FRACGP AKT RESPIRATORY DR JAWAID

A 74-year-old smoker presented to his GP with cough and shortness of breath. Exam

revealed pigmentation of the oral mucosa and also over the palms and soles. Tests show

that he is diabetic and hyperkalemic. What is the most probable diagnosis?

A 26-year-old man presents to emergency department with increasing shortness of breath

on left side and chest pain. He has been a heavy smoker for the past 4 years. He doesn’t

have any past med history. What is the likely diagnosis?

A 35-year-old man presents with progressive breathlessness. He gave a history of

polyarthralgia with painful lesions on the shin. CXR: bilateral hilar lymphadenopathy. What’s

the most likely diagnosis?

A 10-year-old girl presents with hoarseness of the voice. She is a known case of bronchial

asthma and has been on oral steroids for a while. What is the most likely cause of?

hoarseness?

A 20-year-old student attends the OPD with complaint of breathlessness on and off, cough

and sputum. His sleep is disturbed and skin is very dry in flexural areas of the body. Exam:

tachypnoea, hyper resonant percussion and wheezing on auscultation. What is the most likely diagnosis?

An old alcoholic presents with cough, fever, bilateral cavitating consolidation. What is the

most probable cause?

A 20-year-old man has a head on collision in a car. On presentation he is breathless, has

chest pain and fracture of 5-7th rib. CXR confirms this. What is the most appropriate initial

action in this patient?

A 50-year-old chronic smoker came to OPD with complaint of chronic productive cough, SOB(shortness of breath) and wheeze. Labs: FBE=increase in PCV. Sats 96% on room air

What is the most likely diagnosis?

A 32-year-old previously healthy woman has developed pain and swelling of both knees and ankles with nodular rash over her shins. As part of the investigation a chest X-ray has been performed. What is the single most likely chest X-ray appearance?

A patient complains of SOB (shortness of breath), wheeze, cough and nocturnal waking. He has dry scaly shin with rashes that are itchy. What is the single most likely diagnosis?

A 48-year-old farmer presented with fever, malaise, cough and SOB. Examination:

tachypnoea, coarse end inspiratory crackles and wheeze throughout, cyanosis. Also, complaint severe weight loss. His CXR shows fluffy nodular shadowing and there is PMN leucocytosis. What is the single most appropriate diagnosis?

A 30-year-old female attends OPD with a fever and dry cough. She says that she had headache, myalgia and joint pain like one week ago. Examination: pulse 100bpm,

temperature 37.5C. CXR: bilateral patchy consolidation. What is the single most likely

causative organism?

A 45-year-old IV drug abuser is brought into the emergency department with complaint of fever, shivering, malaise, SOB and productive cough. Examination: temperature 39C, pulse 110bpm, BP 100/70mmHg. Investigation: CXR bilateral cavitating bronchopneumonia. What is the single most likely causative organism?

A 45-year-old chronic smoker attends the OPD with complaints of persistent cough and

copious amount of purulent sputum. He had history of measles in the past. Exam: finger

clubbing and inspiratory crepitations on auscultation. What is the single most likely

diagnosis?

A 68-year-old man has had malaise for 5 days and fever for 2 days. He has cough and there is dullness to percussion at the left lung base. What is the single most appropriate

investigation?

45-year-old tall thin young man has sudden pain in the chest and becomes breathless . He denies any history of trauma. On examination his Sats are 89%. Pulse 100 b/ min. BP 144/90mm hg, What is the single most appropriate investigation?

A 55-year-old woman with a persistent cough and history of smoking develops left sided

chest pain exacerbated by deep breathing with fever and localized crackles. What is the

single most appropriate diagnosis?

A 14-year-old boy with asthma suddenly developed chest pain and increasing breathlessness during a game of football. When seen in the emergency department he was not cyanosed. He has reduced breath sounds on the right side. His oxygen saturation is 94% on air. What is the single most appropriate investigation?

A 39-year-old man presents to the emergency department with persistent cough, sputum and dyspnoea. He gave a history of smoking 20 cigarettes/day for the last 10 years. Patient was given oxygen in ambulance but he is not improving. What is the next step?

A 35-year-old man has a temperature of=39C, cough with purulent sputum and right sided chest pain on inspiration. He has herpes labialis. What is the single most likely causative organism?

A 16-year-old girl has been unwell for 5days with malaise, headache and dry cough. She has a few crackles in her chest. Her CXR shows patchy consolidation in the lower lobes. What is the single most likely causative organism?

A 56-year-old man complains of increased volume of sputum for 6 months. He has a history of DVT in past. Examination shows clubbing. What is your likely diagnosis?

A 32-year-old female has a history of SOB (shortness of breath) and fever. Pre-bronchodilation test was done and it was 2/3.5 and post-bronchodilator was 3/3.7. The patient has history of eczema and past TB. What is the possible diagnosis?

A 53-year-old man with previous history of COPD presents with breathlessness and purulent sputum. O2 stat 85% on air. ABG: PaO2-7.6, PaCO2-7. What is the appropriate management for his condition?

A 60-year-old is on treatment for IHD (ischemic heart disease), HTN (hypertension) and

hyperlipidaemia. During the night he complains of wheeze and SOB (shortness of breath).

Which of the following medicine is responsible for that?

A patient presents with progressive dyspnoea. He complains of cough, wheeze and a table spoonful of mucopurulent sputum for the last 18 months. Spirometry has been done. FEV1/FVC 2.3/3.6. After taking salbutamol, the ratio is 2.4/3.7. What is the most likely diagnosis?

A 62-year-old man presents with cough, breathlessness and wheeze. 24% O2,salbutamol and hydrocortisone were given. The symptoms haven’t improved and so nebulized bronchodilator was repeated and IV aminophylline was given. ABG: pH 7.31, RR 32. What is the next appropriate management?

A 27-year-old man presents with chest pain and respiratory distress. Examination:

tachycardia, hypotension and neck vein distension. Trachea is deviated to the left side,

breath sounds on right side are absent and diminished on left side. What is the next

appropriate management?

An 83-year-old man with longstanding COPD has become progressively breathless over the last 2yrs. He is on salbutamol, ipratropium, salmeterol, beclomethasone and theophylline. His FEV1<30%. What is the next appropriate management?

A 33-year-old man has a temperature 38.5C, cough and chest pain on the right side on

inspiration. He also has purulent sputum. What is the most likely organism to cause

pneumonia in this patient?

A tall rugby player was hit in the chest by a player of the opponent team. He developed

breathlessness and his face went blue and purple. You have been called to look at him, how

will you manage him. What is the best initial management step

A 64-year-old man complains of increasing SOB (shortness of breath)and cough for the past 18 months. He has dry cough with occasional specks of blood. What is the most likely underlying cause?

A 75-year-old man presents with Bell’s palsy. His past medical history is significant for late onset asthma and heart failure. He also reports to have consulted his GP for generalized

rash previously. CXR shows multiple soft shadows and CBC eosinophilia. What is the single

most likely positive antibody?

A 68-year-old woman presents to the ED with confusion. Temp=39.3C and productive cough. Sputum is rusty coloured after 2 days. CXR shows right lower lobe consolidation. What is the most likely organism?

A non-smoker who has worked in coal mines for 20yrs presents with gradually increasing

SOB, limited exercise tolerance and a dry cough. His CXR shows round fibrotic tissue

demonstrating a mixed restrictive and obstructive ventilator defect with irreversible airflow

limitation and reduced gas transfer. What is the single most appropriate diagnosis?

A 25-year-old man has been suffering from breathlessness and wheeze for 3months. He has been taking salbutamol 2puffs as required. In the last 2 weeks his symptoms have worsened and he has to take salbutamol more frequently during the day time. He also complains of excessive dyspnoea at night. What medication would you like to add?

A 12-year-old presents with chest pain. Examination shows Pulse 120b/ min, BP 90/60 mmHg , dilated neck veins and the trachea is not centrally placed. What is the next appropriate management?

A 55-year-old male presents to the emergency department after an RTA (road traffic

accident) with breathlessness, engorged neck veins and a dull percussion note on the right

side of his chest. Examination: pulse 140bpm, BP 80/50mmHg. What is the most likely

diagnosis?

A 16-year-old boy came home from boarding school with a cough. His CXR showed bilateral consolidations. What is the most likely organism which would have caused his symptoms?

A young man returns to his hostel and gets headache and lethargy. Now presents with fever. There are crepitations on the auscultation of lung. What is the most likely organism which would have caused his symptoms?

A 24yo male is admitted with acute severe asthma. Treatment is initiated with 100% oxygen, nebulized salbutamol and ipratropium bromide nebulizers and IV hydrocortisone. Despite initial treatment, there is no improvement. Which is the next step in management?

A house-bound 78-year-old man with severe COPD has had a gradual deterioration over

recent months and is now breathless at rest. He is on maximal inhaled medical therapy.

Result: pH 7.36, PaCO2= 5.9kPa, PaO2= 6.9kPa. What is the single most appropriate

additional treatment?

A 16-year-old boy in boarding school feels unwell. He developed cough and rash. His CXR

showed bilateral consolidations. What is the cause of his symptoms?

A man suffering from Influenza A since 5 days ago. He presented with high grade fever chesty cough with phlegm and shortness of breath. CXR: pneumonia. What organism is

responsible for pneumonia in this patient?

A 35-year-old man has been recently diagnosed with asthma and allergic rhinitis .He presented to you with shortness of breath. Examination reveals peripheral

neuropathy with tingling and numbness in a ‘glove and stocking’ distribution. Also, you notice Skin lesions in the form of tender subcutaneous nodules. You start him on prednisolone which significantly improve the symptoms. What is the single most appropriate diagnosis?

A 40-year-old patient came to emergency department with complaint of fever, pleuritic chest pain, productive cough. Exam: temp 38C. He has a history of splenectomy last year. What is the single most likely causative organism?

A 37-year-old male patient who recently returned back to UK from UAE attends the OPD

with complaint of dry cough, breathlessness and anorexia. According to him he had flu like

symptoms a week ago. He is slightly confused. Investigations: lymphopenia & decreased

Na+. CXR: bi-basal consolidation. What is the single most likely causative organism?

A 20-year-old student came to the ED with complains of headache, malaise, dry cough,

joint pain and vomiting. Examination: temperature 39C. CXR: patchy consolidation. What is

the single most likely causative organism?

A man with chronic cough presents with copious purulent sputum. On examination his temperature is 37.5. sats 97 on room air. Chest – Few bilateral crepts. General physical examination shows clubbing. What is the single most likely diagnosis?

A 25-year-old patient came to your practice with complaint of fever, malaise, breathlessness, cough and anorexia. His girlfriend has got similar symptoms. He had history of sore throat and ear discharge a month ago. What is the single most likely

causative organism?

A 29-year-old woman who returned from Egypt 2 weeks ago now presents with difficulty in breathing, chest pain, cough and purulent sputum with an episode of blood staining sputum. She is on COCPs. What is the most likely diagnosis?

A 37-year-old man presents with some raised lesions on the shin. He came with cough and also complains of arthralgia. Examination: bilateral hilar lymphadenopathy and erythema nodosum is present. What is the single most likely cause?

A patient who works in a pet shop has temperature of 37.5C, dyspnoea, chest pain and

cough. CXR: patchy consolidation. What is the most suitable treatment?

An 83-year-old woman admitted with a chest infection becomes confused with impaired

attention and poor concentration. She is restless and frightened. She is verbally abusive and

has perceptual abnormalities. There is no significant previous psychiatric history. What is

the SINGLE most likely diagnosis?

A 20-year-old previously healthy woman presents with general malaise, severe cough and breathlessness which has not improved with a seven-day course of amoxycillin. There is

nothing significant to find on examination. The x-ray shows patchy shadowing throughout

the lung fields. The blood film shows clumping of red cells with suggestion of cold

agglutinins.

A patient with chronic neutropenia develops a chronic cough. A CXR reveals a cavitating

intrapulmonary lesion containing a movable rounded ball lesion. A likely diagnosis is?

A 29-year-old Afro-Caribbean man presents with a non-productive cough mild aches in the ankles. The symptoms have been present for 2 months. His ESR is elevated. Ca: 2.69 mmol/l; PO4 -: 1.20 mmol/l; ALP: 80 iu/L. Serum 25(OH) D: 180 nmol/l

Normal values for Calcium: 2.12-2.65mmol/l

Phosphate: 0.8-1.45mmol/l

ALP 30-300iu/L

Serum 25(OH) D: 20-105nmol/l

Urea: 2.5-6.7mmol/l

Creatinine: 70-120μmol/l