A 26-year-old male presents with sudden onset of chills and fever (temperature 39°C), left-sided chest pain, and cough with scant white sputum after catching a cold. Chest X-ray shows a patchy shadow in the left lower lung field. After 1 day of penicillin treatment, his temperature normalizes. The most likely diagnosis is:
A 28-year-old male developed chills and high fever after playing basketball in the rain, accompanied by myalgia, right chest pain worsened by deep breathing, and rusty sputum. He presented with an acute illness appearance and herpes at the mouth corner. Physical exam: temperature 39°C, pulse 88/min, increased tactile fremitus in the right lung, dullness on percussion, and bronchial breath sounds. Lab tests: WBC 25×10⁹/L, neutrophils 0.90 with left shift. The most likely diagnosis is:
A 21-year-old male presents with low-grade fever, night sweats, dry cough, and fatigue. Two months ago, he developed right-sided chest pain. Physical exam shows tracheal deviation to the left, dullness to percussion in the right lower chest, and absent breath sounds. Chest X-ray reveals a large right-sided pleural effusion. Diagnostic thoracentesis yields pale yellow fluid with: specific gravity 1.020, Rivalta test (+), protein 47g/L, WBC count 685x10^6/L (70% lymphocytes), and ADA >45U/L. What is the most likely diagnosis?
A 42-year-old woman with a 5-year history of recurrent wheezing attacks has experienced worsening symptoms over the past 2 days, with nightly episodes. Physical examination reveals bilateral wheezing and a heart rate of 80 bpm. FEV<sub>1</sub>/FVC is 60%. What treatment regimen should be initiated?
A 30-year-old male presents with a 2-day acute attack of asthma. Self-administration of aminophylline and beclomethasone inhalation provided no relief. Examination reveals clear consciousness, cyanosis of the lips, and bilateral wheezes on lung auscultation. The emergency management is:
A 20-year-old female presents with expiratory dyspnea accompanied by wheezes lasting for 1 day. The patient has profuse sweating, cannot speak, and appears anxious. Examination reveals: respiratory rate 30/min, pulse 118/min, BP 10/8 kPa, and bilateral wheezes on auscultation. Which of the following emergency measures is LEAST indicated?
A 30-year-old male presents with a 2-day acute attack of asthma, unresponsive to self-administered aminophylline and beclomethasone dipropionate inhaler. Examination reveals delirium, cyanosis, paradoxical pulse, diffuse wheezes, and heart rate of 120/min. The emergency management should be:
A 20-year-old male presents with an acute attack of allergic asthma. Physical examination reveals severe dyspnea with mild cyanosis, bilateral wheezes, and a heart rate of 110/min. Which of the following treatments is NOT the first-line choice?
A 30-year-old woman presents with wheezing and dyspnea for 1 day, with a history of similar episodes. Physical examination shows shortness of breath, cyanosis, bilateral diffuse wheezes, heart rate 120/min with regular rhythm, and no murmurs. Previous treatment with aminophylline and terbutaline was ineffective. Besides immediate oxygen therapy, what is the first-line treatment for this patient?
A 30-year-old male presents with recurrent moderate to massive hemoptysis since age 15, occasionally with purulent sputum. Recently, he coughed up 50ml of blood. Physical exam reveals fixed rales in the right lower lung. Chest X-ray shows coarse lung markings bilaterally. Clinical diagnosis is bronchiectasis. The patient requests surgical treatment, and the physician advises further evaluation. The decisive factor for determining surgical candidacy in this patient is:
A 52-year-old male has had a persistent cough since childhood measles, often with purulent sputum and minor hemoptysis. Bronchography previously confirmed bronchiectasis in the right lower lobe's posterior basal and medial segments. Symptoms worsened over the past 4-5 years, with added dyspnea. Pulmonary function tests 1 month ago showed FEV<sub>1</sub> at 38% of vital capacity. Over the past 2 days, hemoptysis persisted, exceeding 600ml in 24 hours. Which treatment option is inappropriate?
A 40-year-old male with a history of pulmonary tuberculosis 20 years ago, previously healthy, has had an irritative cough for the past 3 months, occasionally with blood-streaked sputum and intermittent fever. Chest X-ray shows a 2cm × 2.5cm lobulated mass with irregular margins in the anterior segment of the right upper lobe. Three sputum cytology tests were negative. The most likely diagnosis is:
A 50-year-old male presents with a 2-month history of irritating dry cough and persistent hemoptysis. No history of fever or purulent sputum. Physical examination shows no cyanosis but significant clubbing. The most likely diagnosis is:
A 55-year-old male with poorly differentiated squamous cell carcinoma of the right upper lung develops leukopenia (WBC count <0.5×10⁹/L, neutrophils <0.5×10⁹/L) after chemotherapy. He has had cough and high fever for 3 days. X-ray examination shows shrinkage of the right upper lung mass and dense consolidation in the right mid-lower lung fields. Which of the following empiric antibiotic therapies is inappropriate before obtaining microbiological results?
A 54-year-old male presents with a 2-month history of irritative cough, hemoptysis, accompanied by chest tightness and dull right-sided chest pain. Routine chest X-ray shows no abnormalities. Which of the following diagnostic tests should be prioritized?
A 58-year-old male presents with cough and hemoptysis for over 1 month. X-ray examination reveals a mass shadow at the right hilum with 'elevated right hemidiaphragm'. To differentiate between diaphragmatic paralysis and subpulmonary effusion, the simplest and most effective method is
A 69-year-old male presents with chest tightness and dyspnea for 2 weeks. Examination reveals massive right-sided pleural effusion without fever. The pleural fluid is bloody. Suspected diagnosis is pleural metastasis from lung cancer. Which imaging study should be prioritized for further diagnosis?
A 38-year-old male presents with a 2-week history of cough and hemoptysis. X-ray examination reveals atelectasis in the posterior basal segment of the left lower lobe. Fiberoptic bronchoscopy and biopsy confirm small cell undifferentiated carcinoma. CT shows no hilar lymphadenopathy. Which of the following treatment measures is inappropriate?
A 65-year-old male presents with low-grade fever, cough, and blood-tinged sputum for 3 months. Chest X-ray (CXR) reveals left upper lobe atelectasis and a small pleural effusion. Which diagnostic test should be prioritized for confirmation?
A 35-year-old woman with a 3-year history of irregularly treated pulmonary tuberculosis developed fever (38°C) 2 days ago after catching a cold. Physical examination shows no significant abnormalities. Chest X-ray (CXR) reveals patchy shadows in both upper lungs with irregular lucency. Which of the following is most significant to determine if the tuberculosis is active?
A 25-year-old male presents with low-grade fever and cough for 2 months. Chest X-ray reveals a 2cm×2cm round shadow in the posterior segment of the right upper lobe, with spiculated margins, heterogeneous density, and multiple surrounding satellite lesions. The most likely diagnosis is:
A 26-year-old male presented with fever and hemoptysis, diagnosed with right upper lobe tuberculosis (TB) with cavity formation. After standard anti-TB chemotherapy, the lesion significantly improved but left a thin-walled cavity, with conversion to negative sputum culture for TB. After 1 year of follow-up without medication, sputum cultures remain negative. Which of the following is the most appropriate management at this stage?
A 60-year-old male presents with recurrent cough for 2 years, accompanied by low-grade fever and weight loss. Physical examination reveals tracheal deviation to the left and moist rales in the left upper lung. Chest X-ray (CXR) shows multiple thick-walled cavities in the left upper lung with upward displacement of the left hilum. The most likely diagnosis is:
A 20-year-old female presents with afternoon fever and cough with hemoptysis for 1 week. Physical exam reveals rales in the left interscapular region. ESR is 50mm/1st hour, WBC count 10.9×10⁹/L (70% neutrophils). CXR shows patchy shadows in the left upper lung with a 1cm×1cm lucent area. The most likely diagnosis is:
A 32-year-old male presents with cough for over 1 month and low-grade fever with hemoptysis for 10 days. Chest X-ray (CXR) shows inflammation with cavity formation in the apical segment of the right upper lobe. The most likely diagnosis is:
The principle of a positive tuberculin test reaction is
A 48-year-old male with cough and a mass in the right upper lobe underwent transbronchial lung biopsy (TBLB) via fiberoptic bronchoscopy. Pathology revealed typical tuberculous granulomas. During rounds, the attending physician asked which component of Mycobacterium tuberculosis is associated with this finding.
A 22-year-old female presents with low-grade fever, weight loss, amenorrhea, and occasional mild cough for over 2 months. Tuberculin skin test (5IU) shows a 20mm×20mm induration (strongly positive) at 72 hours. Which of the following is the most appropriate management?
A 30-year-old woman presents with fever, cough, and dyspnea for half a month, with a history of mushroom cultivation. Physical examination shows no cardiopulmonary abnormalities, and acid-fast bacilli are found in sputum. Chest X-ray (CXR) reveals bilateral diffuse, uniformly distributed, equal-sized, and equal-density opacities. The most likely diagnosis is:
A 30-year-old male presents with a 3-month history of cough, occasional hemoptysis, fatigue, and weight loss, but no fever. Physical examination reveals bilateral neck lymph nodes the size of broad beans, slightly firm and non-tender, with few rales in the right upper lung. The most likely diagnosis is:
A 32-year-old male developed high fever, cough, and copious purulent foul-smelling sputum for 2 weeks after catching a cold. Physical examination reveals dullness on percussion and moist rales in the right lower lung. Lab tests show WBC 12×10<sup>9</sup>/L with 92% lobulated neutrophils. Chest X-ray (CXR) demonstrates a large shadow with thick-walled cavity in the posterior segment of the right lower lobe. The most important next diagnostic test should be:
A 50-year-old woman with right lower lung abscess showed symptom improvement after 4 months of intensive medical treatment, but chest X-ray (CXR) reveals a 3cm thick-walled cavity. What is the next preferred treatment?
A 62-year-old male underwent dental extraction 1 week ago. For the past 3 days, he has presented with cold intolerance, fever, cough with purulent sputum, and slightly foul-smelling sputum. X-ray shows a left lower lobe lung abscess. Gram stain of sputum smear reveals gram-negative bacilli, but there is no growth on routine culture. The most likely pathogen is:
A 60-year-old male underwent subtotal gastrectomy for gastric cancer. On postoperative day 3, he developed high fever, chills, cough with small amounts of purulent sputum, and left lower chest pain. Chest X-ray showed left lower lobe pneumonia with abscess formation. Sputum cultures repeatedly grew Staphylococcus aureus, with drug sensitivity testing showing resistance to oxacillin. Which of the following antibiotic choices is inappropriate?
A 60-year-old male with hematogenous lung abscess suddenly develops left chest pain followed by dyspnea. On examination: cyanosis of the lips, tracheal deviation to the right, and decreased breath sounds in the left lung. The most likely diagnosis is:
A patient has chronic cough with purulent sputum and recurrent hemoptysis for over 10 years, with multiple chest X-rays showing no abnormalities. In the past two weeks, high fever developed, with increased foul-smelling purulent sputum. Chest X-ray reveals a large dense shadow in the right lower lobe, containing a cavity with air-fluid level. WBC count is 18×10<sup>9</sup>/L. The diagnosis is:
A 50-year-old male presents with cold intolerance, high fever for 10 days, and productive cough with purulent sputum. Temperature: 39.5°C, WBC: 15.4×10⁹/L. Physical exam reveals dullness on percussion and rales in the right upper and middle lung fields. He has a history of tuberculosis exposure. Chest X-ray shows a large dense shadow with a lucent area and air-fluid level in the right upper and middle lung zones. The most likely diagnosis is:
A 65-year-old male, 1 week after intestinal obstruction surgery, suddenly developed chest pain and dyspnea after defecation. Physical exam: heart rate 130/min, P2>A2. Blood gas analysis shows PaO2 decreased from 98mmHg to 70mmHg, PaCO2 30mmHg. Echocardiogram shows pulmonary hypertension. The most likely diagnosis is:
A 50-year-old male, 1 month post-hip surgery, suddenly developed chest pain, hemoptysis, and dyspnea after getting up. Physical exam: tachypnea, rales in lungs, accentuated P<sub>2</sub>, left lower limb swelling with tenderness. ECG shows SⅠQⅢTⅢ pattern, WBC(+), D-dimer(+). The most likely diagnosis is:
A 27-year-old female with a history of congenital heart disease (CHD) presents with persistent fever for 2 weeks. On admission: anemic appearance, grade 4/6 harsh systolic murmur with thrill at left sternal border (3rd-4th intercostal space), spleen 2 cm below the costal margin, and two positive blood cultures. On day 3, she suddenly develops dyspnea, chest pain, and recurrent hemoptysis. The most likely diagnosis is:
A 20-year-old male presented with chills, high fever, cough, and scant bloody sputum for 3-4 days. He died due to dyspnea, cyanosis, and shock. Pathology revealed alveoli filled with red and white blood cells and serous exudate, but intact alveolar walls. The most likely diagnosis is:
A 32-year-old woman developed sudden cold intolerance, fever, right chest pain, shortness of breath, and a small amount of rusty sputum two days after catching a cold. She has no significant past medical history. Chest examination reveals dullness on percussion in the lower right anterior chest with tubular breath sounds. The most likely diagnosis is:
A 60-year-old male presents with a 3-month history of cough and blood-streaked sputum, accompanied by progressive dyspnea over the past month. Dyspnea worsens in the supine position. Physical examination reveals inspiratory dyspnea with three-retraction sign (suprasternal, intercostal, and subcostal retractions) and bilateral wheezing. Chest X-ray (CXR) shows no significant abnormalities. What is the most likely diagnosis?
A 67-year-old male with a 10-year history of chronic bronchitis and emphysema, along with well-controlled hypertension (HTN), presents with sudden right-sided chest pain and worsening dyspnea after a severe coughing episode, unable to lie flat. The most likely diagnosis is:
A 64-year-old male underwent surgery for esophageal cancer with a nasogastric tube placed. On postoperative day 4, he developed cough with yellowish sputum, fever (38.4°C), dyspnea, and fine moist rales in the right lower lung. Chest X-ray showed a large inflammatory lesion in the right lower lobe. What is the most likely pathogen?
A 28-year-old male with acute myeloid leukemia undergoing chemotherapy (neutrophils 0.4×10<sup>9</sup>/L) presents with high fever, purulent cough, and extensive moist rales in the right lung. Chest X-ray shows dense consolidation in the right mid-lung field with areas of reduced density. The most likely causative pathogen of this pulmonary infection is:
A 60-year-old male with alcoholism presents with acute onset high fever, cough with copious mucopurulent sputum, and chest pain. Chest X-ray (CXR) shows consolidation in the right upper lobe with multiple honeycomb-like cavities and downward bulging of the interlobar fissure. Which diagnosis is most likely?
A 48-year-old woman with diabetes mellitus (DM) sustained a left foot injury with delayed wound healing. Three days ago, she developed sudden high fever, chills, chest pain, cough, and purulent pinkish creamy sputum. Chest X-ray (CXR) shows multiple patchy infiltrates in both lungs with 1-2 cm air-fluid cavities. The most likely diagnosis is:
A 55-year-old female with multiple dental caries presents with high fever, cough, and foul-smelling yellow sputum for 1 week. Physical examination reveals consolidation in the left lung. Two days later, she develops right-sided chest pain, and X-ray confirms right-sided pleural effusion. Thoracentesis yields foul-smelling purulent fluid. The most likely pathogen is:
A 30-year-old male developed chills, high fever (39.1°C), dry cough, and right-sided chest pain worsened by deep breathing or coughing after a tiring business trip. Physical examination shows an acutely ill appearance, facial flushing, herpes labialis, and bronchial breath sounds in the right mid-to-lower lung. The clinical diagnosis is acute pneumonia. What is the most likely pathogen?
A 62-year-old male underwent dental extraction 1 week ago. For the past 3 days, he has presented with chills, fever, cough, and foul-smelling purulent sputum. X-ray shows a left lower lobe lung abscess. Gram stain of sputum smear reveals gram-negative bacilli, but no growth on routine culture. The most likely pathogen is:
A 30-year-old female farmer sustained a right lower leg skin laceration during field work 2 weeks ago. She developed chills and high fever 1 week ago, followed by cough, dyspnea, and right-sided chest pain for 3 days. Imaging shows right-sided pneumonia with pyopneumothorax. The most likely causative pathogen is:
A 70-year-old male presents with fever and cough for 3 days, producing brick-red jelly-like sputum. Physical examination reveals consolidation signs in the right upper lobe. Chest X-ray shows right upper lobar pneumonia with downward bulging of the horizontal fissure. The most likely pathogen is:
A 60-year-old male with chronic obstructive pulmonary disease (COPD) and respiratory failure is receiving mechanical ventilation. He develops right lower lobe pneumonia, with Pseudomonas aeruginosa identified as the pathogen. Which of the following antibiotic therapy regimens is most appropriate?
A 23-year-old male presents to the emergency department with a 3-day history of high fever, right-sided chest pain, cough with rusty sputum after catching a cold. Chest X-ray shows a large area of dense shadow in the right lower lobe. A diagnosis of Streptococcus pneumoniae pneumonia is suspected. Regarding the pathogenicity and pathological changes of the causative organism, which of the following statements is incorrect?
A 60-year-old male underwent subtotal gastrectomy for gastric cancer. On postoperative day 3, he developed high fever, chills, cough with scant purulent sputum, and left lower chest pain. X-ray showed left lower lobe pneumonia with abscess formation. Sputum cultures repeatedly grew methicillin-resistant Staphylococcus aureus (MRSA). Which of the following antibiotic choices is inappropriate?
A 16-year-old male student presents with a 3-day history of dry cough and fever (37.8°C). Chest X-ray shows hazy patchy opacities in the right lower lung field. Cold agglutinin test is positive at 1:64. A diagnosis of Mycoplasma pneumoniae pneumonia is suspected. Which of the following management options is incorrect?
A 30-year-old woman presents with chills, fever, chest pain, cough, and shortness of breath for 5 days after getting caught in the rain. She has a history of tuberculosis. Physical examination reveals dullness on percussion and crackles in the left lower lung. Sputum is negative for Mycobacterium tuberculosis. White blood cell (WBC) count is 32×10<sup>9</sup>/L. Chest X-ray (CXR) shows a large dense shadow in the left lower lobe. The most likely diagnosis is:
A 32-year-old woman developed a furuncle on her foot 1 week ago. Two days ago, she developed fever, headache, high fever with chills, productive cough with blood-tinged sputum, and chest pain. Auscultation revealed increased breath sounds with occasional fine crackles in both lungs. WBC was 2×10<sup>9</sup>/L with 90% neutrophils. Chest X-ray showed scattered faint round lesions in both lungs, some with cavities containing air-fluid levels. The most likely diagnosis is:
A 30-year-old woman presents with sudden high fever, chest pain, and rusty sputum. Chest X-ray shows left lower lobe pneumonia. Despite intramuscular penicillin (1.6 million units TID for 5 days), she remains febrile with left chest fullness and absent breath sounds. The most important next investigation is:
A 50-year-old male presents with progressively worsening dyspnea over the past year, occasionally with dry cough. Chest X-ray shows bilateral diffuse reticulonodular opacities. Pulmonary function tests reveal restrictive ventilatory impairment. A diagnosis of idiopathic pulmonary fibrosis (IPF) is suspected. Which of the following physical findings most supports this diagnosis?
A 40-year-old woman developed progressive chest tightness and dyspnea after a cold 1 year ago, now unable to climb to the second floor. Chest X-ray (CXR) shows diffuse reticular shadows in both lungs, suggesting idiopathic pulmonary interstitial fibrosis. The typical pulmonary function findings would be:
A 62-year-old male has had chronic cough and sputum production for nearly 20 years, accompanied by progressively worsening dyspnea. Even walking slightly faster on level ground causes dyspnea. The clinical diagnosis is chronic bronchitis and obstructive emphysema. Which of the following signs is NOT essential for diagnosing the latter?
A 65-year-old woman with a 30-year history of recurrent cough, sputum production, and wheezing was admitted due to worsening symptoms for 1 week. Examination: conscious, cyanotic, jugular vein distension, scattered medium and fine crackles and rhonchi in both lungs, heart rate 120 bpm with regular rhythm. Liver 3 cm below the costal margin, pitting edema in both lower limbs. Peripheral WBC count 12×10<sup>9</sup>/L (neutrophils 80%). CXR shows right inferior pulmonary artery trunk 17 cm and prominent lung markings. The most critical treatment for this patient is:
A 60-year-old patient with pulmonary heart disease has recently experienced worsening cough and shortness of breath, along with confusion. Arterial blood gas (ABG) analysis shows pH 7.31, PaO2 50 mmHg, and PaCO2 80.6 mmHg. What should be administered immediately?
A 65-year-old male with a 15-year history of intermittent cough and sputum production, and 3 years of palpitations and shortness of breath on exertion. Over the past 5 days, he developed fever, cough with yellow sputum, worsening breathlessness, oliguria, and bilateral lower extremity edema. Which of the following is the most critical treatment measure?
A 60-year-old male with cor pulmonale presents to the emergency department with fever, purulent sputum, and worsening dyspnea for 3 days. Which of the following principles is most appropriate for selecting antibiotics before identifying the causative pathogen of pulmonary infection?
A 58-year-old male presents with recurrent cough and sputum production for 15 years, and palpitations and dyspnea for 3 years. Physical examination reveals hyperresonance on percussion, diminished breath sounds, basal rales/crackles, prominent apical impulse at the xiphoid process with a 3/6 systolic murmur, and accentuated P2 sound in the pulmonary valve area. The most likely diagnosis is:
A 66-year-old male presents with a 20-year history of chronic cough and progressively worsening dyspnea over the past 5 years, now barely able to manage daily activities. Examination reveals weight loss and dyspnea at rest with shoulder shrugging and mouth opening. The physician advises him to practice pursed-lip deep breathing because:
A 70-year-old male with a 30-year history of recurrent cough and sputum production, and 12 years of shortness of breath on exertion. Arterial blood gas (ABG) shows PaCO₂ 50 mmHg and PaO₂ 45 mmHg. The most effective home-based therapy to prolong life and prevent pulmonary hypertension progression is:
In obstructive emphysema, the primary mechanism leading to hypoxemia is
A patient with chronic bronchitis suddenly experienced brief stabbing pain in the left upper chest this morning, gradually developed dyspnea, inability to lie flat, heart rate 120/min with irregular rhythm, and markedly diminished breath sounds in the left lung. Which condition do you suspect?
A 60-year-old male presents with chronic cough and sputum production for 12 years, and progressive dyspnea for 3 years. Chest X-ray shows increased intercostal spaces, increased lung transparency, and disordered lower lung markings. The most likely diagnosis is:
A 60-year-old male with 15-year history of chronic obstructive pulmonary disease (COPD) presents with worsening cough and dyspnea, marked cyanosis, and restlessness. Blood gas analysis shows pH 7.4, PaO2 40 mmHg, PaCO2 70 mmHg. Which oxygen therapy should be administered?
A 68-year-old male with a 10-year history of chronic obstructive pulmonary disease (COPD) presents with worsening cough and dyspnea for 3 days following a cold. Arterial blood gas (ABG) analysis (without oxygen supplementation): pH 7.38, PaCO₂ 6 kPa (45 mmHg), PaO₂ 9.4 kPa (70 mmHg). The most likely cause of his hypoxemia is due to:
A 75-year-old woman with a 20-year history of chronic cough and dyspnea has had bilateral lower extremity edema for the past 3 years. Over the past 5 days, her cough and dyspnea worsened despite antibiotic and diuretic use. She now presents with insomnia and agitation. Blood gas analysis: pH 7.35, PaO₂ 55 mmHg, PaCO₂ 74 mmHg, AB 42 mmol/L, serum chloride (Cl) 80 mmol/L. The most likely diagnosis is:
A 72-year-old male has a history of chronic cough for 25 years, with progressively worsening dyspnea over the past 10 years. Arterial blood gas (ABG) analysis shows: PaCO₂ 6 kPa (45 mmHg), PaO₂ 6.4 kPa (48 mmHg). What is the most effective home treatment and nursing measure?
A 56-year-old woman with chronic bronchitis and obstructive emphysema for nearly 10 years. Over the past 3 days, her cough and wheezing worsened due to a cold, with slightly increased purulent sputum. The most likely pathogens causing her secondary infection are:
A 60-year-old male presents with a 5-year history of cough and worsening dyspnea for 7 days. Physical examination reveals barrel chest. Chest X-ray shows increased lung translucency, widened intercostal spaces, and depressed diaphragms. Pulmonary function tests demonstrate RV/TLC=40%, MVV is 50% of predicted value, and FEV1/FVC=55%. The most likely diagnosis is:
A 54-year-old male presents with a 10-year history of chronic cough and sputum production, and dyspnea for 3 years that has progressively worsened. Chest X-ray shows increased intercostal spaces, hyperlucent lungs, a round lucent area in the right upper lobe, and thickened, disorganized lung markings in both lower lobes. The most likely diagnosis is:
A 50-year-old male presents with left-sided chest pain for 1 month. He has a 20-year history of smoking. Chest X-ray (CXR) shows left pleural effusion with an enlarged left hilar shadow. Pleural fluid analysis: bloody, specific gravity 1.020, protein 30g/L, white blood cell (WBC) count 0.8*10⁹/L (neutrophils 72%, lymphocytes 28%). The most likely diagnosis is:
A 60-year-old woman with chronic cough and dyspnea for 18 years, experiencing wheezing on exertion and lower extremity edema for 3 years. Over the past week, worsening cough and dyspnea with poor response to antibiotics and diuretics, accompanied by insomnia and irritability for 2 days. Blood gas analysis: pH 7.35, PaO₂ 56 mmHg, PaCO₂ 75 mmHg, AB 41 mmol/L, Cl⁻ 78 mmol/L. Based on the history, the most likely diagnosis is:
A 28-year-old male presents with chills, fever, and left-sided chest pain for 3 days. Chest X-ray (CXR) shows moderate to large left-sided pleural effusion. Diagnosed with left-sided tuberculous exudative pleurisy, what is the most important additional treatment besides antitubercular drugs?
In a patient with pleural effusion, foul-smelling turbid fluid is obtained via thoracentesis. Which test should be performed on the fluid to identify the etiology?
A 48-year-old male presents with chills, high fever, right-sided chest pain, and mild cough for 1 week. He is diagnosed with right-sided purulent pleurisy. The supervising physician suggests that, in addition to aggressive antibiotic therapy, placement of a pleural drainage tube should be guided by which of the following test indicators?
A 39-year-old woman presents with fever, dry cough, and chest pain for 20 days, and shortness of breath for the past week. Examination reveals dullness on percussion and absent breath sounds below the right second anterior rib, with tracheal deviation to the left. Pleural fluid analysis shows: positive mucin test, protein 29g/L, total cell count 700*10^9/L, RBCs 4*10^9/L, LDH 400U/L, and ADA >45. Which of the following is the most critical treatment measure?
A 32-year-old male with a history of rheumatoid arthritis on oral steroid therapy presents with worsening fever, chest pain, and dyspnea over 15 days. Pleural fluid is straw-colored, Rivalta test (+), specific gravity 1.024, WBC 300×10<sup>6</sup>/L (lymphocytes 60%). Chest X-ray shows moderate right pleural effusion and right hilar lymphadenopathy. The most likely diagnosis is:
A 39-year-old male with a 15-year smoking history presents with fever for 2 weeks (37.5°C~38°C), right chest pain (reduced in intensity over the past 4 days), chest tightness, and shortness of breath. Physical examination reveals decreased vocal fremitus in the right lower chest, dullness on percussion, and decreased breath sounds. The most likely diagnosis is:
A 28-year-old woman presents with low-grade fever for 1 week accompanied by dry cough and left chest pain, and dyspnea after activity for 2 days. Chest X-ray shows left pleural effusion. Blood white blood cell (WBC) count is 7.8*10<sup>9</sup>/L, and pleural fluid is a bloody exudate with lymphocytes (L) 0.65. The most likely diagnosis is:
A 30-year-old woman with an 11-year history of asthma has experienced recurrent attacks over the past year, particularly at midnight or early morning, and more frequently during spring and the rainy season. Physical examination: generally stable, coherent history without dyspnea, scattered wheezes in both lungs. According to asthma management guidelines, what is the preferred route of administration for corticosteroids and β<sub>2</sub>-agonists in asthma treatment?
A 22-year-old female with a history of persistent post-measles cough and wheezing since childhood. Recent years show increased frequency and severity of attacks. Hospitalized due to unresolved asthma exacerbation after a cold 1 week ago. Examination: apathy, dyspnea, orthopneic position, no significant cyanosis with oxygen. Bilateral wheezes, heart rate 126/min with regular rhythm and pulsus paradoxus. Which test should be immediately performed for objective assessment?
A 30-year-old male developed shortness of breath after activity 6 months ago, and has experienced shortness of breath at rest for the past 2 months, along with occasional white sputum production, leading to hospitalization. Physical exam: RR 24/min, few crackles audible at lung bases. Chest X-ray: bilateral diffuse 'ground-glass' opacities. Bronchoalveolar lavage fluid appears milky, forms sediment upon standing, has high lipoprotein content, and is PAS-positive. The most likely diagnosis is:
A 30-year-old woman with a 10-year history of asthma has experienced recurrent attacks over the past 2 years, often at midnight or early morning, particularly during spring and rainy seasons. Physical examination reveals stable general condition, coherent history without dyspnea, and scattered wheezes in both lungs. Which of the following medications is suitable for long-term use and prevention of nocturnal attacks in this patient?
A 52-year-old male presents with recurrent episodes of dyspnea, chest tightness, and cough for 8 years, occurring every spring and self-resolving. The current episode has lasted 2 days and is worsening. Physical exam: bilateral diffuse wheezes, heart rate 79/min, regular rhythm, no murmurs. The most likely diagnosis is:
A 52-year-old male has had cough, sputum production, and wheezing since childhood, often triggered by cold exposure and relieved by intravenous penicillin. He was symptom-free from ages 10-20 but had a severe attack at age 20, presenting with profuse sweating, cyanosis, orthopnea, and wheezes on auscultation, which resolved completely with IV theophylline and dexamethasone. Since then, he has recurrent nocturnal wheezing (>3 episodes/week) affecting sleep, with a PEF variability of 35%. Current exam reveals no crackles or wheezes on lung auscultation and a heart rate of 89 bpm. The most likely diagnosis is:
A 25-year-old male developed dry cough and chest tightness 2 days ago without obvious cause, followed by wheezing, which was unresponsive to intravenous aminophylline. Over the past 3 years, he has had episodic cough and shortness of breath in autumn. Examination reveals orthopnea, cyanosis, decreased breath sounds with scattered wheezes bilaterally, normal cardiac size, no murmurs, pulse rate of 120/min, and pulsus paradoxus. The most likely diagnosis is:
A 30-year-old woman with an 11-year history of asthma has experienced recurrent attacks over the past year, often occurring at midnight or early morning, particularly during spring and the rainy season. Physical examination: generally stable, coherent history without dyspnea, scattered wheezes in both lungs. According to asthma prevention and treatment guidelines, what is the preferred route of administration for corticosteroids and β<sub>2</sub>-agonists in asthma management?
A 60-year-old male is admitted with a 6-month history of dry cough, fatigue, shortness of breath on exertion, and significant weight loss. Physical examination: respiratory rate 28/min, bilateral end-inspiratory Velcro rales at lung bases, and clubbing. Chest X-ray shows diffuse reticulonodular infiltrates in mid-lower lung fields. Pulmonary function tests reveal restrictive ventilatory defect and reduced diffusion capacity. The most likely diagnosis is:
A 42-year-old woman is admitted with 'shortness of breath on exertion for 6 months, worsening over 1 month.' Physical examination reveals fine rales/crackles in both lungs. Chest X-ray shows multiple pulmonary infiltrates and thickening of the interlobular septa in the subpleural regions. Interstitial lung disease can involve:
A 45-year-old male presents with chronic irritative dry cough, fatigue, and progressive dyspnea worsening with exertion for over 5 years. Physical examination shows normal temperature, pulse 102/min, respiratory rate 30/min, and mild cyanosis. Chest X-ray reveals bilateral diffuse reticulonodular opacities, predominantly in the middle and lower lung fields with peripheral predominance and indistinct borders, accompanied by small honeycomb-like lucencies. The most likely physical examination finding is:
A 40-year-old male with rheumatic arthritis and pulmonary interstitial fibrosis is on maintenance steroid therapy. For the past week, he has had a cough with slightly purulent sputum and low-grade fever. Over the last 2 days, dyspnea has progressively worsened. Examination shows marked dyspnea, cyanosis, and widespread crackles in both lower lung fields. Heart rate is 110/min with regular rhythm. Arterial blood gas (ABG) on room air shows pH 7.48, PaCO<sub>2</sub> 30 mmHg, PaO<sub>2</sub> 45 mmHg. What is the appropriate oxygen therapy for this patient's respiratory failure?
A 40-year-old male with rheumatic arthritis and pulmonary interstitial fibrosis is on maintenance steroid therapy. For the past week, he has had a cough with slightly purulent sputum and low-grade fever. Over the last 2 days, dyspnea has progressively worsened. Examination reveals marked dyspnea, cyanosis, and widespread crackles in both lower lung fields. Heart rate is 110/min with regular rhythm. Arterial blood gas (ABG) on room air shows pH 7.48, PaCO2 30 mmHg, PaO2 45 mmHg. Despite aggressive treatment, dyspnea does not improve, and mechanical ventilation is considered. Which of the following opinions is most reasonable?
A 27-year-old male presents with cough and blood-streaked sputum for 6 days, accompanied by low-grade fever. Chest X-ray (CXR) shows inflammatory lesions with cavity formation in the right upper lobe. Tuberculin skin test reveals an induration of 15mm×18mm. The mechanism underlying this positive tuberculin reaction is:
A 52-year-old male presents with cough, blood-streaked sputum, and weight loss for 2 months. Examination reveals a cavitary lesion in the right upper lobe with smooth walls, suspected to be tuberculosis. Which of the following is characteristic of tuberculous cavities?
A 59-year-old male with confirmed pulmonary tuberculosis was hospitalized for 1 month. After defecation, he developed chest tightness, shortness of breath, cyanosis of lips and nails, pallor, and profuse sweating. He has no history of hypertension or coronary artery disease (CAD). The most likely diagnosis for these new symptoms is:
A 49-year-old patient presents with fever and cough for nearly 2 weeks, scant occasionally yellowish sputum, and chest tightness. Over the past 2 days, hemoptysis occurred with approximately 50ml of fresh blood daily. Physical exam reveals dullness on percussion and decreased breath sounds in the right upper lung, with moist rales. Chest X-ray shows consolidation with cavity formation in the right upper lobe (cavity diameter ~2.5cm, smooth wall, no air-fluid level). The preliminary diagnosis is most likely:
A 48-year-old woman, diagnosed with right upper lobe tuberculosis (TB) with positive sputum test for Mycobacterium tuberculosis 5 years ago, received 6 months of treatment with isoniazid (INH), streptomycin, and ethambutol (EMB). After sputum conversion to negative for Mycobacterium tuberculosis and significant resolution of lesions, she self-discontinued medication without follow-up. For the past month, she experienced fatigue, and 2 days ago presented with hemoptysis with cough. Chest X-ray shows a large dense shadow with indistinct margins and heterogeneous density in the right upper lobe, with calcification seen in high-density lesions. On lateral view, the lesion is located in the apical-posterior segment of the upper lobe, appearing mass-like (approx. 4cm × 4.5cm) with irregular borders. There is a recent history of TB in a family member. The most likely diagnosis is:
A 42-year-old woman was admitted with the chief complaint of 'shortness of breath after activity for 6 months, worsening over the past month'. Physical examination revealed fine rales/crackles in both lungs. Chest X-ray showed multiple pulmonary infiltrates and thickening of the subpleural interlobular septa. Interstitial lung disease can involve:
A 32-year-old male with chronic nephritis underwent allogeneic renal transplantation 5 months ago and has been on immunosuppressive therapy. For the past 2 weeks, he has had fever (38.5–39°C), mild cough, and dyspnea. Chest X-ray shows diffuse, fine nodular opacities (∼0.8 mm) uniformly distributed in both lungs, with some areas of coalescence. Hematogenous disseminated pulmonary tuberculosis is suspected. Which test is most valuable for confirmation?
A 66-year-old male presents with a 5-month history of irritating dry cough and progressive right upper chest pain. Over the past 2 weeks, the pain has radiated to the right shoulder, upper arm, and forearm, accompanied by anhidrosis on the right forehead and difficulty opening the right eye. Physical examination reveals: right miosis, enophthalmos, ptosis, dullness on percussion over the right upper lung, and decreased breath sounds. The rest of the lungs are clear, and the heart shows no abnormalities. Chest X-ray shows a poorly defined mass shadow at the right lung apex. The most likely diagnosis is:
A 55-year-old male presents with cough, blood-streaked sputum, and weight loss for 3 months. Hoarseness developed in the past 2 weeks. Sputum cytology is positive, and fiberoptic bronchoscopy reveals a neoplasm completely obstructing the right upper lobe bronchus. The typical radiographic findings on X-ray examination would be:
A 64-year-old male with a 40-year history of smoking presents with a 6-month history of cough and blood-tinged sputum, and a 3-month history of hoarseness. Physical examination reveals a 2cm*2cm firm, non-tender enlarged lymph node in the right supraclavicular fossa. The most likely diagnosis is:
A 48-year-old male presents with cough, hemoptysis, and right-sided chest pain for 3 weeks. Clinical and imaging findings confirm central right lower lobe lung cancer. The most critical factor to further determine and evaluate in this patient is:
A 60-year-old male presents with a 6-month history of dry cough, fatigue, shortness of breath on exertion, and significant weight loss. Physical examination: respiratory rate 28/min, bilateral end-inspiratory Velcro crackles at lung bases, and clubbing. Chest X-ray: diffuse reticulonodular infiltrates in mid and lower lung fields. Pulmonary function tests show restrictive ventilatory defect and reduced diffusion capacity. The most likely diagnosis is:
A 45-year-old male presents with chronic irritative dry cough, fatigue, and progressive dyspnea worsening with exertion for over 5 years. Physical examination: normal temperature, pulse 102/min, respiratory rate 30/min, mild cyanosis. Chest X-ray shows bilateral diffuse reticulonodular opacities, most prominent in the middle and lower lung fields laterally, with ill-defined borders and honeycombing lucencies. The most likely physical examination finding is:
A 40-year-old male with rheumatic arthritis and pulmonary interstitial fibrosis is on maintenance steroid therapy. For the past week, he has had a cough with slightly purulent sputum and low-grade fever. Over the last 2 days, dyspnea has progressively worsened. Examination shows marked dyspnea, cyanosis, and widespread crackles in both lower lungs. Heart rate is 110/min with regular rhythm. Arterial blood gas (ABG) on room air reveals pH 7.48, PaCO₂ 30 mmHg, and PaO₂ 45 mmHg. What is the appropriate oxygen therapy for this patient's respiratory failure?
A 40-year-old male with rheumatic arthritis and pulmonary interstitial fibrosis is on maintenance steroid therapy. Over the past week, he developed a cough with slightly purulent sputum and low-grade fever. Two days ago, dyspnea progressively worsened, prompting medical evaluation. Examination reveals marked dyspnea, cyanosis, and widespread bilateral basilar rales. Heart rate is 110/min with regular rhythm. Arterial blood gas (ABG) on room air shows pH 7.48, PaCO2 30 mmHg, and PaO2 45 mmHg. Which mechanical ventilation mode is most appropriate?
A 68-year-old female patient was admitted with the chief complaint of 'recurrent cough and sputum production for 30 years, worsened with bilateral lower extremity edema for 1 week'. Physical examination revealed cyanosis of the lips and nail beds, jugular vein distension, fine crackles in both lower lung fields, liver palpable 3 fingerbreadths below the right costal margin, and lower extremity edema. The most likely diagnosis is:
A 72-year-old male patient with a 40-year history of smoking, recurrent cough and sputum production for 30 years, shortness of breath on exertion for 13 years, and bilateral lower extremity edema for 5 years. Echocardiogram (ECHO) shows right ventricular hypertrophy and widened right ventricular outflow tract. What is the most common cause of chronic cor pulmonale?
A 70-year-old male with a 20-year history of chronic cough and sputum production lasting 3-4 months annually, experiencing exertional dyspnea for the past 2-3 years and occasional bilateral lower extremity edema. This morning, he suddenly developed sharp left upper chest pain related to respiration, followed by dyspnea, profuse sweating, and inability to lie flat. The most critical aspect of history-taking should be:
A 56-year-old male with a 20-year history of recurrent cough and sputum production has experienced progressive dyspnea, oliguria, and lower extremity edema over the past 3 years. Symptoms worsened 1 week ago due to a cold. Examination: alert, marked dyspnea, cyanosis, mild conjunctival congestion/edema, jugular vein distension. Diminished breath sounds with fine rales/crackles at lung bases. Normal cardiac size, heart rate 106 bpm, regular rhythm, accentuated P2, no murmurs. Liver palpable 2.5 cm below costal margin, soft/tender, positive hepatojugular reflux, ++ lower extremity edema. Sputum smear shows polymorphic gram-negative bacilli. ABG (room air): pH 7.30, PaCO2 50 mmHg, PaO2 45 mmHg. What is the FIRST-LINE treatment for right heart failure (HF) in this case?
A 76-year-old male with a history of obstructive emphysema presents with worsening cough with purulent sputum and dyspnea for 2 weeks, and clouding of consciousness this morning. Physical exam: somnolence, cyanosis, bilateral wet rales, heart rate 116/min with regular rhythm, BP 190/105 mmHg. Neurological examination shows no abnormalities. The most likely diagnosis is:
An elderly patient with a diagnosis of cor pulmonale 2 years ago presents with worsening cough, sputum production, wheezing, and bilateral lower extremity edema over the past week. Physical examination reveals extensive rales/crackles in the lungs, heart rate of 100 bpm, liver palpable 2.5 cm below the costal margin, and bilateral lower extremity edema. Lab results show elevated white blood cell (WBC) count and neutrophil (N) percentage. Blood gas analysis: pH 7.335, PaCO₂ 78 mmHg, PaO₂ 50 mmHg, HCO₃⁻ 34 mmol/L. Which of the following complications is NOT present in this patient?
A 55-year-old male with recurrent cough and wheezing for over 10 years, worsening in autumn/winter. Recently experiences dyspnea even when climbing 2 floors during remission. Examination: eupneic at rest, no cyanosis. Decreased breath sounds bilaterally with scattered dry rales. Which is the preferred test to assess airway obstruction and its severity?
A 71-year-old male with chronic bronchitis and obstructive emphysema for nearly 10 years, previously resuscitated twice for respiratory failure. Currently experiences dyspnea on exertion, with arterial blood gas (ABG) showing PaO₂ < 6.7 kPa (50 mmHg) and PaCO₂ 6.7 kPa (50 mmHg) without oxygen. Under physician-guided respiratory rehabilitation. To alleviate pulmonary hypertension and improve quality of life, which treatment is preferred?
A 44-year-old male with a 5-year history of cough, sputum production, and wheezing. Three days prior to admission, he developed worsened cough and wheezing with yellow sputum after catching a cold. On admission: barrel chest, hyperresonance on percussion, liver-lung border at the seventh intercostal space along the right midclavicular line, bilateral wheezes and crackles with scattered wheezes. Pulmonary function tests: FEV1/FVC ratio 56%, maximal voluntary ventilation (MVV) 60%, reduced vital capacity (VC), residual volume/total lung capacity (RV/TLC) 43%. On day 2, he developed chest pain and dyspnea after exertion. Examination revealed tympany on percussion of the right chest and absent breath sounds with cyanosis. What is the most likely diagnosis on admission?
A 70-year-old male with a history of cough and sputum production for 30 years, shortness of breath on exertion for 10 years, and bilateral lower extremity edema for the past 1 year. Pulmonary function tests show obstructive ventilatory impairment with FEV<sub>1</sub>%:50%. The obstructive emphysema caused by chronic bronchitis is most commonly:
A 63-year-old male with a confirmed diagnosis of chronic obstructive pulmonary disease (COPD) for nearly 10 years, requiring daily assistance due to dyspnea, suddenly experiences significantly worsened dyspnea accompanied by chest pain during morning defecation and is brought to the emergency department. When taking the history, what should be particularly emphasized?
A 63-year-old male with a history of chronic cough for nearly 20 years and progressively worsening dyspnea for 3 years, now struggling with daily activities. One hour ago, after a vigorous sneeze, he experienced aggravated dyspnea with right-sided chest pain and presented to the ER. Examination reveals confusion, marked dyspnea, cyanosis, decreased breath sounds bilaterally, and fine crackles at the lung bases. The direct cause of his respiratory failure is most likely related to which of the following?
A patient presents with sudden onset of right-sided chest pain accompanied by dyspnea. Physical examination reveals tracheal deviation to the left, bulging of the right chest wall, decreased respiratory movement and tactile fremitus, tympanic percussion note, and absent breath sounds. Suspecting pneumothorax, which test is required for confirmation?
A 20-year-old male underwent thoracentesis for fluid drainage. Upon extracting 30ml of straw-colored fluid, the patient suddenly experienced dizziness, palpitations, pale complexion, cold extremities, and thready pulse. The most likely diagnosis is:
A 50-year-old male presents with chest tightness and shortness of breath for 2 months, and left chest pain for over 20 days (worsening at night). Physical examination shows mild swelling of the face, neck, and chest wall, dilated chest wall veins, a thumb-sized axillary lymph node (no tenderness, mobile), heart rate 108 bpm (regular rhythm), and absent breath sounds in the left lung. The most likely diagnosis is:
A 21-year-old male presents with low-grade fever, night sweats, dry cough, and fatigue. Right-sided chest pain began 2 months ago. Physical exam: tracheal deviation to the left, dullness to percussion in the right lower chest, and absent breath sounds. Chest X-ray shows a large right-sided pleural effusion. To confirm the diagnosis, thoracentesis is performed. To avoid re-expansion pulmonary edema, fluid removal should be: