shortness of breath

A 72-year-old male presents to the emergency department complaining of sudden onset shortness of breath and right-sided chest pain. He reports that the pain started acutely this morning and has been gradually worsening. He has a history of atrial fibrillation and has been taking warfarin for the past 5 years. He denies any recent trauma or injury. On examination, his vital signs are: heart rate 110 bpm, blood pressure 100/60 mmHg, respiratory rate 28 breaths per minute, oxygen saturation 88% on room air. Auscultation reveals decreased breath sounds on the right side. The patient is pale and diaphoretic. A chest X-ray was initially performed, followed by the image shown. Given the clinical presentation and the findings on the image, what is the MOST appropriate next step in management?

A 7-year-old boy with a history of asthma presents to the clinic with increased wheezing and shortness of breath over the past week. He has been using his salbutamol inhaler more frequently, but his symptoms persist. His mother reports that he has been waking up at night due to coughing. What is the most appropriate next step in managing this child's asthma?

A 70-year-old man with severe COPD (FEV1 30% predicted), on triple inhaled therapy and supplemental oxygen, presents with a 3-day history of increased dyspnoea, productive cough with purulent sputum, and reduced exercise tolerance. He denies fever or chest pain. On examination, he is tachypnoeic (RR 24), saturating 88% on 2 L/min oxygen, with diffuse wheeze and prolonged expiration. His chest X-ray shows hyperinflation but no new infiltrates. His arterial blood gas on 2 L/min oxygen shows pH 7.32, pCO2 68 mmHg, pO2 55 mmHg, bicarbonate 35 mmol/L. Given this presentation, what is the most appropriate immediate management step?

A 7-year-old boy is brought to the emergency department by his parents due to sudden onset wheezing and difficulty breathing. He has a history of asthma, for which he uses a salbutamol inhaler as needed. His parents report that he had a cold over the past few days, and today he started wheezing and became short of breath. On examination, he is in moderate respiratory distress, with a respiratory rate of 30 breaths per minute, oxygen saturation of 92% on room air, and widespread wheezing on auscultation. What is the most appropriate initial management step for this child?

A 45-year-old woman presents to the emergency department with a 3-day history of progressive shortness of breath, dry cough, and fatigue. She has a history of systemic lupus erythematosus (SLE) and is currently on hydroxychloroquine and low-dose prednisone. She denies fever, chest pain, or recent travel. On examination, her temperature is 37.2°C, blood pressure is 110/70 mmHg, heart rate is 95 bpm, respiratory rate is 22 breaths per minute, and oxygen saturation is 89% on room air. Lung auscultation reveals bilateral basal crackles. Laboratory tests show a hemoglobin level of 10.5 g/dL, white blood cell count of 4,000/mm³, and platelets of 150,000/mm³. Arterial blood gas analysis reveals a pH of 7.45, PaCO2 of 35 mmHg, and PaO2 of 55 mmHg. A chest X-ray shows bilateral interstitial infiltrates. Which of the following is the most appropriate next step in management?

A 78-year-old male on warfarin presents with dyspnea and pleuritic chest pain after a fall. INR is 7.0. A chest CT is performed (image attached). After initial resuscitation, what is the MOST appropriate next step?

A 72-year-old male presents with increasing dyspnea. He has a history of GORD. The provided image was taken. What is the most appropriate next step?

A 72-year-old man presents to the clinic with progressive shortness of breath and a chronic cough producing white sputum. He has a 40-pack-year smoking history and worked in construction for most of his life. On examination, he has clubbing of the fingers and crackles at the lung bases. A chest X-ray shows diffuse reticular opacities, particularly at the lung bases. What is the most likely diagnosis?

A 68-year-old woman with a history of hypertension and heart failure is admitted to the hospital with increasing shortness of breath and peripheral edema. She is currently taking furosemide 40mg daily. Her blood tests reveal the following: Na+ 130 mmol/L (135-145 mmol/L), K+ 3.1 mmol/L (3.5-5.0 mmol/L), Cl- 95 mmol/L (98-107 mmol/L), HCO3- 32 mmol/L (22-29 mmol/L). What is the most appropriate initial management?

A 68-year-old woman with a history of heart failure presents to the emergency department with increasing shortness of breath and lower extremity edema. She has been taking furosemide 40mg daily for the past year. Her blood pressure is 110/70 mmHg, heart rate is 90 bpm, and respiratory rate is 24 breaths/min. An ECG shows flattened T waves and prominent U waves. Which of the following is the most likely electrolyte abnormality contributing to her presentation?

An 82-year-old woman is admitted to the hospital with increasing shortness of breath and intermittent chest discomfort over the past week. She reports some difficulty swallowing larger food boluses recently but denies significant heartburn. Her past medical history includes hypertension and osteoarthritis. On examination, her vital signs are stable: BP 135/85 mmHg, HR 78 bpm, RR 18/min, SpO2 94% on room air, Temp 36.8°C. Auscultation of the chest reveals decreased breath sounds at the left base. A central venous catheter is noted in the right subclavian vein. Initial blood tests show a mild normocytic anaemia (Hb 105 g/L) and normal inflammatory markers. An urgent imaging study is performed. Considering the clinical presentation and the provided imaging study, what is the most appropriate next step in the management of this patient?

An 82-year-old female presents with a 3-month history of intermittent retrosternal burning pain, worse after meals, and occasional shortness of breath on exertion. Vital signs are stable. Physical exam unremarkable. A chest X-ray is performed. Considering the findings on the image, what is the most appropriate initial management step?

A 72-year-old male presents to the ED with sudden onset shortness of breath and right-sided chest pain. He has a history of atrial fibrillation and has been taking warfarin for the past 5 years. His INR is currently 6.0. A CT scan of the chest is performed (image attached). What is the MOST appropriate initial management step?

A 60-year-old man presents to the emergency department with sudden onset of chest pain and shortness of breath. He has a history of chronic obstructive pulmonary disease (COPD) and is a current smoker. On examination, he is tachypneic and has decreased breath sounds on the right side. A chest X-ray reveals a large right-sided pneumothorax. What is the most appropriate initial management?

A 68-year-old male on warfarin presents post-fall with dyspnea and pleuritic chest pain. INR is 4.8. Vitals: HR 115, BP 95/60, RR 26, SpO2 89% on air. The provided image was obtained. What is the MOST appropriate next step?

A 62-year-old man with a history of chronic obstructive pulmonary disease (COPD) and type 2 diabetes presents to the emergency department with increasing shortness of breath over the past two days. He reports a productive cough with greenish sputum and denies chest pain. On examination, he is using accessory muscles to breathe, has a respiratory rate of 28 breaths per minute, and oxygen saturation of 88% on room air. His blood pressure is 130/85 mmHg, and his heart rate is 105 bpm. Auscultation of the chest reveals diffuse wheezing and decreased breath sounds bilaterally. An arterial blood gas analysis shows pH 7.32, PaCO2 55 mmHg, and PaO2 60 mmHg. What is the most appropriate next step in the management of this patient?

A 45-year-old man presents to the general practice clinic with a 6-month history of progressive shortness of breath and a persistent dry cough. He works as a construction worker and has a 20-pack-year smoking history. On examination, he has clubbing of the fingers and fine inspiratory crackles at the lung bases. Pulmonary function tests show a restrictive pattern. A high-resolution CT scan of the chest reveals reticular opacities and honeycombing predominantly in the lower lobes. Which of the following is the most likely diagnosis?

A 68-year-old male on warfarin presents with pleuritic chest pain and mild dyspnea. INR is 4.5. The image was obtained. What is the MOST appropriate initial intervention?

A 72-year-old male presents to the ED with sudden onset shortness of breath and right-sided chest pain. He reports a recent fall but denies any significant trauma. He has a history of atrial fibrillation and is currently taking warfarin. His INR is 6.5. A CT scan of the chest is performed (image attached). What is the MOST appropriate immediate next step in management?

An 80-year-old man with known severe COPD and stable ischaemic heart disease presents to the emergency department with a 2-day history of worsening shortness of breath, increased cough productive of yellow sputum, and ankle swelling. He is usually independent but now struggles to walk across a room. On examination: Alert but distressed. BP 130/85 mmHg, HR 110 bpm, RR 28 breaths/min, Temp 37.8°C, SpO2 88% on room air. Chest examination reveals diffuse wheezes and crackles bilaterally, reduced air entry at the bases. JVP is elevated to 5 cm above the sternal angle. Mild pitting edema to the knees. ECG shows sinus tachycardia, no acute ischaemic changes. Chest X-ray shows hyperinflation, flattened diaphragms, increased bronchial markings, and mild interstitial prominence. Given this presentation, what is the most appropriate initial management step?

A 72-year-old male presents to the ED with increasing shortness of breath and epigastric pain, especially when lying down. He has a history of GORD, hypertension and COPD. His vitals are stable. An X-ray is performed. What is the MOST appropriate next step in management?

A 55-year-old woman presents to her GP with a 3-month history of fatigue, pallor, and shortness of breath on exertion. She has a history of menorrhagia. On examination, she appears pale and has conjunctival pallor. Blood tests reveal a hemoglobin level of 8 g/dL, mean corpuscular volume (MCV) of 70 fL, and low serum ferritin. What is the most appropriate next step in management?

A 5-year-old child with a known history of asthma presents with acute shortness of breath and wheezing after playing outside. What is the most appropriate initial treatment?

A 72-year-old male presents with increasing shortness of breath and epigastric discomfort, particularly after meals. He has a history of well-controlled hypertension. An X-ray is performed. What is the MOST appropriate next step in management?

A 65-year-old man with a history of hypertension and ischemic heart disease presents to the emergency department with worsening shortness of breath, orthopnea, and peripheral edema. On examination, he has elevated jugular venous pressure, bilateral basal crackles, and pitting edema in the lower limbs. An echocardiogram shows an ejection fraction of 35%. What is the most appropriate initial management step for this patient?

A 10-year-old girl with a 3-day history of shortness of breath, fever, and headache has been diagnosed with pneumonia. What signs might be seen in severe pneumonia?

A 10-year-old boy with a history of asthma presents to the emergency department with wheezing and shortness of breath. His mother reports that he has been using his salbutamol inhaler more frequently over the past two days. On examination, he has a respiratory rate of 28 breaths per minute, and his oxygen saturation is 92% on room air. What is the most appropriate initial management step?

A 65-year-old man with a history of type 2 diabetes mellitus and hypertension presents with exertional dyspnea and fatigue. His physical examination reveals a blood pressure of 150/90 mmHg, a heart rate of 88 bpm, and a soft S4 gallop. There is no peripheral edema. An electrocardiogram shows left ventricular hypertrophy with repolarization abnormalities. Which of the following diagnostic tests would be most appropriate to evaluate for underlying coronary artery disease in this patient?

A 68-year-old man with known severe COPD presents with a 3-day history of increased cough, purulent sputum, and worsening dyspnoea. He uses salbutamol more frequently. On examination, he is afebrile, respiratory rate 24, SpO2 90% on air. Scattered wheezes are heard. Which of the following is the most appropriate initial management step?

An 82-year-old patient presents with a 6-month history of chronic cough, intermittent dyspnea, and occasional regurgitation, particularly when lying flat. They deny significant chest pain or weight loss. Past medical history includes well-controlled hypertension and mild asthma managed with salbutamol PRN. On examination, vital signs are stable, and lung sounds are clear with no wheeze. An outpatient chest X-ray was performed as part of the workup for the cough and dyspnea. Considering the radiographic findings in conjunction with the clinical history, which of the following investigations is most appropriate at this stage?

A 72-year-old man with a history of hypertension and atrial fibrillation presents to the emergency department with worsening shortness of breath and fatigue over the past two weeks. He reports occasional palpitations but denies chest pain or syncope. On examination, his blood pressure is 110/70 mmHg, heart rate is 130 bpm (irregularly irregular), respiratory rate is 22 breaths per minute, and oxygen saturation is 94% on room air. Jugular venous pressure is elevated, and there are bilateral lung crackles. An ECG shows atrial fibrillation with a rapid ventricular response. An echocardiogram reveals moderate mitral regurgitation and left atrial enlargement. Which of the following is the most appropriate initial management step?

A 34-year-old man presents to the Emergency Department with acute-onset shortness of breath. A CT pulmonary angiogram (CTPA) is ordered, shown in the photograph, confirming a diagnosis of pulmonary embolism. Which of the following is the most appropriate initial treatment option for this patient?

A 72-year-old male presents to the ED with increasing shortness of breath and epigastric pain, especially when lying down. He has a history of GORD, hypertension and COPD. His vitals are stable. An X-ray is performed. What is the MOST likely underlying cause of his presentation?

A 72-year-old woman presents with sudden onset shortness of breath and pleuritic chest pain. She had knee surgery 10 days ago. She has a history of hypertension. On examination, she is anxious, respiratory rate is 24, heart rate 105, BP 130/80, SpO2 92% on room air. Lungs are clear. ECG shows sinus tachycardia. There is mild swelling in the operated leg. Considering the likely diagnosis, which initial investigation is most appropriate?

A 45-year-old man presents to the clinic with a 3-month history of persistent cough and shortness of breath. He is a non-smoker and works as a carpenter. On examination, there are bilateral inspiratory crackles at the lung bases. A chest X-ray shows reticular opacities predominantly in the lower lobes. Pulmonary function tests reveal a restrictive pattern. What is the most likely diagnosis?

A 78-year-old male on warfarin for atrial fibrillation presents to the emergency department with sudden onset of severe dyspnoea and right-sided pleuritic chest pain. He denies trauma. On examination, he is tachypnoeic, oxygen saturation is 92% on room air. Blood pressure 110/70 mmHg, heart rate 95 bpm. Chest examination reveals decreased breath sounds on the right. A CT scan of the chest is performed. Considering the patient's clinical presentation, medical history, and the findings demonstrated in the provided image, which of the following interventions is most critical to initiate *before* considering invasive drainage?

A 72-year-old male on warfarin presents with sudden onset shortness of breath and right-sided chest pain after a fall. His INR is 4.5. The provided image was obtained. What is the MOST appropriate next step in management?

An 82-year-old patient presents to the emergency department with a 3-month history of intermittent retrosternal chest discomfort, worse after meals, and mild shortness of breath on exertion. They report occasional regurgitation but deny significant dysphagia. Past medical history includes hypertension and osteoarthritis. Medications are perindopril and paracetamol. On examination, vital signs are stable, and lung sounds are clear. A chest X-ray is performed. Based on the findings in the image, what is the most appropriate next step in management or investigation?

A 62-year-old woman presents to her general practitioner with a 3-month history of progressive shortness of breath, fatigue, and a persistent dry cough. She has a history of rheumatoid arthritis, for which she takes methotrexate and low-dose prednisone. She denies fever, weight loss, or night sweats. On examination, she has clubbing of the fingers and fine inspiratory crackles at the lung bases. Her oxygen saturation is 92% on room air. A chest X-ray shows reticular opacities predominantly in the lower lung zones. Pulmonary function tests reveal a restrictive pattern with reduced diffusion capacity for carbon monoxide (DLCO). Which of the following is the most appropriate next step in the management of this patient?

An 82-year-old patient presents to their GP with a 3-month history of intermittent retrosternal chest discomfort, often described as a burning sensation, worse after meals and when lying flat. They also report mild shortness of breath on exertion and occasional regurgitation, but deny significant dysphagia or weight loss. Past medical history includes hypertension and osteoarthritis. Medications are perindopril and paracetamol. On examination, vital signs are stable (BP 130/80, HR 75, RR 16, SpO2 97% on air), and lung sounds are clear. A chest X-ray is performed as part of the workup. Based on the clinical context and the findings demonstrated in the image, what is the most appropriate next step in investigation?

A 45-year-old male presents to the emergency department with severe chest pain radiating to his left arm, shortness of breath, and diaphoresis. He has a history of hypertension and hyperlipidemia. On examination, he is diaphoretic, and his blood pressure is 90/60 mmHg. An ECG shows ST-segment elevation in leads II, III, and aVF. What is the most appropriate initial management for this patient?

A 65-year-old patient with a history of DVT presents with sudden onset dyspnoea and pleuritic chest pain. Examination is unremarkable except for mild tachypnoea. Wells score is 4. Which initial investigation is most appropriate in the diagnostic pathway?

A 72-year-old male presents with increasing shortness of breath and epigastric discomfort, particularly after meals. He has a history of well-controlled hypertension and takes aspirin daily. An X-ray is performed. What is the most appropriate next step in management?

A 68-year-old man with moderate COPD (FEV1 55%) on a LAMA reports persistent breathlessness (mMRC 2) and one moderate exacerbation requiring oral steroids last year. What is the most appropriate next step in maintenance therapy?

An 82-year-old woman is admitted to the hospital with increasing shortness of breath and intermittent chest discomfort over the past week. She reports some difficulty swallowing larger food boluses recently but denies significant heartburn. Her past medical history includes hypertension and osteoarthritis. On examination, her vital signs are stable: BP 135/85 mmHg, HR 78 bpm, RR 18/min, SpO2 94% on room air, Temp 36.8°C. Auscultation of the chest reveals decreased breath sounds at the left base. A central venous catheter is noted in the right subclavian vein. Initial blood tests show a mild normocytic anaemia (Hb 105 g/L) and normal inflammatory markers. An urgent imaging study is performed. Considering the clinical presentation and the findings on the imaging study, which of the following is the most likely underlying cause of the patient's anaemia?

A 75-year-old male is brought to the emergency department by ambulance with sudden onset severe shortness of breath and left-sided pleuritic chest pain that began approximately 4 hours ago. He reports feeling lightheaded and generally unwell. His past medical history includes chronic atrial fibrillation, hypertension, and type 2 diabetes mellitus. He is currently prescribed warfarin 5mg daily, metoprolol 50mg twice daily, perindopril 4mg daily, and metformin 1000mg twice daily. He denies any recent falls, trauma, or invasive procedures. On examination, he is visibly distressed and tachypnoeic. His vital signs are: temperature 36.8°C, heart rate 125 bpm (irregularly irregular), blood pressure 88/55 mmHg, respiratory rate 32 breaths per minute, oxygen saturation 85% on room air. Jugular venous pressure is not elevated. Cardiac auscultation reveals a rapid, irregular rhythm with no murmurs. Pulmonary auscultation reveals significantly diminished breath sounds over the entire left hemithorax, with dullness to percussion. The right lung field is clear. Abdominal examination is unremarkable. Peripheral pulses are weak but present. His capillary refill time is prolonged at 4 seconds. Initial laboratory results show haemoglobin 135 g/L (baseline 140 g/L three months ago), white cell count 9.2 x 10^9/L, platelets 250 x 10^9/L, creatinine 110 µmol/L, electrolytes within normal limits. His INR is 7.8. An urgent CT scan of the chest is performed, and a representative axial image is shown. Based on the clinical presentation and the findings demonstrated in the image, what is the single MOST appropriate immediate management step?

A 63-year-old man presents to the emergency department complaining of increasing shortness of breath and epigastric discomfort over the past several months. He reports feeling full quickly after eating only small amounts. He denies any chest pain, fever, or recent weight loss. His past medical history includes hypertension and well-controlled type 2 diabetes. He takes lisinopril and metformin daily. On examination, his vital signs are stable: blood pressure 130/80 mmHg, heart rate 82 bpm, respiratory rate 18 breaths/min, and oxygen saturation 96% on room air. Auscultation of the chest reveals decreased breath sounds at the left base. Abdominal examination reveals mild epigastric tenderness to palpation, but no rebound tenderness or guarding. The provided image was obtained. Which of the following is the MOST appropriate next step in management?

A 72-year-old male on warfarin presents with sudden onset dyspnea. His INR is 6.0. The provided image was obtained. What is the MOST appropriate next step?

A 62-year-old woman presents to the emergency department with acute onset of chest pain and shortness of breath. She describes the pain as sharp and worse with inspiration. She has a history of deep vein thrombosis and is currently on warfarin. On examination, her blood pressure is 110/70 mmHg, heart rate is 110 bpm, respiratory rate is 24 breaths per minute, and oxygen saturation is 88% on room air. Her jugular venous pressure is elevated, and she has clear lung fields on auscultation. An ECG shows sinus tachycardia with right axis deviation. Which of the following is the most likely diagnosis?

A 62-year-old man presents to the emergency department with sudden onset chest pain and shortness of breath that started 2 hours ago while he was gardening. He describes the pain as a tightness across his chest, radiating to his left arm. He has a history of hypertension and hyperlipidemia, and he is a current smoker. On examination, his blood pressure is 150/90 mmHg, heart rate is 110 bpm, respiratory rate is 22 breaths per minute, and oxygen saturation is 94% on room air. He appears anxious and diaphoretic. An ECG shows ST-segment elevation in leads II, III, and aVF. Which of the following is the most appropriate immediate management step?