Peter is a 64 year old man. He has become unwell over the past couple of days, he feels very under the weather, tired, feverish and has a productive cough of green sputum. He ignored this for a couple of days as he often has a smokers cough. He has a 100 pack year history and has continued to smoke despite recent increased shortness of breath on exercise. He has seen his GP recently and he has referred him to hospital for further investigations. His wife became very concerned about him and has brought him to A&E. What is the most appropriate first line investigation for this gentleman?
A Sputum culture
B Chest X-ray
C Spirometry
D Peak flow
E C-Reactive Protein
Peter is a 64 year old man. He has become unwell over the past couple of days, he feels very under the weather, tired, feverish and has a productive cough of green sputum. He ignored this for a couple of days as he often has a smokers cough. He has a 100 pack year history and has continued to smoke despite recent increased shortness of breath on exercise. He has seen his GP recently and he has referred him to hospital for further investigations. After a course of antibiotics and steroids, the patient improves. However, his cough remains and he continues to be short of breath on exercise. He is continuing to smoke. What is the most important follow up investigation?
Spirometry
Blood culture
Chest Xray
Arterial blood gas
No investigations needed
You are a fourth year medical student sitting in a spirometry clinic. You take a brief history from the patient, a 44 year old female, before they have spirometry. You find out they have been having problems with their breathing for the last month or so. She previously smoked 30 a day for 'quite a few years', and has not had any exposure to any industrial chemicals or asbestos. They have never had any problems with their breathing in the past. In terms of past medical history, she has previously had severe joint pains, worse in her hands. However she has been on treatment for the last 6 months and this is now much improved. Her spirometry results are as follows: FEV1: 2.0 (Normal for age and height 2.79) FVC: 2.8 (Normal for age and height 3.25) What is the most likely pathology causing these results, taking into account the clinical history?
A Tuberculosis
B Pulmonary fibrosis
C COPD
D Asthma
E Bronchiectasis
Tony, a 55 year old male, who works as a teacher, presents to his GP. He has progressive shortness of breath on exercise, a dry cough and has lost some weight recently. He's not sure how much weight he has lost, but he has had to tighten his belt on his trousers. He is a previous smoker of 10/day for 29 years. On examination the ends of his fingers appear rounded and there are inspiratory crackles on auscultation. PEFR was normal. Despite a 5 day course of doxycyclin, Tony feels no better. A chest X ray is organised, which shows no obvious mass, however there appears to be some haziness at both lung bases. What is the most likely cause of the above presentation?
A COPD
B Lung cancer
C Idiopathic pulmonary fibrosis
D Coal workers pneumoconiosis
E Tuberculosis
Mr Wilson is a 64yr old gentleman who saw his GP with SOB and a productive cough. He has attended the practice multiple times in the last few years for similar problems, particularly in winter. He explains he normally coughs a lot, bringing up a small amount of white sputum but currently is much more SOB and producing large volumes of green sputum. He is an ex-smoker with a 20 pack year history, and used to work as a pub landlord. His GP treats him with a course of antibiotics for a chest infection, which is very effective. She also refers him for pulmonary functions tests (PFTs) given the recurrent nature of his symptoms. The results of his PFTs post bronchodilation are as follows: FVC: 3.58 (predicted value 3.76 litres) 95% FEV1: 1.9 (predicted value 2.94 litres) 65% FEV1/FVC ratio: 0.53. What is this pattern consistent with?
A Normal lung function
B Restrictive disease
C Obstructive disease
D Mixed disease
E Severe COPD with limited response to bronchodilation.
Mr Stokes is a 68yr old man who is seen in his annual review at the respiratory clinic, he has COPD, currently controlled with inhalers. His pulmonary lung function test (PFT) results are as follows: FVC: 3.40 (predicted value 4.23 litres) 80%, FEV1: 1.54 (predicted value 3.25 litres) 47%, FEV1/FVC ratio: 0.45. What severity of COPD does Mr Y have based on the PFT findings?
A The findings are not consistent with a diagnosis of COPD
B Mild COPD
C Moderate COPD
D Severe COPD
E Very severe COPD
Mrs Dahls is a 70yr old lady who presents to the GP with a 6 month history of progressive SOB and dry cough. She feel very fatigued and has lost around half a stone over the last 6 months. She is an ex-smoker, and has a PMH of hypertension and rheumatoid arthritis, for which she has been on methotrexate for a number of years. On examination she has fine inspiratory crackles and clubbing. CXR shows no acute consolidation or masses, but does show widespread increase in interstitial lung markings which appears to be longstanding. To further investigate her symptoms the GP requests a CT scan of the thorax and pulmonary function tests (PFTs). The results of the PFTs are as follows: FVC: 1.6 (predicted value 2.4) 67%, FEV1: 1.3 (predicted value 2.0) 65%, FEV1/FVC: 0.81. What are the above PFTs consistent with?
E Idiopathic pulmonary fibrosis
