A 24-year-old male with no past medical history presents to the Emergency Department with pleuritic chest pain. There is no history of a productive cough and he is not short of breath. Chest x-ray shows a right-sided pneumothorax with a 1 cm rim of air and no mediastinal shift.
What is the most appropriate management?
Correct Answer B: It would of course be prudent to give advice about what he should do if his symptoms worsen and also suggest routine follow-up with his GP.
Pneumothorax: The British Thoracic Society (BTS) published updated guidelines for the management of spontaneous pneumothorax in 2010. A pneumothorax is termed primary if there is no underlying lung disease and secondary if there is.
1- Primary pneumothorax: Recommendations include:
2- Secondary pneumothorax: Recommendations include:
3- Iatrogenic pneumothorax Recommendations include:
A 45-year-old man is noted to have bilateral hilar lymphadenopathy on chest x-ray.
Which one of the following is the least likely cause?
Correct Answer A: Amyloidosis is not commonly associated with bilateral hilar lymphadenopathy.
Bilateral hilar lymphadenopathy:
The most common causes of bilateral hilar lymphadenopathy are sarcoidosis and tuberculosis.
Other causes include:
A 41-year-old female presents with 3 day history of a dry cough and shortness of breath. This was preceded by flu-like symptoms. On examination there is a symmetrical, erythematous rash with 'target' lesions over the whole body.
What is the likely organism causing the symptoms?
Correct Answer C: Pneumococcus may also cause erythema multiforme.
Mycoplasma pneumoniae:
Mycoplasma pneumoniae is a cause of atypical pneumonia which often affects younger patients. It is associated with a number of characteristic complications such as erythema multiforme and cold autoimmune haemolytic anaemia. Epidemics of Mycoplasma pneumoniae classically occur every 4 years. It is important to recognize atypical pneumonias as they may not respond to penicillins or cephalosporins.
Features:
Complications:
Diagnosis:
Management:
Which one of the following types of lung cancer is most associated with cavitating lesions?
Correct Answer D: Whilst the other types of lung cancer may cause cavitating lesions, it is most commonly seen in squamous cell cancer.
Chest x-ray:
cavitating lung lesion:
Differential:
You are reviewing the results from investigations requested at the previous respiratory clinic. A 40- year-old man is being investigated for increasing shortness of breath. The notes show he has smoked for the past 25 years.
Pulmonary function tests reveal the following:
Which one of the following is the most likely explanation?
Correct Answer C: These results show a restrictive picture, which may result from a number of conditions including kyphoscoliosis.
The other answers cause an obstructive picture.
Pulmonary function tests: Pulmonary function tests can be used to determine whether a respiratory disease is obstructive or restrictive.
The table below summarizes the main findings and gives some example conditions:
Click to expand