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This question is part of the following fields:
- Respiratory
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Question 15
Incorrect
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A 68-year-old retired plumber presents with progressive shortness of breath, haemoptysis and weight loss. He has a smoking history of 25 pack years.
A focal mass is seen peripherally in the left lower lobe on chest X-ray (CXR).
Serum biochemistry reveals:
Sodium (Na+): 136 mmol/l (normal range: 135–145 mmol/l)
Potassium (K+): 3.8 mmol/l (normal range: 3.5–5.0 mmol/l)
Corrected Ca2+: 3.32 mmol/l (normal range: 2.20–2.60 mmol/l)
Urea: 6.8 mmol/l (normal range: 2.5–6.5 mmol/l)
Creatinine: 76 μmol/l (normal range: 50–120 µmol/l)
Albumin: 38 g/l (normal range: 35–55 g/l)
What is the most likely diagnosis?Your Answer: Mesothelioma
Correct Answer: Squamous cell bronchial carcinoma
Explanation:Understanding Squamous Cell Bronchial Carcinoma and Hypercalcemia
Squamous cell bronchial carcinoma is a type of non-small cell lung cancer that can cause hypercalcemia, a condition characterized by elevated levels of calcium in the blood. This occurs because the cancer produces a hormone that mimics the action of parathyroid hormone, leading to the release of calcium from bones, kidneys, and the gut. Focal lung masses on a chest X-ray can be caused by various conditions, including bronchial carcinoma, abscess, tuberculosis, and metastasis. Differentiating between subtypes of bronchial carcinoma requires tissue sampling, but certain features of a patient’s history may suggest a particular subtype. Small cell bronchial carcinoma, for example, is associated with paraneoplastic phenomena such as Cushing’s syndrome and SIADH. Mesothelioma, on the other hand, is linked to asbestos exposure and presents with pleural thickening or malignant pleural effusion on a chest X-ray. Overall, a focal lung mass in a smoker should be viewed with suspicion and thoroughly evaluated to determine the underlying cause.
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This question is part of the following fields:
- Respiratory
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Question 16
Incorrect
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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?
Your Answer: Arterial blood gas
Correct Answer: Pulmonary function tests with transfer factor
Explanation:Pulmonary Function Tests with Transfer Factor in Sarcoidosis: An Overview
Sarcoidosis is a complex inflammatory disease that can affect multiple organs, with respiratory manifestations being the most common. Pulmonary function tests with transfer factor are a useful tool in assessing the severity of sarcoidosis and monitoring response to treatment. The underlying pathological process in sarcoidosis is interstitial fibrosis, leading to a restrictive pattern on pulmonary function tests with reduced transfer factor. While steroids are often effective in treating sarcoidosis, monitoring transfer factor levels can help detect exacerbations and assess response to treatment. Other diagnostic tests, such as arterial blood gas, chest X-ray, serum ACE levels, and HRCT of the chest, may also be useful in certain situations but are not always necessary as an initial test. Overall, pulmonary function tests with transfer factor play a crucial role in the management of sarcoidosis.
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This question is part of the following fields:
- Respiratory
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Question 17
Incorrect
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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?Your Answer: Partial compensation for respiratory acidosis secondary to chronic respiratory disease
Correct Answer: Compensation for respiratory acidosis secondary to chronic respiratory disease
Explanation:Understanding ABGs: A Five-Step Approach and Mnemonic
Arterial blood gas (ABG) analysis is a crucial tool in assessing a patient’s respiratory and metabolic status. The Resuscitation Council (UK) recommends a five-step approach to interpreting ABGs:
1. Assess the patient.
2. Assess their oxygenation (pa(O2) should be >10 kPa).
3. Determine if the patient is acidotic (pH < 7.35) or alkalotic (pH > 7.45).
4. Assess respiratory status by determining if their pa(CO2) is high or low.
5. Assess metabolic status by determining if their bicarbonate (HCO3) is high or low.To aid in understanding ABGs, the mnemonic ROME can be used:
– Respiratory = Opposite: A low pH and high pa(CO2) indicate respiratory acidosis, while a high pH and low pa(CO2) indicate respiratory alkalosis.
– Metabolic = Equivalent: A high pH and high HCO3 indicate metabolic alkalosis, while a low pH and low HCO3 indicate metabolic acidosis.Compensation for respiratory acidosis secondary to chronic respiratory disease is characterized by a normal pH, high pa(CO2), and high HCO3, indicating renal compensation. In contrast, compensation for respiratory alkalosis secondary to chronic respiratory disease would show a low pa(CO2) and a high pH.
Partial compensation for respiratory acidosis secondary to chronic respiratory disease is characterized by a high pa(CO2) and a high HCO3, with a normal pH indicating full compensation and a mildly altered pH indicating partial compensation. Compensation for metabolic acidosis secondary to chronic respiratory disease is not applicable, as this condition would present with low HCO3 levels.
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This question is part of the following fields:
- Respiratory
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Question 18
Incorrect
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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?
Your Answer: CT thorax
Correct Answer: Ultrasound-guided pleural fluid aspiration
Explanation:Left Pleural Effusion Diagnosis
A left pleural effusion is present in this patient, which is likely to be significant in size. To diagnose this condition, a diagnostic aspiration is necessary. The fluid obtained from the aspiration should be sent for microscopy, culture, and cytology to determine the underlying cause of the effusion. Proper diagnosis is crucial in determining the appropriate treatment plan for the patient. Therefore, it is essential to perform a diagnostic aspiration and analyze the fluid obtained to provide the best possible care for the patient.
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This question is part of the following fields:
- Respiratory
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Question 19
Incorrect
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A 35-year-old woman of Chinese descent is referred to a Respiratory Physician by her General Practitioner due to a productive cough with mucopurulent sputum and occasional blood tinges. She has also been experiencing shortness of breath lately. Her medical history shows that she had a similar episode of shortness of breath and productive cough a year ago, and had multiple bouts of pneumonia during childhood. What is the most reliable test to confirm the probable diagnosis for this patient?
Your Answer: Chest X-ray
Correct Answer: High-resolution computed tomography (HRCT) chest
Explanation:Diagnostic Tests for Bronchiectasis: Understanding Their Uses and Limitations
Bronchiectasis is a respiratory condition that can be challenging to diagnose. While there are several diagnostic tests available, each has its own uses and limitations. Here, we will discuss the most common tests used to diagnose bronchiectasis and their respective roles in clinical practice.
High-Resolution Computed Tomography (HRCT) Chest
HRCT chest is considered the gold-standard imaging test for diagnosing bronchiectasis. It can identify bronchial dilation with or without airway thickening, which are the main findings associated with this condition. However, more specific findings may also point to the underlying cause of bronchiectasis.Chest X-Ray
A chest X-ray is often the first imaging test ordered for patients with respiratory symptoms. While it can suggest a diagnosis of bronchiectasis, it is not the gold-standard diagnostic test.Autoimmune Panel
Autoimmune diseases such as rheumatoid arthritis, Sjögren syndrome, and inflammatory bowel disease can cause systemic inflammation in the lungs that underlies the pathology of bronchiectasis. While an autoimmune panel may be conducted if bronchiectasis is suspected, it is not very sensitive for this condition and is not the gold standard.Bronchoscopy
Bronchoscopy may be used in certain cases of bronchiectasis, particularly when there is localized bronchiectasis due to an obstruction. It can help identify the site of the obstruction and its potential cause, such as foreign-body aspiration or luminal-airway tumor.Pulse Oximetry
Pulse oximetry is a useful tool for assessing the severity of respiratory or cardiac disease. However, it is not specific for any particular underlying pathology and is unlikely to help make a diagnosis. It is primarily used to guide clinical management.In conclusion, while there are several diagnostic tests available for bronchiectasis, each has its own uses and limitations. HRCT chest is the gold-standard test, while other tests may be used to support a diagnosis or identify potential underlying causes. Understanding the role of each test can help clinicians make an accurate diagnosis and provide appropriate treatment.
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This question is part of the following fields:
- Respiratory
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Question 20
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A 54-year-old smoker comes to the clinic with complaints of chest pain and cough. He reports experiencing more difficulty breathing and a sharp pain in his third and fourth ribs. Upon examination, a chest x-ray reveals an enlargement on the right side of his hilum. What is the most probable diagnosis?
Your Answer: Tuberculosis
Correct Answer: Bronchogenic carcinoma
Explanation:Diagnosis of Bronchogenic Carcinoma
The patient’s heavy smoking history, recent onset of cough, and bony pain strongly suggest bronchogenic carcinoma. The appearance of the chest X-ray further supports this diagnosis. While COPD can also cause cough and dyspnea, it is typically accompanied by audible wheezing and the presence of a hilar mass is inconsistent with this diagnosis. Neither tuberculosis nor lung collapse are indicated by the patient’s history or radiographic findings. Hyperparathyroidism is not a consideration unless hypercalcemia is present. Overall, the evidence points towards a diagnosis of bronchogenic carcinoma.
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This question is part of the following fields:
- Respiratory
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