Respiratory KFP 101-150 revised MRQ

An 82-year-old woman is reviewed following hospital discharge after treatment for moderate community-acquired pneumonia. She initially presented with fever, cough, and hypoxia, and required IV antibiotics and oxygen for five days. Her comorbidities include chronic heart failure, insulin-dependent type 2 diabetes, and mild cognitive impairment. At review, she remains fatigued and has a poor appetite, with reduced physical activity compared to her baseline. Her daughter is concerned about her long-term recovery and potential complications. The GP explains that certain factors are associated with poorer outcomes in older adults recovering from pneumonia and guides her on prognosis and expectations.

 

 

A 69-year-old man is seen in follow-up two weeks after discharge from hospital where he was treated for community-acquired pneumonia affecting the right lower lobe. At presentation, his CRB-65 score was 2, and he required IV antibiotics and supplemental oxygen during admission. His comorbidities include COPD, chronic kidney disease (stage 3), and ischaemic heart disease with preserved ejection fraction. Since discharge, he has regained some strength but continues to experience reduced exercise tolerance and mild breathlessness on exertion. He lives alone and has no formal support services. The GP discusses long-term recovery and the factors associated with poor prognosis in pneumonia.

 

 

A 70-year-old man presents to your practice with a productive cough, dyspnoea, fever, and pleuritic chest pain. You suspect community-acquired pneumonia and begin workup accordingly. He is a retired builder with a history of smoking (40 pack-years), COPD, type 2 diabetes, and mild cognitive decline. He lives with his wife but has recently been less mobile due to a fall two weeks ago, which left him largely homebound. His vaccinations are not up to date. The clinical team considers not just diagnosis and treatment, but also the various risk factors that may have predisposed him to developing pneumonia, as part of a broader prevention strategy.

 

 

A 76-year-old woman presents with fever, productive cough, and confusion. She is brought in by her daughter who reports that her mother had recently developed difficulty swallowing and had an episode of choking during a meal two days ago. She also notes that the patient has become more drowsy and less mobile over the past month due to increasing frailty. Her past history includes hypertension, mild dementia, and osteoarthritis. She resides in a residential aged care facility and is not up to date with her pneumococcal vaccinations. The clinical team suspects pneumonia and begins diagnostic and management steps. As part of comprehensive care planning, they also assess for modifiable and non-modifiable risk factors that may have contributed to this episode.

 

 

A 63-year-old man presents to the clinic with progressive shortness of breath on exertion, morning cough with sputum production, and intermittent wheezing. He is a current smoker with a 45-pack-year history. He has no history of asthma or recent respiratory infections. His BMI is 28, and he reports getting breathless when climbing a single flight of stairs. Cardiovascular examination is normal. Chest auscultation reveals mild expiratory wheeze but no crackles. You suspect underlying chronic obstructive pulmonary disease (COPD). To confirm the diagnosis and assess severity, you perform spirometry before and after bronchodilator administration. You plan to interpret the results in accordance with Australian spirometry guidelines.

 

 

A 38-year-old woman presents with a 6-month history of intermittent wheezing, chest tightness, and a persistent dry cough, particularly at night and with exercise. She has no significant past medical history and does not smoke. There is no recent history of respiratory infection. Her symptoms improve temporarily with salbutamol, which she has been using occasionally from a previous prescription. On examination, there are no abnormal findings. You suspect asthma and arrange pre- and post-bronchodilator spirometry to support your clinical diagnosis. She completes the test in a respiratory laboratory under standard conditions.

 

 

A 68-year-old retired smoker presents with chronic cough, progressive dyspnoea, and frequent morning sputum production. He smoked a pack per day for 40 years and quit five years ago. He has had two chest infections in the past year, one of which required hospitalisation. On auscultation, there are bilateral wheezes and decreased breath sounds. Chest X-ray is unremarkable. You suspect chronic obstructive pulmonary disease (COPD) and order pre- and post-bronchodilator spirometry to confirm the diagnosis and assess severity. The patient is clinically stable at the time of testing. You plan to interpret the spirometry according to Australian and international standards.

 

 

A 72-year-old man presents with worsening shortness of breath over the past year, chronic productive cough, and occasional wheezing. He has a smoking history of 60 pack-years and worked in construction for most of his life. He has had two courses of antibiotics this year for “chest infections.” Examination reveals reduced breath sounds and mild wheezing bilaterally. You suspect chronic obstructive pulmonary disease (COPD) and request spirometry with pre- and post-bronchodilator testing to confirm the diagnosis and assess severity. The patient performs spirometry under standard conditions, and results show an FEV₁/FVC ratio of 0.63 post-bronchodilator.

 

 

A 62-year-old woman is referred for evaluation of progressive exertional dyspnoea and a dry cough that has been worsening over the past six months. She denies wheezing or sputum production. Her medical history includes longstanding rheumatoid arthritis. She has never smoked. On examination, she has fine inspiratory crackles at both lung bases and mild digital clubbing. Oxygen saturation is 96% at rest. Chest X-ray shows reticulonodular shadowing bilaterally. You suspect interstitial lung disease and request spirometry with full lung volumes and DLCO testing to support your diagnosis and assess disease pattern and severity.

 

 

A 65-year-old retired teacher presents with a year-long history of progressive exertional dyspnoea and persistent dry cough. He denies wheezing, chest pain, or significant smoking history. His past history includes gastroesophageal reflux disease and occupational exposure to bird droppings in his backyard aviary. He is not on any respiratory medications. On examination, he has fine end-inspiratory crackles at both lung bases and finger clubbing. Chest X-ray shows basal reticular changes, and HRCT reveals honeycombing consistent with usual interstitial pneumonia. You arrange spirometry and DLCO testing to assess baseline lung function and assist in monitoring disease progression.

 

 

A 58-year-old woman presents with gradual onset shortness of breath on exertion and a persistent dry cough over the last 8 months. She has no history of asthma, smoking, or recent respiratory infections. Her past medical history includes gastroesophageal reflux disease (GORD) and autoimmune hypothyroidism. On examination, she has fine basal crackles on auscultation and mild digital clubbing. Chest X-ray shows basal reticular shadowing, and high-resolution CT confirms interstitial lung disease with a usual interstitial pneumonia (UIP) pattern. The team initiates further investigations to determine underlying causes and evaluates for predisposing factors that may have contributed to her ILD.

 

 

A 61-year-old man presents with progressive shortness of breath over the past year and a chronic dry cough. He has never smoked, denies wheeze or chest tightness, and has no history of asthma. His past history includes treated prostate cancer and chronic gastroesophageal reflux. He worked in agriculture for 35 years and reports regular use of pesticides and exposure to hay and mouldy grain. There is no family history of lung disease. On examination, he has fine crackles at both lung bases and mild digital clubbing. Chest X-ray shows bilateral reticulonodular opacities. The clinical team suspects interstitial lung disease and begins evaluating for potential underlying causes.

 

 

A 59-year-old man presents to your clinic with a 10-month history of progressive dyspnoea on exertion and a persistent dry cough. He has never smoked, but he worked as a metal polisher for several decades and has frequent exposure to dust and fumes. He reports no chest pain, wheeze, or haemoptysis. His past medical history includes hypertension and gastroesophageal reflux disease. On examination, he has fine inspiratory crackles at both lung bases and digital clubbing. Chest X-ray shows bilateral interstitial markings. You suspect interstitial lung disease and decide to initiate a structured diagnostic workup.

 

 

A 66-year-old woman presents with persistent dry cough and progressive shortness of breath over the last 9 months. She has no history of asthma or smoking, but reports long-standing autoimmune thyroid disease. She also keeps birds at home and reports cleaning their cage daily. On examination, she has fine inspiratory crackles at both lung bases and mild digital clubbing. Her chest X-ray shows bilateral lower zone interstitial infiltrates. You suspect interstitial lung disease and decide to conduct further diagnostic evaluation to assess the extent of disease, exclude mimics, identify underlying causes, and guide management.

 

 

A 64-year-old man presents to respiratory clinic with a one-year history of gradually worsening breathlessness on exertion and a persistent dry cough. He is a retired farm worker with regular past exposure to mouldy hay and grain dust. HRCT of the chest confirms a usual interstitial pneumonia (UIP) pattern. Pulmonary function tests show reduced FVC and DLCO consistent with restrictive lung disease. He has no signs of connective tissue disease, and autoimmune screening is negative. A diagnosis of idiopathic pulmonary fibrosis (IPF) is made. The clinical team discusses treatment options, lifestyle modifications, and supportive measures based on current Australian guidelines for ILD.

 

 

A 70-year-old woman presents for follow-up after being diagnosed with fibrotic hypersensitivity pneumonitis confirmed by HRCT and occupational history. She had years of exposure to bird antigens and was recently advised to rehome her pet parrots. Spirometry shows a restrictive pattern with an FVC of 55% predicted, and her DLCO is reduced. She experiences breathlessness on minimal exertion but remains independent with daily tasks. She has no known autoimmune conditions. The respiratory team now discusses long-term management goals including symptom relief, prevention of disease progression, and maintenance of function.

 

 

A 68-year-old man with a known diagnosis of idiopathic pulmonary fibrosis (IPF) presents for routine follow-up. He reports increased breathlessness on exertion and mild peripheral oedema over the past 2 months. He has been on antifibrotic therapy and has had a stable course until recently. Spirometry performed today shows a further decline in FVC and DLCO compared to his last test 6 months ago. On examination, there are fine bibasal crackles and elevated jugular venous pressure. You suspect progression of ILD and consider potential complications contributing to his symptoms.

 

 

A 72-year-old woman with connective tissue disease-associated interstitial lung disease (CTD-ILD) presents with worsening exertional dyspnoea and non-productive cough. She was previously managed with mycophenolate and low-dose prednisolone. Her recent spirometry shows a decline in FVC and DLCO over the last 6 months. On examination, she is hypoxic at rest (SpO₂ 88% on room air), with mild peripheral oedema, bilateral basal crackles, and elevated jugular venous pressure. Chest X-ray shows reticular opacities with no consolidation. The team considers disease progression and complications that may be contributing to her symptoms and clinical decline.

 

 

A 69-year-old man with idiopathic pulmonary fibrosis (IPF) returns for routine follow-up. He was diagnosed 18 months ago based on HRCT showing a definite usual interstitial pneumonia (UIP) pattern. Despite being on antifibrotic therapy and adhering to lifestyle recommendations, he reports increasing breathlessness with daily activities and requires rest breaks when walking short distances. Spirometry shows further decline in FVC, and DLCO has dropped by 15% over the last 6 months. Oxygen saturation is 90% on room air. You assess his overall prognosis and discuss future planning with him and his family.

 

 

A 74-year-old woman with a 3-year history of fibrotic hypersensitivity pneumonitis presents for a respiratory review. Over the past 6 months, she has developed increasing dyspnoea with daily activities and now requires supplemental oxygen at rest. Her FVC has declined by 12% since her last review, and her DLCO is 35% of predicted. She was previously independent but now requires help with some basic daily tasks. A six-minute walk test reveals oxygen desaturation to 84% and reduced walking distance. You assess her current functional status and discuss disease trajectory and prognosis with her and her caregivers.

 

 

A 6-month-old infant presents with failure to thrive, frequent bulky foul-smelling stools, and a chronic wet cough. The parents mention that the child was born at term, but has had multiple respiratory infections since birth and is not gaining weight despite good feeding. There is no known family history of lung disease. Physical examination reveals nasal polyps and bilateral crackles in the chest. The GP suspects a genetic disorder and refers for further investigation. A sweat chloride test is ordered, and you consider the risk factors that would increase the likelihood of cystic fibrosis in this case.

 

 

A 4-week-old male infant is brought in by his parents for a routine check-up. The baby has had poor weight gain since birth despite regular feeding. He also has greasy, pale stools and frequent episodes of coughing. On examination, the infant appears underweight, and auscultation reveals fine crepitations at both lung bases. The parents are both of European descent and are concerned about the possibility of an inherited condition. The GP considers cystic fibrosis as a differential diagnosis and evaluates the child for potential risk factors that would increase the likelihood of CF in this clinical context.

 

 

A 3-month-old female infant is referred to the paediatric clinic due to ongoing failure to thrive, steatorrhoea, and recurrent episodes of bronchiolitis since birth. The child was born at term and has been fully vaccinated. Despite adequate feeding, she continues to drop percentiles on the growth chart and has persistent greasy, foul-smelling stools. On examination, there is nasal congestion with bilateral crackles on chest auscultation. The GP suspects cystic fibrosis as a possible diagnosis and initiates appropriate investigations to confirm the diagnosis and assess disease involvement.

 

 

A 7-year-old boy is referred to a paediatric respiratory clinic with a history of chronic productive cough, recurrent sinus infections, and poor weight gain despite a healthy appetite. His parents report that he had meconium ileus at birth requiring surgery, and since infancy, he has experienced frequent chest infections requiring multiple courses of antibiotics. They also mention that his stools are greasy, bulky, and difficult to flush. He has been falling behind his peers in growth charts and often appears tired. Examination reveals nasal polyps, digital clubbing, and coarse crackles over both lung fields. The GP has raised suspicion for cystic fibrosis and wants to confirm the diagnosis while also assessing the extent of organ involvement.

 

 

A 12-year-old boy with a confirmed diagnosis of cystic fibrosis (homozygous ΔF508 mutation) is reviewed in a multidisciplinary CF clinic. He has a history of pancreatic insufficiency, chronic colonisation with Pseudomonas aeruginosa, and moderate bronchiectasis on imaging. He is underweight despite enzyme replacement therapy and a high-calorie diet. His parents report frequent productive cough, decreased exercise tolerance, and three hospitalisations in the past year for respiratory exacerbations. His current medications include inhaled salbutamol, pancreatic enzyme supplements, and vitamin A, D, E, and K. The team discusses optimisation of long-term management, aiming to reduce exacerbations, improve nutrition, and preserve lung function.

 

 

A 16-year-old girl with a known diagnosis of cystic fibrosis (compound heterozygote for ΔF508 and G551D mutations) is seen for a comprehensive review. She has pancreatic insufficiency, chronic Pseudomonas aeruginosa colonisation, and mild bronchiectasis on HRCT. Despite adherence to her medications and chest physiotherapy, she reports increasing fatigue, occasional haemoptysis, and declining exercise tolerance over the past six months. Her most recent spirometry showed an FEV₁ of 65% predicted, down from 72% a year ago. Her BMI is just below the 10th percentile. She also reports difficulty with maintaining daily airway clearance due to school stress and social commitments. The multidisciplinary CF team aims to optimise her management by addressing airway disease, nutrition, treatment burden, and psychosocial support.

 

 

A 19-year-old man with cystic fibrosis presents to the respiratory clinic with worsening shortness of breath, productive cough with green sputum, and fatigue. He has chronic Pseudomonas aeruginosa colonisation and mild bronchiectasis seen on CT. Despite regular use of airway clearance techniques and CFTR modulator therapy, his lung function has been gradually declining over the past year. He has also developed steatorrhoea, poor weight gain, and reports two recent episodes of haemoptysis. On examination, he is underweight, has digital clubbing, and oxygen saturation of 91% on room air. The team discusses both acute issues and long-term complications of CF that may affect this patient.

 

 

A 22-year-old woman with cystic fibrosis presents to the multidisciplinary clinic for routine follow-up. She was diagnosed in infancy and has a history of pancreatic insufficiency, vitamin deficiencies, and recurrent Staphylococcus aureus and Pseudomonas airway infections. Over the past year, she has had two hospital admissions for acute pulmonary exacerbations, and her FEV₁ has declined from 78% to 61%. She has also recently developed postprandial abdominal pain and bloating, with mildly elevated liver enzymes. On review, she is underweight and reports increasing fatigue and difficulty with concentration. The team discusses complications that may be contributing to her worsening symptoms and overall disease burden.

 

 

A 24-year-old man with cystic fibrosis attends a follow-up appointment at the adult CF clinic. He has been on CFTR modulator therapy (elexacaftor/tezacaftor/ivacaftor) for the past two years. His FEV₁ has remained stable at 62% predicted, and he has not required hospitalisation in the past 12 months. He continues daily airway clearance and inhaled antibiotics for chronic Pseudomonas aeruginosa colonisation. However, he reports new onset fatigue, reduced exercise tolerance, and mild ankle swelling. His weight has been stable, but there is a slight decline in his DLCO and desaturation noted on a 6-minute walk test. The clinical team evaluates prognostic indicators to guide further monitoring and intervention.

 

 

A 28-year-old woman with cystic fibrosis presents for her annual multidisciplinary review. She was diagnosed at age 3 and has been on CFTR modulator therapy for the past 3 years. Her current FEV₁ is 58% of predicted, and she uses pancreatic enzyme replacement therapy with meals. She reports one hospitalisation for an exacerbation in the past year and mild haemoptysis during colds. She remains independent with activities of daily living but has recently developed cystic fibrosis-related diabetes (CFRD), and her BMI has declined from 21 to 18.5 over the last year. Her 6-minute walk test shows oxygen desaturation, and echocardiogram reveals mild pulmonary hypertension. The team assesses factors that indicate a poorer long-term prognosis.

 

 

A 63-year-old man presents to your general practice with a recent positive COVID-19 test. He reports mild symptoms including fatigue, low-grade fever, and a dry cough. He has not received a COVID-19 vaccine booster in over a year. His medical history includes hypertension, type 2 diabetes, and stage 3 chronic kidney disease. He is a former smoker and has a BMI of 34 kg/m². He lives alone and is unsure about when to seek hospital care. You assess his risk of developing severe disease to decide whether to initiate antiviral treatment and consider early referral to hospital if his condition worsens.

 

 

A 55-year-old woman presents to your clinic after testing positive for COVID-19 on a rapid antigen test. She is currently asymptomatic except for a mild sore throat and nasal congestion. Her past medical history includes systemic lupus erythematosus managed with immunosuppressants, bronchiectasis, and hypertension. She has received two doses of a COVID-19 vaccine but missed her most recent booster. She is concerned about whether she’s at risk of becoming severely unwell and asks whether she needs antivirals or closer monitoring. You evaluate her underlying conditions and demographic profile to determine whether she meets high-risk criteria for severe COVID-19 illness.

 

 

A 68-year-old man presents to the emergency department with a 4-day history of fever, shortness of breath, myalgia, and a persistent dry cough. He has tested positive for COVID-19 on a rapid antigen test at home. He is fully vaccinated but has multiple comorbidities including chronic kidney disease stage 3, ischemic heart disease, and type 2 diabetes mellitus. On arrival, his oxygen saturation is 89% on room air, respiratory rate is 26 breaths per minute, and auscultation reveals bilateral basal crackles. The treating team suspects moderate to severe COVID-19 pneumonitis and begins urgent assessment. You consider appropriate investigations to confirm diagnosis, assess severity, rule out complications, and guide management.

 

 

A 73-year-old woman with a history of hypertension, heart failure with preserved ejection fraction, and type 2 diabetes presents to the emergency department with a 5-day history of worsening cough, low-grade fever, fatigue, and increasing breathlessness. A rapid antigen test at home was positive for COVID-19. On arrival, she is febrile at 38.4°C, with a respiratory rate of 30 breaths per minute, oxygen saturation of 88% on room air, and diffuse crackles heard on auscultation. The team initiates oxygen therapy and plans hospital admission. You are asked to identify investigations that are relevant to confirm diagnosis, assess severity, exclude complications, and guide management.

 

 

A 67-year-old man presents to the emergency department with a 5-day history of cough, fever, dyspnoea, and myalgia. He has a past medical history of type 2 diabetes, hypertension, and stage 3 chronic kidney disease. He is fully vaccinated with his last COVID-19 booster given 10 months ago. On examination, he is febrile (38.5°C), oxygen saturation is 89% on room air, respiratory rate is 28/min, and auscultation reveals bilateral crackles. Chest X-ray shows diffuse patchy infiltrates. Blood tests reveal elevated CRP and D-dimer, and a positive PCR confirms COVID-19. The clinical team considers his management options given moderate to severe disease in a high-risk patient.

 

 

A 59-year-old woman presents to your GP clinic after testing positive for COVID-19 on a rapid antigen test. She is on day 2 of symptoms, which include sore throat, fatigue, nasal congestion, and a mild cough. Her past medical history includes poorly controlled type 2 diabetes, obesity (BMI 35), and hypertension. She is vaccinated with her primary course and one booster, the last dose being over 14 months ago. On examination, her vital signs are stable with an oxygen saturation of 97% on room air. She is concerned about deteriorating and asks about treatments to reduce the risk of hospitalisation. You evaluate her eligibility for outpatient antiviral treatment and consider other evidence-based management strategies.

 

 

A 70-year-old woman with a history of hypertension and type 2 diabetes was hospitalised with moderate COVID-19 pneumonitis two weeks ago. She required low-flow oxygen and was treated with dexamethasone and prophylactic anticoagulation. She has now returned for follow-up complaining of persistent fatigue, breathlessness on exertion, and occasional chest discomfort. She also reports difficulty concentrating and disturbed sleep. Blood pressure and oxygen saturation are within normal limits. You are asked to assess for potential complications of COVID-19, both during acute illness and in the post-acute recovery period, to guide ongoing management and referral.

 

 

A 65-year-old man was hospitalised three weeks ago for moderate COVID-19 pneumonitis requiring low-flow oxygen and dexamethasone. He now presents to his GP for follow-up, reporting persistent fatigue, poor concentration, mild chest discomfort, and shortness of breath on exertion. He also notes a new resting tremor and mild numbness in his fingertips. His oxygen saturation is 94% on room air, and chest auscultation reveals scattered crackles. His past medical history includes obesity, hypertension, and obstructive sleep apnoea. You review his recent illness and current symptoms to assess for potential post-acute or delayed complications of COVID-19 infection.

 

 

A 72-year-old man with confirmed COVID-19 presents to the emergency department with dyspnoea, fever, and cough for five days. His oxygen saturation is 89% on room air, respiratory rate is 30/min, and chest X-ray shows bilateral infiltrates. He has comorbidities including type 2 diabetes mellitus, obesity (BMI 36), and chronic kidney disease stage 3. Initial blood tests reveal elevated CRP, lymphopenia, and increased D-dimer. He has received his primary course of vaccination, but no booster in the past year. The medical team evaluates his likely disease course and considers prognostic indicators to guide monitoring, escalation of care, and family discussions.

 

 

A 68-year-old woman with confirmed COVID-19 is admitted to hospital with shortness of breath, persistent fever, and dry cough. Her past medical history includes well-controlled type 2 diabetes, chronic obstructive pulmonary disease (COPD), and a recent diagnosis of heart failure with preserved ejection fraction. She is fully vaccinated, but her last booster was over 14 months ago. On arrival, her oxygen saturation is 91% on room air. Blood tests show elevated CRP, lymphopenia, and mildly impaired renal function. A chest X-ray reveals bilateral patchy infiltrates. The clinical team assesses factors that may predict a poorer prognosis and determine the need for escalation of care.

 

 

A 74-year-old man presents with progressive shortness of breath over the past few weeks. He also reports a dry cough and chest discomfort that worsens with deep inspiration. He has a history of congestive heart failure, chronic kidney disease, and rheumatoid arthritis. He is afebrile and haemodynamically stable. On examination, decreased breath sounds and dullness to percussion are noted over the right lower chest. A chest X-ray reveals a moderate right-sided pleural effusion. The GP refers him for thoracentesis and considers possible underlying causes of the effusion while awaiting pleural fluid analysis.

 

 

A 61-year-old woman presents with gradually worsening shortness of breath and vague right-sided chest heaviness for the past three weeks. She denies fever or productive cough. She has a past medical history of breast cancer (treated five years ago), rheumatoid arthritis, and hypertension. She takes methotrexate and a low-dose steroid. On examination, there is stony dullness to percussion at the right base, decreased breath sounds, and reduced chest expansion. Chest X-ray confirms a large right-sided pleural effusion. There are no signs of infection. You consider the possible underlying causes of pleural effusion in this patient while awaiting pleural fluid analysis.

 

 

A 66-year-old man presents with progressive dyspnoea and a non-productive cough over the past month. He has no fever or chest pain but reports mild weight loss. His past medical history includes hypertension and a remote smoking history. On examination, he has decreased breath sounds and dullness to percussion over the left lower chest. Chest X-ray confirms a moderate left-sided pleural effusion. There is no evidence of pulmonary oedema or consolidation. You plan to investigate the underlying cause and confirm the nature of the effusion.

 

 

A 70-year-old woman presents with increasing dyspnoea and non-productive cough over the past month. She denies fever or chest pain. Her history includes breast cancer treated with radiotherapy 6 years ago, hypertension, and hypothyroidism. On examination, she has decreased breath sounds and stony dullness to percussion over the lower left chest. Chest X-ray reveals a large left-sided pleural effusion without signs of consolidation or cardiomegaly. She is haemodynamically stable, and the team plans a diagnostic work-up to confirm the underlying cause and guide treatment.

 

 

A 72-year-old man presents with worsening dyspnoea and chest heaviness. He has a history of congestive heart failure and was recently hospitalised for pneumonia. A chest X-ray reveals a large right-sided pleural effusion. He is clinically stable, afebrile, and oxygenating well on room air. Bedside ultrasound confirms free-flowing fluid. Diagnostic thoracentesis reveals an exudative effusion with high protein, elevated LDH, and neutrophil predominance. Gram stain is negative, and no malignant cells are seen on cytology. The effusion partially recurs within days. The team now considers appropriate management strategies based on clinical context and test results.

 

 

A 69-year-old man with a history of congestive heart failure and rheumatoid arthritis was admitted with progressive dyspnoea. Chest imaging revealed a large right-sided pleural effusion. Diagnostic thoracentesis showed an exudative fluid with low glucose and pH, suggestive of a complicated parapneumonic effusion. He was started on antibiotics and a chest drain was inserted. Over the following days, the patient developed a persistent air leak and worsening hypoxia. The clinical team monitors him closely and discusses possible complications associated with pleural effusion itself, its underlying causes, or related interventions.

 

 

A 75-year-old woman with a background of metastatic breast cancer presents with worsening dyspnoea and is found to have a large left-sided pleural effusion on imaging. A diagnostic thoracentesis reveals an exudative, serosanguinous fluid with malignant cells. She undergoes therapeutic drainage, which provides symptom relief. However, over the next few days, she develops worsening breathlessness, a persistent air leak through the chest tube, and decreased oxygen saturation. The respiratory team evaluates her for potential complications associated with malignant pleural effusion and its management.

 

 

A 73-year-old man presents with progressive dyspnoea and fatigue. He has a history of chronic heart failure and was recently diagnosed with stage IV non-small cell lung cancer. A chest X-ray reveals a large right-sided pleural effusion. Diagnostic thoracentesis reveals an exudative, lymphocyte-predominant fluid with malignant cells. Despite drainage, the effusion reaccumulates within a few days. He reports weight loss, anorexia, and difficulty performing daily tasks. The team reviews his overall prognosis in the context of pleural effusion and underlying conditions to guide goals-of-care discussions and further planning.

 

 

A 78-year-old woman presents with dyspnoea and weight loss over the past two months. She has a history of chronic kidney disease, hypertension, and suspected metastatic ovarian cancer. Imaging reveals a large, left-sided pleural effusion with mediastinal shift. Thoracentesis yields serous, straw-colored fluid with low glucose, low pH, and elevated LDH. Cytology later confirms malignant cells consistent with adenocarcinoma. Despite drainage, the effusion reaccumulates rapidly. She is now oxygen-dependent and reports reduced appetite, fatigue, and reduced functional status. The team meets to evaluate her overall prognosis and suitability for further intervention.

 

 

A 65-year-old man presents with a 6-month history of exertional dyspnoea and dry cough. He denies chest pain or wheeze. He is a non-smoker with no occupational dust exposure. His past history includes well-controlled type 2 diabetes. Examination reveals fine inspiratory crackles at both lung bases and digital clubbing. Chest X-ray shows bilateral reticulonodular opacities. High-resolution CT (HRCT) reveals subpleural basal predominant honeycombing with traction bronchiectasis. Pulmonary function testing shows a restrictive pattern with reduced diffusion capacity (DLCO). An autoimmune screen and bronchoalveolar lavage (BAL) are ordered. The respiratory physician suspects idiopathic pulmonary fibrosis (IPF), a subtype of ILD, and assesses the diagnostic criteria.