KFP – Respiratory

Julie Thompson, aged 74, presents to your general practice in rural Victoria with a two-week history of progressive shortness of breath, productive cough, and low-grade fever. She reports she has had increasing difficulty walking up the hill to her letterbox and has been needing to rest more frequently. She denies chest pain but feels tight in the chest. She has had several episodes of bronchitis in the past and is worried this could be her ‘lungs playing up again’.

Medications: Perindopril 5 mg daily, Salbutamol inhaler PRN

Allergies: Nil known

Past history: Hypertension, smoking history of 35 pack-years, previous community-acquired pneumonia 3 years ago

Social history: Lives alone, retired school teacher, still drives locally, independent with activities of daily living

Examination findings: Temperature 37.6°C, SpO2 92% on room air, RR 22, HR 88, BP 135/78 mmHg. Bibasal crackles on auscultation, no wheeze. Mild peripheral oedema.

Investigations:

What is the most likely diagnosis and what are the most appropriate next steps in management? Select three (3) from the following list:

Oliver Nguyen, a 5-year-old boy, is brought in by his mother due to a persistent dry cough that has lasted for four weeks following an upper respiratory tract infection. He is otherwise well, eating and drinking normally, and has no fever. His mother is concerned as the cough worsens at night and during play. There is no history of wheeze, chest pain, or shortness of breath. No contact with TB or recent travel. His vaccinations are up to date.

Past history: Eczema, no known asthma diagnosis

Family history: Father has asthma, mother has allergic rhinitis

Social history: Non-smoker household, lives with both parents and a younger sister

Examination findings: Afebrile, HR 90 bpm, RR 18, SpO2 98% on room air. Chest clear on auscultation. Growth parameters are within normal limits.

Investigations: Not performed

What are the most likely diagnoses or contributing factors? Select three (3) from the following list:

Hamza El-Rafiq, a 62-year-old man, presents to your metropolitan general practice for review of his chronic obstructive pulmonary disease (COPD). He has had increasing breathlessness over the past six months, now requiring rest after walking 50 metres. He has also noticed more frequent use of his salbutamol inhaler. He had one hospitalisation for an exacerbation eight months ago and two courses of oral corticosteroids and antibiotics from his GP in the last year.

Medications: Salbutamol inhaler PRN, tiotropium daily

Allergies: Nil known

Past history: COPD (GOLD stage II), hypertension

Social history: Smoked 25 cigarettes/day for 40 years; quit three years ago. Lives with wife, retired factory worker

Examination findings: SpO2 95% on room air, RR 20, HR 78, BP 134/82. Chest hyperinflated, reduced breath sounds bilaterally, no wheeze or crackles

Investigations: Recent spirometry shows FEV1/FVC 0.60, FEV1 58% predicted

What are the most appropriate next steps in the management of Hamza’s COPD? Select four (4) from the following list:

Sophie Langford, a 29-year-old primary school teacher, presents with a two-month history of episodic shortness of breath, dry cough, and wheeze. Symptoms are worse with exercise and at night, and occasionally wake her from sleep. She denies chest pain, haemoptysis, or fever. She has no known allergies but reports that her symptoms seem worse during spring. She is otherwise well and not on any regular medications.

Past history: Mild childhood asthma (no inhaler use for over 10 years)

Family history: Mother has allergic rhinitis and eczema

Social history: Lives in an inner-city apartment with no pets; non-smoker

Examination findings: Chest clear to auscultation, no wheeze heard. Vitals normal, including SpO2 99% on room air

Investigations: Spirometry results:

What are the most appropriate next steps in management? Select three (3) from the following list:

David Armstrong, a 57-year-old truck driver, presents with excessive daytime sleepiness, loud snoring, and reports from his wife that he frequently stops breathing during sleep. He often wakes feeling unrefreshed and struggles to stay awake while driving. His symptoms have been ongoing for over a year and are worsening. He has not seen a doctor in years.

Medications: None

Past history: Nil significant

Social history: Smokes 10 cigarettes/day, BMI 34 kg/m², drinks 3–4 standard drinks most nights

Examination findings: BP 146/92 mmHg, HR 88, neck circumference 44 cm. No oropharyngeal abnormality noted. Cardiovascular and respiratory exams unremarkable.

Investigations: Epworth Sleepiness Score: 17/24

What are the most appropriate next steps in management? Select three (3) from the following list:

Emma Roberts, a 19-year-old university student, presents with sudden onset pleuritic chest pain and shortness of breath that started while she was walking between classes. She is otherwise healthy, has no recent illness, and denies cough or fever. She does not take any regular medications.

Past history: Nil

Social history: Non-smoker, BMI 19 kg/m², no family history of lung disease

Examination findings: HR 110, RR 22, SpO2 97% on room air, BP 118/74. Chest expansion reduced on the right, hyperresonant to percussion, and breath sounds are diminished on the right side. No tracheal deviation noted.

What are the most appropriate next steps in management? Select three (3) from the following list:

Pauline Mirovic, a 76-year-old woman, presents to your practice with a one-month history of progressive dyspnoea on exertion and a dry cough. She denies chest pain, wheeze, or fever. She has noted that her symptoms are worse when walking uphill and have gradually limited her daily activities.

Medications: Amlodipine, atorvastatin

Past history: Hypertension, osteoarthritis

Social history: Retired hairdresser, lifelong non-smoker, no pets, lives independently. Her husband died of ‘lung scarring’ in his 70s.

Examination findings: HR 82, RR 20, BP 138/76, SpO2 95% on room air. Bibasal fine end-inspiratory crackles, no wheeze or peripheral oedema.

What are the most appropriate next steps in investigating Pauline’s symptoms? Select three (3) from the following list:

Marcus El-Badri, a 41-year-old construction worker, presents with a four-day history of high fever, productive cough with green sputum, myalgia, and pleuritic chest pain. He feels increasingly short of breath and has taken two days off work. He denies recent travel but mentions that two co-workers had ‘bad colds’ last week. He has no significant past medical history and is not on any regular medications.

Social history: Smokes 15 cigarettes/day, occasional alcohol. Lives with partner and two children.

Examination findings: Temp 38.9°C, HR 104, RR 24, BP 124/76, SpO2 93% on room air. Crackles and bronchial breath sounds at the right base. No signs of consolidation on percussion.

What are the most appropriate steps in management? Select three (3) from the following list:

Levi Tan, a 3-year-old boy, is brought to your practice by his father with a two-day history of a barking cough and hoarse voice. He has had mild fever and noisy breathing at night. His father reports that Levi had an episode of noisy breathing and difficulty settling around 2 am last night. He is eating and drinking normally today but still has a harsh-sounding cough.

Medications: Nil

Past history: Fully immunised, no significant medical history

Examination findings: Alert and interactive. Temp 37.8°C, HR 108, RR 22, SpO2 97% on room air. Mild inspiratory stridor at rest, harsh cough audible. No intercostal recession. Oral examination unremarkable.

What are the most appropriate next steps in management? Select three (3) from the following list:

Glenda Harkness, a 68-year-old woman, presents for review of her chronic cough. She has had a daily productive cough for over a year, especially in the mornings. She describes white sputum, without haemoptysis. She has had two courses of antibiotics over the past 12 months for similar episodes with increased sputum purulence. She denies weight loss, night sweats or fevers.

Medications: Salbutamol inhaler PRN, ramipril

Past history: Type 2 diabetes, 50 pack-year smoking history (ceased 5 years ago)

Social history: Lives with husband, no pets. No recent travel. No occupational exposures.

Examination findings: Mild digital clubbing, coarse crackles at both lung bases. SpO2 95% on room air. No peripheral oedema or lymphadenopathy.

What are the most appropriate next steps in her management? Select four (4) from the following list:

Aliya Begum, a 34-year-old woman, presents with a 3-week history of a dry cough, low-grade fever, and night sweats. She has also noticed some unintentional weight loss. She recently returned from a six-month visit to Bangladesh. She has no known past medical conditions and takes no regular medications.

Social history: Non-smoker, lives with husband and two young children in a suburban home. No known sick contacts. Works in IT.

Examination findings: T 37.8°C, HR 92, RR 18, SpO2 98% on room air. Chest clear on auscultation. No lymphadenopathy or hepatosplenomegaly.

What are the most appropriate next steps in the investigation of Aliya’s symptoms? Select four (4) from the following list:

Nathan Chiu, a 52-year-old accountant, presents with complaints of persistent nasal congestion, facial pressure, and postnasal drip for the past 10 weeks. He describes reduced sense of smell and occasional dull headache over the maxillary region. He denies fever, purulent nasal discharge, or visual symptoms. Symptoms are worse in the mornings and improve slightly during the day. He has been using over-the-counter decongestant sprays daily for 3 weeks.

Medications: Nil

Past history: Allergic rhinitis

Social history: Non-smoker, works in an air-conditioned office, no recent travel

Examination findings: Afebrile. Mild facial tenderness over maxilla, nasal mucosa appears swollen and pale. No cervical lymphadenopathy. No neurological deficits.

What are the most appropriate next steps in Nathan’s management? Select three (3) from the following list:

Isaac Petrou, a 45-year-old teacher, presents with acute shortness of breath, dry cough, and fever that started two days ago. He recently returned from a bushwalking trip in regional Victoria and recalls pulling a tick off his leg during the hike. He has no significant past medical history and takes no medications.

Social history: Non-smoker, no known allergies, lives with wife and teenage children

Examination findings: Temp 38.2°C, HR 102, RR 24, BP 128/82, SpO2 93% on room air. Bibasal crackles on auscultation. No skin rash or lymphadenopathy. No hepatosplenomegaly.

What are the most appropriate next steps in investigation and management? Select three (3) from the following list:

Claire Donnelly, a 26-year-old professional violinist, presents with episodes of shortness of breath and chest tightness that occur exclusively during performances or rehearsals. She denies symptoms at rest or during exercise outside of her work. There is no associated cough or wheeze. She has no past history of asthma or other respiratory disease.

Medications: Nil

Social history: Non-smoker, lives alone, otherwise fit and well

Examination findings: Vitals normal. Chest clear to auscultation at rest. No stridor or wheeze. No signs of anxiety at rest. Peak expiratory flow rate is normal.

What are the most appropriate next steps in the evaluation and management of her condition? Select three (3) from the following list:

Barbara Yuen, a 61-year-old woman with a known diagnosis of COPD, presents with worsening shortness of breath, increased sputum volume, and a change in sputum colour over the last 3 days. She denies chest pain but has some fatigue and poor appetite. She has had two similar episodes in the past year requiring antibiotics.

Medications: Tiotropium daily, salbutamol PRN

Past history: COPD (GOLD stage II), hypertension

Social history: Former smoker (30 pack-years), lives alone in a retirement village

Examination findings: RR 24, HR 94, SpO2 92% on room air, temp 37.6°C. Scattered wheeze and crackles bilaterally. No signs of consolidation or oedema.

What are the most appropriate next steps in management? Select four (4) from the following list:

Tomás Delgado, a 22-year-old university student, presents to your clinic after experiencing recurrent episodes of wheezing and chest tightness during exercise. He is otherwise well and reports no symptoms at rest. The symptoms are worse in cold weather and resolve after about 30 minutes of rest. He has no history of eczema, hay fever, or previous asthma diagnosis.

Medications: Nil

Past history: Nil significant

Social history: Plays soccer at competitive level, non-smoker

Examination findings: Normal respiratory exam at rest. Vitals normal. SpO2 98% on room air.

What are the most appropriate next steps in investigation and management? Select three (3) from the following list:

Kevin Mitchell, a 73-year-old retired farmer, presents with a 3-month history of worsening dyspnoea and chronic dry cough. He reports that the symptoms improve when he goes away from home for extended periods. He lives on a small hobby farm with several birds and uses hay in his shed. He has no fever or chest pain.

Medications: Perindopril, aspirin

Past history: Hypertension, hyperlipidaemia

Social history: Non-smoker, lives with wife, no known occupational exposures beyond hobby farm work

Examination findings: Fine end-inspiratory crackles at both lung bases. No clubbing. SpO2 94% on room air. No wheeze.

What are the most appropriate next steps in the investigation and management of Kevin’s condition? Select four (4) from the following list:

Aleena Rahman, a 9-year-old girl, is brought in by her parents with a history of frequent coughing at night, occasional wheeze, and shortness of breath during physical activity. These symptoms have occurred intermittently for the past six months. They are worse in spring and after playing soccer. She has no history of chest infections or other chronic illnesses.

Medications: Nil

Past history: Atopic dermatitis as a toddler

Family history: Mother has asthma and hay fever

Social history: Lives with family in suburban area, no pets, non-smoking household

Examination findings: Vitals normal. Chest clear on auscultation. No wheeze heard at rest. Growth parameters within normal range.

What are the most appropriate next steps in Aleena’s assessment and management? Select three (3) from the following list:

Ramesh Iyer, a 58-year-old man, presents with a 2-month history of chronic cough that is dry and occurs mostly at night. He also reports occasional hoarseness and a sensation of something in his throat. He denies dyspnoea, wheeze, or chest pain. He has not responded to previous empirical treatment with an inhaled corticosteroid.

Medications: Atorvastatin

Past history: Hypertension, hypercholesterolaemia

Social history: Non-smoker, drinks 2–3 glasses of wine daily. Works in an office. No exposure to irritants.

Examination findings: Vitals normal. Chest clear to auscultation. ENT examination shows mild erythema of the posterior pharynx. No cervical lymphadenopathy.

What are the most appropriate next steps in Ramesh’s assessment and management? Select three (3) from the following list:

Helen Botros, a 67-year-old woman with a history of breast cancer in remission, presents with progressive dyspnoea over the last two weeks. She also reports a dry cough and some chest discomfort. She denies fever or sputum production. She completed chemotherapy two years ago and has been in remission since. She is otherwise well and independent in her daily activities.

Medications: Letrozole, calcium/vitamin D

Past history: Breast cancer (stage II, treated with lumpectomy, chemo and radiotherapy)

Social history: Lives with partner, non-smoker, no pets or occupational exposures

Examination findings: HR 96, RR 20, BP 128/78, SpO2 91% on room air. Decreased breath sounds and stony dullness to percussion over the right lower lung zone. No peripheral oedema or lymphadenopathy.

What are the most appropriate next steps in investigating and managing Helen’s symptoms? Select four (4) from the following list:

Lydia Crane, a 35-year-old primary school teacher, presents with recurrent episodes of upper respiratory tract infections over the past 6 months. Each episode is associated with significant nasal congestion, fatigue, and a persistent dry cough that lasts several weeks. She reports some nasal drip and occasional facial pressure but no fevers or purulent sputum. She also reports difficulty sleeping due to nasal blockage and dry mouth in the mornings.

Medications: Occasional paracetamol, over-the-counter decongestant spray

Past history: Eczema, seasonal allergic rhinitis

Social history: Non-smoker, no pets, works with young children

Examination findings: Mild mucosal swelling in the nasal turbinates, no cervical lymphadenopathy, clear lungs on auscultation. Oropharynx dry, no postnasal drip visible. No facial tenderness on palpation.

What are the most appropriate next steps in Lydia’s management? Select three (3) from the following list:

Jared Wong, a 46-year-old man, presents with persistent wheeze and cough that has gradually worsened over the past six months. He reports waking at night with breathlessness, and using his salbutamol inhaler more than four times a week. He was diagnosed with asthma in childhood but has not seen a doctor about it in years. He works as a chef and recently started a second job cleaning commercial ovens.

Medications: Salbutamol inhaler PRN

Past history: Asthma (childhood), hay fever

Social history: Non-smoker, lives with wife and two children

Examination findings: RR 18, HR 84, SpO2 96% on room air. Mild expiratory wheeze bilaterally. Chest otherwise clear.

What are the most appropriate next steps in Jared’s management? Select four (4) from the following list:

Maria da Silva, a 70-year-old woman, presents with gradual onset of exertional dyspnoea and a persistent dry cough over the last six months. She has a past history of rheumatoid arthritis and has recently been started on methotrexate. She denies fever, chest pain, or sputum production. She is a lifelong non-smoker and lives independently.

Medications: Methotrexate, folic acid, esomeprazole

Past history: Rheumatoid arthritis, hypertension

Social history: Retired nurse, no pets, no recent travel or occupational exposures

Examination findings: Fine bibasal end-inspiratory crackles. No wheeze or clubbing. Vitals stable. SpO2 94% on room air.

What are the most appropriate next steps in the investigation of Maria’s respiratory symptoms? Select three (3) from the following list:

Jacob Ghosh, a 64-year-old man, presents with a history of multiple hospitalisations over the past year for COPD exacerbations. He reports chronic breathlessness on minimal exertion, daily sputum production, and a baseline SpO2 of 89% on room air. He is currently stable but feels exhausted with minimal activity. He has completed pulmonary rehabilitation in the past.

Medications: Tiotropium, salbutamol, budesonide/formoterol

Past history: Severe COPD (GOLD stage IV), ischaemic heart disease, former smoker (60 pack-years)

Social history: Lives with wife, receives community nursing support twice weekly

Examination findings: SpO2 89% on room air, RR 22, HR 84, reduced breath sounds bilaterally, mild pedal oedema

What are the most appropriate next steps in Jacob’s management? Select three (3) from the following list:

Emily Tran, a 27-year-old emergency department nurse, presents with a persistent dry cough and occasional wheeze that started four weeks ago after recovering from a confirmed influenza A infection. She reports being otherwise well and denies fever, sputum, or chest pain. She has never smoked and has no known respiratory conditions. The cough is worse at night and after exertion. She has tried over-the-counter cough syrups without relief.

Medications: Nil

Past history: Nil significant

Social history: Lives with housemates, no pets, non-smoker, regular gym attendance

Examination findings: Vitals normal, oxygen saturation 98% on room air. Chest clear to auscultation. No wheeze or crackles heard.

What are the most appropriate next steps in the assessment and management of Emily’s symptoms? Select three (3) from the following list:

Farah Al-Masri, a 17-year-old high school student, presents with episodic wheeze, chest tightness, and shortness of breath occurring primarily during the spring months. She also experiences itchy eyes and nasal congestion around the same time. She reports that these episodes interfere with her participation in sport and worsen when the pollen count is high. She has no prior asthma diagnosis but was treated with antihistamines for hay fever in the past.

Medications: Loratadine PRN

Past history: Allergic rhinitis

Family history: Mother has asthma and eczema

Social history: Non-smoker, lives with parents, no pets

Examination findings: Vitals normal. Chest clear to auscultation. Nasal mucosa pale and boggy. Peak flow within normal range at rest.

What are the most appropriate next steps in assessment and management? Select three (3) from the following list:

George Latu, a 79-year-old man, presents with increasing shortness of breath and orthopnoea over the past month. He has also noted bilateral leg swelling and fatigue. He has a history of hypertension and type 2 diabetes. He denies chest pain or cough, but reports waking up at night feeling breathless.

Medications: Metformin, perindopril, amlodipine

Past history: Hypertension, type 2 diabetes

Social history: Ex-smoker (20 pack-years, quit 25 years ago), lives with his wife, independent with activities of daily living

Examination findings: BP 140/80 mmHg, HR 96 bpm, RR 20, SpO2 92% on room air. Bilateral basal crackles, elevated JVP, bilateral pitting oedema to knees. No wheeze.

What are the most appropriate next steps in the assessment and management of George’s symptoms? Select three (3) from the following list:

Samuel Kent, a 31-year-old FIFO (fly-in-fly-out) mining worker, presents with a two-week history of a persistent dry cough, low-grade fever, and malaise. He also reports intermittent night sweats and unintentional weight loss of 3 kg. He recently returned from working in far north Queensland, where he was exposed to dust and soil while working in tunnels. He has no chest pain or haemoptysis. No known tuberculosis contacts.

Medications: Nil

Past history: Nil significant

Social history: Non-smoker, lives with partner, no recent overseas travel

Examination findings: Temp 37.9°C, HR 88, RR 18, SpO2 97% on room air. Chest clear on auscultation, no lymphadenopathy or skin lesions.

What are the most appropriate next steps in the assessment of Samuel’s symptoms? Select four (4) from the following list:

Angela Rowe, a 48-year-old woman, presents with persistent shortness of breath and dry cough that began three weeks after recovering from a moderate COVID-19 infection. She reports difficulty walking upstairs and feeling easily fatigued. She was not hospitalised and managed her COVID-19 symptoms at home. She has no prior history of lung disease.

Medications: Paracetamol PRN

Past history: Hypothyroidism

Social history: Non-smoker, works as a librarian, fully vaccinated against COVID-19

Examination findings: SpO2 97% on room air, RR 18, HR 76, BP 124/80. No wheeze or crackles on auscultation. Cardiovascular and neurological examinations normal.

What are the most appropriate next steps in the assessment and management of Angela’s post-COVID symptoms? Select three (3) from the following list:

James Holloway, a 55-year-old man, presents with a three-month history of worsening dyspnoea on exertion and a persistent dry cough. He works as a stonemason and has been in the industry for over 30 years. He reports that symptoms have gradually worsened despite using salbutamol, which was prescribed by another doctor. He is otherwise well and denies fever, chest pain, or weight loss.

Medications: Salbutamol inhaler PRN

Past history: Hypertension

Social history: Smokes 10 cigarettes/day, lives with wife, no recent travel

Examination findings: RR 18, HR 84, SpO2 95% on room air. Fine inspiratory crackles at both lung bases. No wheeze. No peripheral oedema. No clubbing.

What are the most appropriate next steps in investigating James’ symptoms? Select four (4) from the following list:

Ryan Bakshi, a 4-year-old boy, is brought in by his father with a three-day history of worsening cough and wheeze. He has had several similar episodes in the past, often triggered by colds. This time, his father reports he’s been using his reliever inhaler frequently over the past 24 hours. Ryan is eating and drinking less but remains alert. He has a known diagnosis of viral-induced wheeze, and this is his third episode in six months.

Medications: Salbutamol inhaler PRN (via spacer)

Past history: Viral-induced wheeze, eczema

Social history: Lives with parents and younger sister, attends daycare, no smokers in the household

Examination findings: Temp 37.5°C, HR 110, RR 30, SpO2 95% on room air. Moderate wheeze bilaterally, no signs of recession, alert and interactive.

What are the most appropriate next steps in the management of Ryan’s current episode? Select three (3) from the following list:

Kathy Douglas, a 62-year-old woman, presents with a six-week history of gradually worsening breathlessness and dry cough. She denies fever, chest pain, or sputum. She is a lifelong non-smoker and works as a florist. She mentions that the symptoms seem worse after working with certain types of flowers and potting mix. She has no past medical history and is otherwise well.

Medications: Nil

Past history: Nil significant

Social history: Lives with husband, no pets, non-smoker

Examination findings: RR 20, HR 82, SpO2 95% on room air. Fine inspiratory crackles at both lung bases. No wheeze. No clubbing. Normal heart sounds.

What are the most appropriate next steps in Kathy’s assessment? Select four (4) from the following list:

Benjamin Taylor, a 61-year-old man, presents with sudden onset of shortness of breath and left-sided pleuritic chest pain that began while gardening. He denies cough, sputum production, or fever. He has a history of mild COPD and is an ex-smoker with a 40 pack-year history. He has no history of trauma or recent illness.

Medications: Tiotropium inhaler

Past history: Mild COPD, hypertension

Social history: Lives alone, quit smoking 5 years ago, no recent travel

Examination findings: HR 102, RR 22, SpO2 92% on room air, BP 126/82. Trachea midline. Reduced breath sounds and hyperresonance to percussion on the left. No wheeze or crackles. No peripheral oedema or calf tenderness.

What are the most appropriate next steps in investigation and management? Select three (3) from the following list:

Olivia Zhou, a 44-year-old high school teacher, presents with persistent nasal congestion, anosmia, and a sensation of facial fullness for the past three months. She also reports a postnasal drip and occasional dry cough, especially at night. She has a history of allergic rhinitis and takes a daily antihistamine. She denies fever or purulent nasal discharge. Her symptoms are interfering with sleep and daily functioning.

Medications: Cetirizine daily

Past history: Allergic rhinitis

Social history: Non-smoker, no pets, works full-time

Examination findings: Nasal mucosa pale and swollen with bilateral polypoid changes visible. No facial tenderness or lymphadenopathy. Lungs clear on auscultation.

What are the most appropriate next steps in the management of Olivia’s condition? Select three (3) from the following list:

Anthony Russo, a 69-year-old man, presents for routine follow-up after recovering from a hospital admission for community-acquired pneumonia six weeks ago. He is now well, with no ongoing fever, cough, or sputum production. He completed a full course of antibiotics in hospital and was discharged with no complications. He has a 40 pack-year smoking history and mentions that this is his second pneumonia in the past year, both affecting the right lower lobe.

Medications: Perindopril, atorvastatin

Past history: Hypertension, hyperlipidaemia

Social history: Lives with wife, retired builder, current smoker

Examination findings: Chest clear, SpO2 97% on room air. No clubbing or lymphadenopathy. Vitals normal.

What are the most appropriate next steps in Anthony’s care? Select three (3) from the following list:

Sophie Nguyen, a 32-year-old school teacher, presents with a 2-month history of chronic dry cough that started after a viral upper respiratory tract infection. She describes a tickling sensation in the throat and frequent throat clearing. She denies fever, wheeze, chest pain, or sputum. She has tried over-the-counter cough suppressants with no relief. Her voice occasionally becomes hoarse, especially after long days of teaching.

Medications: Nil

Past history: Mild seasonal allergic rhinitis

Social history: Non-smoker, no pets, no recent travel

Examination findings: Vitals normal. Chest clear on auscultation. ENT exam reveals mild posterior pharyngeal erythema. No lymphadenopathy.

What are the most appropriate next steps in Sophie’s management? Select three (3) from the following list:

Clive Sanderson, a 75-year-old man, presents with worsening shortness of breath over the past four months. He describes a gradual decline in exercise tolerance and a persistent dry cough. He has a known diagnosis of idiopathic pulmonary fibrosis (IPF), confirmed by high-resolution CT two years ago. He has been managed conservatively with supportive care. He now finds it difficult to walk to his letterbox and reports increased fatigue and occasional dizziness on exertion.

Medications: Esomeprazole, low-dose aspirin

Past history: Idiopathic pulmonary fibrosis, gastro-oesophageal reflux disease

Social history: Lives with wife, non-smoker, no pets, retired accountant

Examination findings: RR 24, HR 88, SpO2 89% on room air. Fine bibasal crackles, no wheeze. Mild finger clubbing present. No peripheral oedema.

What are the most appropriate next steps in Clive’s current management? Select three (3) from the following list:

Abigail Johnson, a 26-year-old paramedic, presents with episodic shortness of breath, throat tightness, and noisy breathing during high-intensity exercise. These symptoms resolve quickly with rest and do not respond to salbutamol. She has had several near syncopal episodes during sprint training but no symptoms at rest. She denies chest pain or wheeze. She has no history of asthma or allergies.

Medications: Nil

Past history: Nil significant

Social history: Non-smoker, highly active, trains daily

Examination findings: Vitals normal at rest. Chest clear. No wheeze or stridor. Cardiovascular and neurological exams unremarkable.

What are the most appropriate next steps in Abigail’s assessment and management? Select three (3) from the following list:

Edward Chan, a 59-year-old taxi driver, presents with a three-week history of worsening cough, low-grade fever, and increasing shortness of breath. He reports weight loss of 4 kg over two months and night sweats. He migrated from Vietnam 15 years ago and lives with his wife and two grandchildren. He denies chest pain or haemoptysis but has not felt well since returning from a family trip to visit relatives interstate.

Medications: Metformin, ramipril

Past history: Type 2 diabetes, hypertension

Social history: Former smoker (10 pack-years), no occupational exposures, no known TB contacts

Examination findings: Temp 37.9°C, RR 20, HR 88, SpO2 95% on room air. Chest examination reveals coarse crackles in the right upper zone. No lymphadenopathy or clubbing. No peripheral oedema.

What are the most appropriate next steps in the assessment of Edward’s symptoms? Select four (4) from the following list:

Leah Williams, a 34-year-old woman, presents with recurrent episodes of cough, shortness of breath, and chest tightness. The symptoms worsen during winter, at night, and when exposed to cold air. She has required multiple courses of antibiotics and prednisolone over the past two winters. She also reports sinus congestion and frequent use of intranasal decongestants. She has never been formally diagnosed with asthma.

Medications: PRN nasal spray (oxymetazoline), occasional salbutamol puffer

Past history: Allergic rhinitis

Social history: Non-smoker, office worker, lives in a centrally heated apartment

Examination findings: SpO2 97% on room air. Chest clear at rest. Nasal mucosa congested with visible rebound swelling. No wheeze or crepitations.

What are the most appropriate next steps in Leah’s assessment and management? Select three (3) from the following list:

Hamish Doyle, a 72-year-old man, presents with a three-month history of progressive shortness of breath and fatigue. He reports mild ankle swelling and occasional palpitations but no chest pain or cough. He has a history of hypertension and atrial fibrillation, for which he takes rate control medication. He has never smoked and has no occupational exposures.

Medications: Bisoprolol, perindopril, apixaban

Past history: Atrial fibrillation, hypertension

Social history: Lives independently with his wife, non-smoker, retired accountant

Examination findings: HR 88 (irregularly irregular), BP 128/76, RR 20, SpO2 95% on room air. Elevated JVP, bibasal crackles, and mild bilateral ankle oedema noted. No wheeze or clubbing.

What are the most appropriate next steps in Hamish’s assessment and management? Select three (3) from the following list:

Daniela Costa, a 29-year-old barista, presents with intermittent episodes of dry cough and breathlessness over the last six months. The symptoms are worse after cleaning the coffee grinder and using cleaning sprays at work. She has never smoked and denies any past respiratory conditions. She also reports nasal congestion and itchy eyes during spring. The symptoms improve when she has time off work.

Medications: Over-the-counter antihistamines as needed

Past history: Allergic rhinitis

Social history: Lives with flatmates, no pets, non-smoker

Examination findings: Vitals normal. Chest clear on auscultation. No wheeze or crepitations. Nasal mucosa pale and boggy.

What are the most appropriate next steps in the assessment and management of Daniela’s symptoms? Select three (3) from the following list:

Michael Tran, a 46-year-old IT technician, presents with sudden onset of dyspnoea and pleuritic chest pain. He returned from an overseas conference two days ago and had a 14-hour flight. He reports mild calf discomfort on the left side but no cough or fever. He has no significant past medical history. He is otherwise fit and healthy and takes no regular medications.

Medications: Nil

Past history: Nil significant

Social history: Non-smoker, exercises regularly

Examination findings: HR 104 bpm, RR 22, BP 122/78, SpO2 94% on room air. Chest clear to auscultation. Mild tenderness in the left calf without swelling or redness.

What are the most appropriate next steps in Michael’s assessment and management? Select three (3) from the following list:

Harriet Collins, a 38-year-old childcare worker, presents with a persistent productive cough and nasal congestion for the past 4 weeks following a viral upper respiratory tract infection. The cough is worse in the mornings and associated with thick postnasal drip. She reports facial pressure but no fever or dental pain. She has tried antihistamines and paracetamol with minimal improvement.

Medications: Paracetamol PRN, cetirizine PRN

Past history: Allergic rhinitis

Social history: Non-smoker, lives with partner and two young children

Examination findings: Afebrile. Nasal mucosa swollen and erythematous. Tenderness over maxillary sinuses. Chest clear on auscultation. No cervical lymphadenopathy.

What are the most appropriate next steps in Harriet’s management? Select three (3) from the following list:

Leonard Baxter, a 65-year-old man, presents with chronic breathlessness and a daily productive cough that has persisted for over two years. He produces white sputum each morning and describes occasional wheezing. He has a 50 pack-year smoking history and worked as a metal fabricator for 35 years. He has not previously been diagnosed with any lung condition. He reports two chest infections in the last year requiring antibiotics.

Medications: Nil

Past history: Hypertension

Social history: Lives alone, retired, quit smoking one year ago

Examination findings: RR 18, HR 84, SpO2 96% on room air. Chest: scattered expiratory wheezes, no crackles. No clubbing. No peripheral oedema.

What are the most appropriate next steps in Leonard’s assessment and management? Select four (4) from the following list:

Monique Fraser, a 22-year-old university student, presents with a 2-week history of a persistent dry cough that started after a viral upper respiratory infection. She has no fever, sputum production, or chest pain. The cough is worse at night and when talking. She denies shortness of breath or wheeze. She is otherwise well and takes no regular medications.

Medications: Nil

Past history: Nil significant

Social history: Non-smoker, lives in a shared house, works part-time in retail

Examination findings: Vitals normal. Chest clear on auscultation. ENT examination normal. No lymphadenopathy or signs of postnasal drip.

What are the most appropriate next steps in managing Monique’s cough? Select three (3) from the following list:

Jillian Park, a 42-year-old administrative assistant, presents with a six-month history of progressive shortness of breath on exertion and a chronic dry cough. She has no history of smoking. She reports joint stiffness in the morning lasting about an hour and occasional dry eyes. She denies fevers or sputum production. She has been previously investigated for anaemia and hypothyroidism, both of which were excluded.

Medications: Nil

Past history: Nil significant

Social history: Non-smoker, lives with partner, no pets or recent travel

Examination findings: RR 18, HR 80, SpO2 95% on room air. Fine end-inspiratory crackles at lung bases bilaterally. No clubbing. No lymphadenopathy.

What are the most appropriate next steps in the assessment of Jillian’s condition? Select four (4) from the following list:

Claire Ritchie, a 5-year-old girl, is brought in by her parents with a history of noisy breathing and a harsh cough that started last night. She had a runny nose and mild fever the day before. The cough is described as ‘barking’, and Claire became distressed during the night with stridor when upset. She is more settled this morning but still has a hoarse voice and intermittent stridor at rest.

Medications: Nil

Past history: Unremarkable, fully immunised

Social history: Lives with parents and two siblings, attends kindergarten

Examination findings: SpO2 97% on room air, HR 108, RR 24, T 37.8°C. Mild inspiratory stridor at rest, barking cough audible. No intercostal recession or cyanosis. Alert and interactive.

What are the most appropriate next steps in Claire’s management? Select three (3) from the following list:

John Minogue, a 71-year-old retired farmer, presents with gradually progressive dyspnoea over the past six months. He also reports a dry cough and increasing fatigue. He has a history of rheumatoid arthritis and has been on methotrexate for 4 years. He has never smoked. There is no history of fever, chest pain, or sputum production. He lives in a rural area and was exposed to dust and animal feed for many years.

Medications: Methotrexate, folic acid, amlodipine

Past history: Rheumatoid arthritis, hypertension

Social history: Lives with his wife on a rural property, retired, non-smoker

Examination findings: RR 22, SpO2 93% on room air, HR 88. Fine bibasal inspiratory crackles. No wheeze. No clubbing or oedema.

What are the most appropriate next steps in John’s assessment? Select four (4) from the following list:

Matthew Singh, a 48-year-old man, presents with wheezing and shortness of breath that started after beginning a new job in a grain storage facility 4 months ago. He notes that his symptoms improve on weekends and during holidays. He has a past history of mild eczema and seasonal hay fever. He has never smoked and takes no regular medications.

Medications: Nil

Past history: Atopy (eczema, allergic rhinitis)

Social history: Works full-time in agriculture, lives with wife and two children

Examination findings: Vitals normal. Mild expiratory wheeze heard bilaterally. No clubbing or lymphadenopathy. Chest clear between episodes.

What are the most appropriate next steps in the assessment and management of Matthew’s condition? Select four (4) from the following list: