Respiratory KFP 51-100 revised MRQ

A 72-year-old retired shipyard worker presents with progressive shortness of breath, weight loss, and chest discomfort over the past 3 months. He has no history of recent infections and was treated for mild COPD five years ago. He migrated to Australia from the UK in his 20s and worked for nearly 40 years in various industrial roles, including shipbuilding and insulation handling. He has never smoked but reports frequent dry coughing and occasional chest tightness. His chest X-ray shows a left-sided pleural effusion. You are considering malignant pleural mesothelioma as part of your differential and reviewing his background for relevant risk factors.

 

 

A 69-year-old man presents with increasing dyspnoea and chest wall discomfort over the past 2 months. He has a past medical history of hypertension and is a retired construction worker. He worked in demolition and roofing for over 30 years and was frequently exposed to old buildings and insulation materials. He never smoked, but recalls having been in dusty work environments without protective gear. A recent chest CT reveals pleural thickening and a moderate left-sided pleural effusion. You are concerned about malignant pleural mesothelioma and are reviewing key risk factors from his occupational and personal history.

 

 

A 74-year-old man presents with progressive shortness of breath, left-sided chest pain, and unintentional weight loss over three months. He previously worked in asbestos removal for 25 years. On examination, he has reduced breath sounds and dullness to percussion over the left lower lung field. Chest X-ray shows a large unilateral pleural effusion. Thoracentesis reveals exudative fluid with elevated LDH and protein but no malignant cells. You suspect malignant pleural mesothelioma and wish to investigate further to confirm the diagnosis and assess disease extent.

 

 

A 70-year-old man presents with worsening dyspnoea, chest wall discomfort, and reduced appetite over several weeks. He worked in a shipyard for over 30 years and was frequently exposed to asbestos without protective equipment. On examination, he has decreased air entry and dullness over the right lower chest. A chest X-ray reveals a moderate pleural effusion and subtle pleural thickening. Initial pleural fluid aspiration is exudative but non-diagnostic. Given his history and clinical features, you suspect malignant pleural mesothelioma and plan further investigations to confirm the diagnosis and stage the disease.

 

 

A 73-year-old man is diagnosed with malignant pleural mesothelioma following a video-assisted thoracoscopic biopsy that confirmed epithelioid subtype. He has a history of long-term asbestos exposure during his work in construction. He presents with increasing dyspnoea, left-sided pleuritic chest pain, and fatigue. Imaging shows moderate left-sided pleural effusion and pleural thickening without evidence of distant metastasis. Pulmonary function testing indicates moderate restriction, and he is considered a candidate for active treatment. You are planning a multidisciplinary approach to manage his condition, aiming to relieve symptoms and improve quality of life.

 

 

A 68-year-old man has recently been diagnosed with malignant pleural mesothelioma following pleural biopsy via thoracoscopy. He worked as a boilermaker for over 25 years and had significant asbestos exposure during that time. He presents with chest discomfort, mild breathlessness, and fatigue. Imaging shows pleural thickening, loculated pleural effusion, and no evidence of distant metastases. His ECOG performance status is 1. He is keen to explore active treatment options and understands that curative therapy is unlikely. The oncology team discusses a range of management options with the patient as part of a multidisciplinary approach.

 

 

A 71-year-old man with known malignant pleural mesothelioma presents with worsening breathlessness, pleuritic chest pain, and increasing fatigue. He has been receiving palliative chemotherapy and had a talc pleurodesis 2 months ago. On examination, he is tachypnoeic with decreased air entry over the left chest. His oxygen saturation is 88% on room air. Chest imaging shows progression of pleural thickening, a large loculated pleural effusion, and early signs of mediastinal shift. The treating team is concerned about the development of complications associated with progressive mesothelioma and is evaluating him for symptom-driven intervention.

 

 

A 74-year-old man with a known diagnosis of epithelioid malignant pleural mesothelioma presents with worsening left-sided chest pain, significant weight loss, and persistent dyspnoea. He previously underwent talc pleurodesis and completed a course of chemotherapy six months ago. Recent imaging shows progression of pleural thickening, encasement of the left lung, and compression of adjacent structures. On examination, he appears cachectic and tachypnoeic with reduced chest wall movement on the affected side. The team is reviewing potential complications of mesothelioma to help explain his symptoms and guide supportive management.

 

 

A 72-year-old man is undergoing review following a confirmed diagnosis of malignant pleural mesothelioma. He has a known history of prolonged asbestos exposure from shipbuilding. His histology reveals sarcomatoid subtype, and imaging shows extensive pleural thickening, mediastinal invasion, and early signs of contralateral pleural involvement. He is experiencing worsening breathlessness and weight loss, with a performance status of 2. The oncology team is discussing his likely prognosis with him and his family, including factors that may indicate a poorer outcome.

 

 

A 70-year-old man with a confirmed diagnosis of malignant pleural mesothelioma is being reviewed in the oncology clinic to discuss prognosis and treatment planning. He reports progressive fatigue and weight loss over the last few months. His histology confirms biphasic subtype, and PET-CT reveals mediastinal lymphadenopathy, pleural thickening encasing the left lung, and no distant metastases. Blood tests show elevated CRP and thrombocytosis. He is currently ECOG performance status 2. The oncology team is evaluating the factors associated with poorer prognosis to guide expectations and management.

 

 

A 52-year-old woman presents with a 6-day history of fever, dry cough, headache, and myalgia. She denies recent travel or known contact with unwell individuals. She works at a regional pet store and is frequently involved in cleaning cages and handling various species of birds. On examination, she is febrile at 38.9°C and mildly tachypnoeic. Her chest X-ray shows patchy infiltrates in the lower lobes. You suspect atypical pneumonia and are considering psittacosis as part of the differential. You begin reviewing her exposure history and clinical background to identify risk factors for psittacosis.

 

 

A 61-year-old man presents with a 7-day history of persistent dry cough, fever, rigors, myalgia, and increasing shortness of breath. He denies any known contact with sick individuals, recent antibiotic use, or overseas travel. His GP initially suspected viral bronchitis, but after no improvement, a chest X-ray was ordered which revealed bilateral patchy infiltrates. On further questioning, he reveals that he recently retired and has taken up a hobby of breeding parrots in his backyard. He spends several hours daily cleaning their cages, replenishing feed, and handling the birds directly. He also mentions helping a neighbour last month to clean out an old chicken coop, which was filled with bird droppings and feathers. He lives in a rural area and frequently visits a local bird sanctuary for photography. You are considering atypical causes of pneumonia and are specifically evaluating for psittacosis.

 

 

A 59-year-old woman presents with a 5-day history of high-grade fever, dry cough, headache, myalgia, and pleuritic chest discomfort. She denies recent overseas travel, known COVID exposure, or contact with sick individuals. She works at an aviary and has daily contact with various birds including parrots, cockatiels, and budgerigars. On examination, she is febrile (38.7°C), with a respiratory rate of 24 and oxygen saturation of 93% on room air. Chest auscultation reveals scattered crackles at both lung bases. Her chest X-ray shows patchy bilateral lower lobe infiltrates. The treating team suspects atypical pneumonia and is considering psittacosis given her occupational exposure. You are asked to recommend the most appropriate investigations to confirm the diagnosis and guide management.

 

 

A 66-year-old retired veterinarian presents with a 5-day history of high fever, headache, myalgia, non-productive cough, and worsening fatigue. He has no history of chronic respiratory disease and is a lifelong non-smoker. On further questioning, he reports recently assisting a neighbour in relocating several exotic birds, including cockatoos and lorikeets, from outdoor cages into an enclosed aviary. He was responsible for handling the birds and cleaning faeces-laden cages without wearing a mask. On examination, he is febrile at 39°C, mildly hypotensive, and has bilateral crackles on auscultation. His chest X-ray shows patchy lower lobe infiltrates. Blood tests show elevated CRP and mild thrombocytopenia. Given his exposure and clinical picture, psittacosis is suspected. You are tasked with ordering the most appropriate investigations to confirm the diagnosis and guide treatment.

 

 

A 63-year-old man presents with a 7-day history of high fever, dry cough, dyspnoea, headache, and generalised myalgia. He has no history of asthma or COPD. On examination, he is febrile (38.9°C), tachypnoeic (RR 28), and has bilateral basal crackles. Chest X-ray shows diffuse patchy infiltrates, predominantly in the lower lobes. He is haemodynamically stable and oxygen saturation is 91% on room air. Further history reveals he is a bird enthusiast and keeps several parrots and cockatiels in his backyard aviary. Based on the clinical features and exposure history, psittacosis is strongly suspected. You are preparing a management plan tailored to confirmed or highly suspected Chlamydia psittaci pneumonia.

 

 

A 58-year-old woman presents to the emergency department with a 6-day history of high fever, chills, dry cough, and pleuritic chest pain. She has no significant past medical history and is not taking any regular medications. She mentions that she recently volunteered at a wildlife sanctuary, assisting in the cleaning of enclosures housing parrots and cockatoos. On examination, she is febrile (39.2°C), has a respiratory rate of 26, and oxygen saturation is 92% on room air. Chest auscultation reveals scattered bilateral crackles. Chest X-ray shows lower lobe infiltrates with no signs of effusion. The clinical suspicion is high for psittacosis. The team is planning her treatment and education regarding zoonotic risk.

 

 

A 65-year-old male poultry worker presents to hospital with a 10-day history of high fever, fatigue, pleuritic chest pain, and shortness of breath. He initially saw his GP and was started on oral amoxicillin for presumed bacterial pneumonia but has continued to deteriorate. On admission, he is febrile (39.1°C), tachypnoeic (RR 30), and has oxygen saturation of 89% on room air. Chest X-ray reveals bilateral lower lobe infiltrates and a small right-sided pleural effusion. Blood tests show elevated CRP, transaminitis, and thrombocytopaenia. Further questioning reveals he recently helped a neighbour clean several aviary cages. A presumptive diagnosis of psittacosis is made. While initiating doxycycline, the team reviews possible complications to monitor during his hospital stay.

 

 

A 70-year-old bird breeder is admitted with severe community-acquired pneumonia. He reports 8 days of fever, dry cough, malaise, and confusion. His family states that he has had poor oral intake and increasing drowsiness for the past 2 days. On examination, he is febrile (38.8°C), confused (GCS 13), hypotensive (BP 88/52 mmHg), and saturating at 87% on room air. Blood tests show elevated liver enzymes, leukopenia, and mild renal impairment. His chest X-ray reveals bilateral infiltrates with a small pleural effusion. He is started on IV doxycycline for presumed psittacosis. The team is evaluating for known complications associated with Chlamydia psittaci infection to guide close inpatient monitoring.

 

 

A 67-year-old man is recovering in hospital after being diagnosed with psittacosis. He had presented 5 days earlier with high-grade fever, dry cough, myalgia, and altered mental status. He required supplemental oxygen on admission but improved quickly after starting doxycycline. His history included recent exposure to infected parrots while helping his son clean an old aviary. Although his clinical response has been encouraging, the team is reviewing prognostic factors associated with psittacosis to assess the risk of complications and prolonged recovery. They also aim to identify patients who may require closer follow-up post-discharge due to poorer expected outcomes.

 

 

A 71-year-old woman is admitted to hospital with a 7-day history of fever, dry cough, pleuritic chest pain, and profound fatigue. She had been treating it as a viral illness at home with paracetamol but developed worsening shortness of breath and confusion. She has no history of chronic lung disease or immunosuppression. Her vital signs reveal a temperature of 38.6°C, respiratory rate of 32, oxygen saturation of 90% on room air, and blood pressure of 92/54 mmHg. Chest X-ray shows bilateral infiltrates with a small pleural effusion. She later mentions rescuing and housing a sick cockatoo 2 weeks ago. A presumptive diagnosis of psittacosis is made, and she is started on IV doxycycline. The team is reviewing the prognostic factors that may be associated with a poorer outcome in such cases.

 

A 42-year-old woman presents with a 3-month history of fatigue, dry cough, and intermittent shortness of breath. She has also noticed some reddish bumps on her shins and mild discomfort in her eyes, which her optometrist described as uveitis. She denies recent infections, travel, or exposure to birds. Her chest X-ray shows bilateral hilar lymphadenopathy. Pulmonary function tests show a mild restrictive pattern. Further investigations are underway for suspected sarcoidosis. You are reviewing her history and epidemiological background to assess for known risk factors that may be associated with increased susceptibility to this condition.

 

 

A 38-year-old man presents with a persistent dry cough, mild dyspnoea on exertion, and generalized fatigue for the past 2 months. He denies smoking or any occupational exposure. On examination, he has bilateral crackles at the lung bases and some erythematous, tender nodules over his shins. Chest X-ray reveals bilateral hilar lymphadenopathy. He is afebrile and haemodynamically stable. Basic blood tests show normal white cell count and slightly elevated serum calcium. Given the findings, sarcoidosis is suspected. You are planning a diagnostic workup to confirm the diagnosis and assess the extent of organ involvement.

 

 

A 45-year-old woman presents with a 3-month history of persistent dry cough, fatigue, and intermittent blurry vision. She also reports red, tender nodules on both shins and describes occasional palpitations. Examination reveals bilateral crackles in the lungs and mild anterior uveitis. Her chest X-ray shows bilateral hilar lymphadenopathy. Sarcoidosis is suspected. The team plans to perform a comprehensive assessment to confirm the diagnosis and evaluate for multi-organ involvement, particularly ocular and cardiac complications. You are asked to identify the most appropriate investigations to support the diagnosis and screen for systemic sarcoidosis.

 

 

A 36-year-old woman is referred to the respiratory clinic after her routine chest X-ray—done for an insurance medical—shows bilateral hilar lymphadenopathy. She reports mild fatigue and a persistent dry cough but is otherwise well. On further questioning, she mentions that her mother was diagnosed with sarcoidosis in her 40s. She works as a dental assistant and has recently helped clean out the basement of an old metal fabrication workshop her partner used to run. She does not smoke, has no history of tuberculosis, and is up to date with all vaccinations. The clinician suspects early sarcoidosis and is assessing for risk factors that could support clinical suspicion.

 

 

A 40-year-old woman is diagnosed with pulmonary sarcoidosis after presenting with persistent dry cough and fatigue over the past four months. Her chest X-ray revealed bilateral hilar lymphadenopathy and interstitial infiltrates, and biopsy confirmed non-caseating granulomas. Pulmonary function tests show mild restriction with a mildly reduced DLCO. She also reports intermittent eye redness and blurry vision, which was diagnosed as anterior uveitis by her optometrist. She has no cardiac or neurological symptoms and remains functionally independent. Her calcium levels are mildly elevated, but her liver and renal function are within normal range. She has no prior history of autoimmune disease or long-term medication use. The team is now planning a management approach tailored to her multi-system involvement.

 

 

A 50-year-old man is being managed for chronic pulmonary sarcoidosis, initially diagnosed 2 years ago following a work-up for persistent dry cough and fatigue. He has bilateral hilar lymphadenopathy and upper lobe fibrosis with traction bronchiectasis on CT chest. His pulmonary function tests have shown gradual decline in FVC and DLCO over the last 18 months, and he now reports exertional dyspnoea and mild weight loss. He has no cardiac or neurological symptoms, but recent lab work revealed persistent hypercalcaemia. He was previously treated with oral prednisone but developed significant side effects including hyperglycaemia and mood changes. The team is considering second-line treatment and overall management strategy to address both disease progression and long-term control.

 

 

A 46-year-old man with a known diagnosis of sarcoidosis presents for routine follow-up. He was diagnosed two years ago based on persistent dry cough, bilateral hilar lymphadenopathy on chest imaging, and non-caseating granulomas confirmed by transbronchial biopsy. He was initially managed with corticosteroids and currently remains off treatment. Over the past few months, he reports palpitations, mild visual blurring, and reduced exercise tolerance. Laboratory tests reveal a mild hypercalcaemia. ECG shows frequent ventricular ectopics, and serum creatinine is slightly elevated. The team is assessing him for complications of sarcoidosis, especially given the potential for silent multi-organ involvement.

 

 

A 52-year-old woman with a known history of sarcoidosis presents with fatigue, worsening breathlessness, and mild swelling in her legs. She was diagnosed 3 years ago based on bilateral hilar lymphadenopathy, skin lesions, and biopsy-confirmed non-caseating granulomas. She initially responded well to corticosteroids but has been off treatment for over a year. On examination, she has bibasal crackles, periorbital swelling, and mild pedal oedema. Chest imaging shows upper lobe fibrosis with traction bronchiectasis. ECG reveals a prolonged PR interval. Blood tests show mildly raised creatinine and corrected calcium of 2.75 mmol/L. The team is reviewing possible complications of chronic sarcoidosis in this patient.

 

 

A 44-year-old woman with newly diagnosed sarcoidosis presents to clinic to discuss the course of her illness and what to expect long-term. She was diagnosed following persistent cough, fatigue, and a chest X-ray showing bilateral hilar lymphadenopathy. A transbronchial biopsy confirmed non-caseating granulomas. Her pulmonary function tests show mild restriction, and she has no extrapulmonary involvement at this stage. She is not currently on any immunosuppressive therapy, and her symptoms have been gradually improving over the past few weeks. She asks about long-term outcomes, including the possibility of spontaneous remission, the need for ongoing treatment, and risks of disease progression. The team considers prognostic factors that may help guide follow-up frequency and counselling.

 

 

A 48-year-old man with biopsy-proven sarcoidosis presents to discuss his recent follow-up results and long-term outlook. He was diagnosed 18 months ago after developing dry cough and fatigue, with imaging showing Stage II sarcoidosis (bilateral hilar lymphadenopathy with pulmonary infiltrates). He was treated with corticosteroids, which led to partial symptom improvement, but he remains mildly breathless on exertion. His recent CT scan shows evidence of fibrotic changes, and PFTs reveal reduced DLCO with a restrictive pattern. He has also developed mild palpitations, although ECG and echocardiogram are currently normal. He is keen to understand the factors that may impact his long-term recovery or risk of deterioration. The team reviews his case in the context of known prognostic indicators.

 

 

A 58-year-old man presents to his GP for routine follow-up. During the exam, the doctor notices digital clubbing affecting all fingers. The patient is unaware of any previous diagnosis of clubbing and reports no pain, but recalls someone commenting on the shape of his fingers a few months ago. He denies cough, haemoptysis, chest pain, or dyspnoea but mentions that he has been feeling more fatigued lately and has unintentionally lost around 4 kg over the past three months. His past history includes hypertension and osteoarthritis, but he has no known lung or heart disease. He is an ex-smoker and worked in construction for over 25 years. On examination, his vital signs are stable, and there is no cyanosis or peripheral oedema. Cardiovascular and respiratory examination is unremarkable apart from the clubbing. You are planning a workup to investigate underlying systemic causes of this new clinical finding.

 

 

A 60-year-old male presents for pre-operative assessment before elective knee replacement. During the clinical examination, the registrar notes digital clubbing affecting both fingers and toes. The patient is surprised by this finding, stating that his fingers have always looked “a bit rounded,” but he never thought anything of it. He denies any current respiratory symptoms, but on direct questioning, he reports a persistent cough over the past year which he attributed to “dust exposure” from his former job in mining. He also describes occasional vague right upper quadrant discomfort, but denies jaundice, weight loss, or changes in bowel habits. His past history includes hypertension, alcohol use (3–4 drinks/day), and a cholecystectomy 15 years ago. Examination reveals no signs of cyanosis or peripheral oedema. Chest auscultation is clear, and there is no hepatosplenomegaly. The team initiates investigations to evaluate underlying systemic causes of the digital clubbing.

 

 

A 55-year-old male presents for evaluation of persistent fatigue and mild exertional dyspnoea. During the clinical examination, his GP observes digital clubbing involving both fingers and toes. The patient denies chronic cough, haemoptysis, chest pain, or joint symptoms. He has no known cardiac or liver disease and is a lifelong non-smoker. His only regular medication is an antihypertensive. On further questioning, he mentions occasional loose stools over the past few months and a 5 kg unintentional weight loss. Vitals are stable, and oxygen saturation is 96% on room air. Cardiorespiratory examination is otherwise unremarkable, and there is no cyanosis. Given the new finding of digital clubbing, the clinician plans a series of investigations to determine the underlying cause and rule out serious systemic disease.

 

 

A 62-year-old man presents for evaluation of recently noticed finger and toe clubbing. He has a 30-year history of smoking but quit five years ago. He denies current cough, haemoptysis, or respiratory distress. However, he reports chronic diarrhoea and a vague, dull pain in the right upper abdomen. He has no history of heart disease or chronic liver conditions. There is no significant family history of lung cancer or gastrointestinal disorders. On examination, digital clubbing is confirmed in both hands and feet. He has mild conjunctival pallor and tenderness in the right upper quadrant but no jaundice. The rest of his physical exam is unremarkable. The GP initiates a workup to investigate systemic causes of clubbing, including respiratory, cardiac, gastrointestinal, and hepatic sources.

 

 

A 59-year-old man is referred for evaluation of digital clubbing noted during a routine examination. He is asymptomatic but has a 40-pack-year smoking history. He denies any cough, haemoptysis, chest pain, or weight loss. He does not have a known history of cardiac or gastrointestinal conditions. His past medical history includes hypertension and controlled type 2 diabetes. Examination confirms clubbing of fingers and toes, but there is no cyanosis, lymphadenopathy, or hepatosplenomegaly. Basic blood tests including FBC, LFTs, and CRP are unremarkable. The GP has ordered a chest X-ray, which shows a suspicious left hilar mass, and the patient is now being referred for further assessment. The clinical team is planning a management approach focused on both diagnostic clarification and addressing underlying causes.

 

 

A 48-year-old woman presents to the emergency department with sudden onset pleuritic chest pain and shortness of breath. She denies fever, cough, or sputum production. Her past history includes hypertension and a laparoscopic cholecystectomy performed 3 weeks ago. She is a non-smoker and works as an office administrator. She returned from a 15-hour international flight five days ago and mentions that she’s been feeling more tired than usual but attributed it to jet lag. She is currently taking the oral contraceptive pill. On examination, her respiratory rate is 26/min, oxygen saturation is 93% on room air, and heart rate is 112 bpm. Chest auscultation is clear. Given the presentation, pulmonary embolism is suspected. The team begins evaluating for potential risk factors to determine her pre-test probability and guide further investigations.

 

 

A 66-year-old man presents to the emergency department with sudden shortness of breath and pleuritic chest pain. He denies cough, fever, or sputum production. He has no known history of lung disease or heart failure. His medical history includes prostate cancer diagnosed six months ago, for which he is undergoing chemotherapy. He recently had a prolonged hospital admission for neutropenic sepsis that required 10 days of bed rest. He also reports intermittent calf swelling over the last week. He is a non-smoker, does not take any hormone therapies, and is generally active when well. On examination, he is tachycardic and mildly hypoxic. PE is suspected. The team begins reviewing his background and recent history to assess clinical risk factors.

 

 

A 42-year-old woman presents with sudden-onset shortness of breath and right-sided chest pain. She denies fever or cough, and her oxygen saturation is 92% on room air. She has no known lung or cardiac conditions. Her history reveals that she recently had laparoscopic ovarian cyst removal two weeks ago and has since been mostly resting at home. She also has polycystic ovarian syndrome and has been taking combined oral contraceptive pills for the past 6 months. She reports some discomfort in her left calf over the past few days but did not seek care. She has a BMI of 36 and reports that her mother had a pulmonary embolism in her 50s. A Wells score is calculated, and imaging is being arranged. The clinical team is reviewing risk factors to understand her predisposition.

 

 

A 50-year-old man presents to the emergency department with sudden onset pleuritic chest pain, shortness of breath, and mild haemoptysis. He has a history of hypertension and recently returned from a 14-hour international flight. His heart rate is 110 bpm, respiratory rate 24/min, and oxygen saturation 91% on room air. Chest auscultation is clear. There is no fever or wheezing. A Wells score is calculated, and pulmonary embolism is deemed likely. The emergency team initiates investigations to confirm the diagnosis and assess severity. Initial blood tests including FBC, renal function, and LFTs are normal. The patient is haemodynamically stable, and no obvious signs of DVT are present.

 

 

A 34-year-old pregnant woman at 28 weeks’ gestation presents with sudden onset shortness of breath and right-sided pleuritic chest pain. She has no fever or cough, and no leg swelling is noted on examination. Her oxygen saturation is 94% on room air, respiratory rate is 22/min, and heart rate is 106 bpm. She has no history of asthma or heart disease. She had a previous DVT during her last pregnancy. Given her clinical presentation and past history, pulmonary embolism is considered a likely diagnosis. The treating team aims to confirm the diagnosis while minimising radiation exposure to both mother and fetus.

 

 

A 45-year-old man presents to a rural general practice with pleuritic chest pain and shortness of breath. His symptoms started suddenly six hours ago. He has no fever or cough and no history of asthma or heart disease. He recently returned from a long-haul flight from Europe and reports mild swelling in his left calf. He is haemodynamically stable with a heart rate of 98 bpm, blood pressure of 128/76 mmHg, and oxygen saturation of 96% on room air. A Wells score indicates moderate to high clinical probability for pulmonary embolism. D-dimer is not ordered due to the high pre-test probability. CT pulmonary angiogram confirms a segmental pulmonary embolism. There is no evidence of right heart strain. The patient is keen to avoid hospital admission. You are managing this case in accordance with Australian (RACGP/NPS) guidelines.

 

 

A 72-year-old man presents to the emergency department with acute pleuritic chest pain and dyspnoea. He is tachycardic (HR 118 bpm) and mildly hypotensive (BP 100/62 mmHg) but alert and orientated. His oxygen saturation is 92% on room air. He has a history of prostate cancer in remission, atrial fibrillation (on rivaroxaban), and stage 3 chronic kidney disease. CT pulmonary angiography confirms a large bilateral PE with right ventricular dilatation on imaging. Troponin is mildly elevated, and echocardiography shows signs of RV strain. He has no active bleeding or contraindications to anticoagulation. The team assesses him for risk stratification and plans treatment according to current RACGP and national guidelines for intermediate-risk PE.

 

 

A 68-year-old woman is reviewed in the outpatient clinic two months after being hospitalised for a confirmed pulmonary embolism. She had presented with pleuritic chest pain and hypoxia, and was found to have a large segmental PE on CT pulmonary angiography. She has been on rivaroxaban since discharge. Today she reports persistent exertional breathlessness and reduced exercise tolerance. She denies chest pain or haemoptysis. Clinical examination is unremarkable, but oxygen saturation at rest is 94%, dropping to 89% on walking. A chest X-ray is normal. The treating team is concerned about possible long-term sequelae and considers complications following pulmonary embolism that might explain her symptoms.

 

A 61-year-old man presents to his GP with persistent breathlessness and reduced exercise tolerance three months after being treated for a submassive pulmonary embolism. He was hospitalised and discharged on rivaroxaban, with good adherence and no bleeding complications. He denies chest pain or new leg swelling but reports a sense of chest tightness when walking uphill. His pulse oximetry shows SpO₂ of 95% at rest but drops to 88% on exertion. Physical examination reveals a loud second heart sound and mild peripheral oedema. The GP is concerned about potential sequelae of his recent PE and considers what long-term complications should be assessed in such patients.

 

 

A 58-year-old woman presents for follow-up 4 months after hospitalisation for a segmental pulmonary embolism. She had been treated successfully with rivaroxaban and is now symptom-free at rest but experiences occasional exertional shortness of breath. There is no history of malignancy or autoimmune disease. Her initial PE was provoked by a prolonged road trip and immobilisation after knee surgery. She has no personal or family history of thrombophilia. The team is discussing prognosis, risk of recurrence, and whether anticoagulation can be safely ceased after the initial 3-month treatment period. They also consider which features in her profile may predict adverse outcomes or chronic complications.

 

 

A 69-year-old man presents for review 6 months after treatment for a high-risk pulmonary embolism. At the time of diagnosis, he was hypotensive and required ICU admission with systemic thrombolysis. He was discharged on apixaban and has remained adherent. He has a history of hypertension and stage 3 chronic kidney disease. Although no malignancy was found on initial workup, he has experienced persistent dyspnoea on exertion and has not returned to baseline function. He denies chest pain or leg swelling. His oxygen saturation is 94% on room air. The clinical team discusses long-term outcomes, risk of recurrence, and potential complications based on current evidence and prognosis markers.

 

 

A 56-year-old man presents to a regional general practice with a 3-day history of fever, productive cough with green sputum, pleuritic chest pain, and shortness of breath. He is normally well but has a 20-pack-year smoking history and drinks alcohol regularly. He has not received any vaccinations in recent years. On examination, his temperature is 38.5°C, respiratory rate is 24/min, blood pressure is 118/76 mmHg, and oxygen saturation is 93% on room air. Chest auscultation reveals coarse crackles at the right lower zone. You assess his CRB-65 score as 1 (due to respiratory rate >20). A diagnosis of community-acquired pneumonia (CAP) is made. Based on current RACGP guidelines, you plan initial management in the outpatient setting.

 

A 72-year-old woman presents to her GP with a 4-day history of productive cough, dyspnoea, and pleuritic chest pain. She reports fatigue and a reduced appetite. Her medical history includes type 2 diabetes, hypertension, and mild chronic kidney disease. She lives alone and is independent with daily activities. On examination, she is febrile (38.1°C), tachypnoeic (RR 26), has a blood pressure of 100/68 mmHg, and oxygen saturation of 91% on room air. Auscultation reveals crepitations in the right mid-zone. Based on clinical judgement and a CRB-65 score of 2, a diagnosis of moderate-severity community-acquired pneumonia is made. The team initiates management as per current RACGP and Therapeutic Guidelines recommendations.

 

A 67-year-old woman presents to hospital with worsening shortness of breath, pleuritic chest pain, and a persistent productive cough despite completing a 7-day course of antibiotics for community-acquired pneumonia. Her symptoms had initially improved but deteriorated again over the past 48 hours. On examination, she is febrile (38.7°C), tachycardic (HR 110), and her oxygen saturation is 89% on room air. Auscultation reveals reduced breath sounds at the right base with dullness to percussion. Repeat chest X-ray shows a persistent right lower lobe opacity with blunting of the costophrenic angle. The treating team suspects a complication of pneumonia and begins further investigation and management.

 

 

A 74-year-old man presents to the emergency department with confusion, worsening dyspnoea, and fever, three days after being diagnosed with community-acquired pneumonia and started on oral antibiotics by his GP. He has a background of type 2 diabetes, atrial fibrillation, and chronic kidney disease. His daughter reports that he’s become increasingly drowsy and less responsive. On arrival, his temperature is 39°C, BP is 88/54 mmHg, and oxygen saturation is 86% on room air. Chest auscultation reveals crackles at the left base. Blood tests show elevated CRP and leukocytosis. Chest X-ray shows a dense consolidation in the left lower lobe. The medical team suspects progression and complication of pneumonia requiring urgent escalation.