Medicine solved scenerio based questions (RESPIRATORY SYSTEM)




A 26-year-old male presents with complaints of shortness of breath and dry cough
for 2 weeks which is gradually worsening. He admits to have similar episodes every
year in spring. His father has history of atopic dermatitis. There is bilateral wheezing
in chest.
a) What is the diagnosis?
b) How will you diagnose this condition?
c) Give four treatment options to treat this patient.

An 18-year-old girl presents to emergency department with unproductive cough,
wheezy dyspnea and two previous sleepless nights. On examination, temperature is
100 F, pulse 100/min, regular and blood pressure is 125/80 mm Hg. She is mildly
cyanosed. Trachea is central. Percussion note is resonant and equal on both sides of
chest. Breath sounds are vesicular with prolonged expiration, scattered bronchi and
few crepitations on both sides. Rest of examination is normal.
a) What is the clinical diagnosis?
b) Give four investigations you would like to carry out.
c) Give brief outline of management.
d) What is the diagnostic criterion?

You have received a patient with known diagnosis of bronchial asthma. For the last 3
days he has been having extremely severe dyspnea. O/E he has central cyanosis and
is drowsy.
a) Name the most important test to determine the prognosis and treatment.
b) Name three most important management steps in this state.

A middle-aged known asthmatic lady has presented with worsening attack of chest
wheeze along with increasing shortness of breath. She has been admitted to the
hospital atleast thrice in the past 3 months requiring in hospital care for 8-10 days
each. On examination, she has increased rate of respiration 35/min with active
accessory muscles of respiration, her pulse rate is 110/min and BP is 90/70 mm Hg
with a paradox of 30 mm Hg. Her FEV1/FVC is 40 and PEFR is less than 50% for her
age and height. On ABG analysis, her arterial blood oxygen on room air is 87% with a
3 PaO2 of 55 mm Hg and PaCO2 of 44 mm Hg. Her blood count is normal and chest Xray shows hyperinflated lungs with normal markings.
a) What is the diagnosis?
b) Outline the steps of management for this patient.


A 60-year-old male with progressive shortness of breath and cough with
expectoration for last 6 months presented with increased symptoms, deterioration
of health status and lung function. He is smoker, febrile with blood pressure 130/85
mm Hg, pulse is and respiratory rate is 30/min.
a) What is your diagnosis?
b) Name three triggering factors for his condition.
c) Enlist the steeps of management.

A 60-year-old heavy smoker for last 20 years presented to Emergency Room with
severe dyspnea, wheeze, central cyanosis and fever. Patient had past history of
tuberculosis with pleural effusion on right side, which was treated with
antituberculosis therapy, with no residual effect. Examination revealed central
cyanosis. His blood pressure was 150/90 mm Hg and breathing rate was 30
breaths/min. Chest examination revealed bilateral crepitations and wheeze.
a) Enumerate four essential investigations required in the management of this
b) What is the management of this patient?
c) What is the risk of giving higher concentration of oxygen to this patient?


A 26-year-old laborer presented in OPD with history of fever, low appetite, easy
fatigability and weight loss for the past 8 weeks. He also complains of productive
cough for the last six weeks and 3 episodes of hemoptysis over the last 1 week.
There are crackles in left apical chest.
a) What is the most likely diagnosis?
b) Give two important investigations most relevant to your diagnosis.
c) How will you treat this patient?

A 25-year-old male presents with history of chronic cough which is productive with
occasional episodes of hemoptysis for two years. His past history is significant for
pulmonary tuberculosis when he was 10 years of age. Clinical examination reveals
clubbing of both hands and bilateral coarse crackles. He is afebrile with ESR of 10
a) What is your provisional diagnosis?
b) Write two investigations to support your diagnosis.
c) Outline the treatment options.

A 35-year-old male has been diagnosed as a case of pulmonary tuberculosis two
years ago. He has taken anti-tuberculous treatment for nine months. For last six
months, he is complaining of malaise, increased cough and copious sputum usually
worse in the morning brought on by change of posture. On examination, he is
tachypneic, his temperature is 101 F, pulse is 110/min and digital clubbing is present.
On auscultation, there is normal vesicular breathing with bilateral coarse
a) What is your diagnosis?
b) How will you confirm your diagnosis?
c) Enlist the steps of management.

A 40-year-old smoker presents to the OPD with cough which is productive and foul
smelling. He feels that he is able to cough out more sputum in particular posture. He
has bilateral clubbing and is febrile.
a) What is the likely diagnosis?
b) Which investigations would you advise?
c) How would you treat this patient?

A middle-aged lady has presented with repeated attacks of cough and of
breathlessness. She has been admitted to the hospital atleast thrice in the past 3
months requiring hospital care for 8-10 days each time due to purulent
expectorations ever since her childhood. On examination, she has increased
respiratory rate of 35/min with active accessory muscles of respiration. Her pulse
rate is 120/min. she has coarse crackles in the lower parts of her chest.
a) Give four specific investigations to evaluate the problem.
b) Outline the management for this patient.


A 68-year-old male presents with history of fever with rigors, chest pain and purulent
sputum for last three days. He also had two episodes of hemoptysis and is confused
since morning. On examination, temperature is 104 F, pulse 120/min, BP 85/40 mm
Hg and R/R 36/min with bronchial breathing and coarse crepitations on left lower
a) Where this patient should be managed and why?
b) What are the four investigational markers of severity?
c) Name any four local complications of the disease if not properly treated?

A young male patient is referred to you from Institute of Mental Health with history
of fever, cough, productive of rusty sputum and pleuritic chest pain for last two days.
His chest radiograph shows parenchyma infiltrates.
a) What is the diagnosis?
b) What are the possible complications?
c) What are the usual organisms involved?

A 42-year-old air conditioning technician in a hotel develops high grade fever with
chills and rigors after short prodrome of aches and myalgias. On the day of
admission, he develops diarrhea and becomes mentally confused. On examination,
he is noted to have a cough with sputum production. His right chest posteriorly in
the infra-scapular area is dull on percussion and has a patch of bronchial breathing.
a) What is the likely diagnosis?
b) What is the drug of choice?
c) What one test would you order to confirm the etiological diagnosis?

A 30-year-old man, previously asymptomatic develops sudden right sided chest pain
followed by dyspnea. On examination, there is mild cyanosis and breath sounds are
diminished. On percussion, there is resonant tone on the affected side.
a) What is the most likely diagnosis?
b) What investigations will be the most helpful to establish the diagnosis?
c) What treatment may be indicated?
d) How can this be prevented in future?


A 45-year-old male is admitted in the Emergency Room with persistent vomiting for
three days. He also complains of distaste of mouth and abdominal discomfort.
Physical examination revealed temperature 100 F, Pulse 110/min, BP 100/70 mm Hg,
jaundice is present. GIT examination showed tenderness in right hypochondrium. On
further inquiry, he reveals that he is on anti-tuberculous therapy for the last 2 weeks
for his chest problem.
a) What is the likely cause of jaundice in this patient?
b) What advice would you give him regarding his antituberculosis treatment?
c) What is DOT program?

A 40-year-old smoker presents to chest clinic with complaints of fatigue, weight loss
and fever for the last one month. He has a productive cough worse at night.
Examination reveals pulse of 110/min and BP 140/90 mm Hg. Chest examination
reveals that trachea is shifted to the left side and there is increased vocal resonance
on left apex. Bronchial breath sounds are also audible on left apex.
a) What is the most likely cause of bronchial breathing in the patient?
b) What is the likely diagnosis?
c) Name drugs you would sue to treat this patient giving one side effect of each.

A 25-year-old gentleman presents with symptoms of low-grade fever, cough and
pain in the right side of chest.
a) What is the possible clinical diagnosis?
b) What are the physical signs you would specifically look for on physical
c) Give a list of investigations required to make final diagnosis.

A 19-year-old house maid who weighs 45 kg presents with a dry irritating cough and
a low-grade fever for the last three weeks. On clinical examination, she is pale and
breathless with dullness over the right lower chest on percussion and absent breath
sounds over this dull area.
a) What are the most likely anatomical possibilities and what is the likely cause?
b) Enumerate the four most important investigations in this case.
c) Write down the prescription for this patient.
Lung Cancer

A fifty-year-old gentleman has been a smoker all his life. Recently his chest
symptoms of cough and sputum have worsened and he has coughed out bloodstained sputum. In the last two weeks, he has been complaining of progressive
weakness of right arm and difficulty in speech.
a) What is the possible cause and how would you explain the development of
b) What are the physical signs to look for on neurological examination?

A 55-year-old man presented with cough, fever and hemoptysis of two months
duration. He has lost 10 kg of weight. He has left smoking six months back. He had
pulmonary tuberculosis five years back which was treated with anti-tuberculous
drugs for 9 months. His chest x-ray shows an opacity in right upper zone with
blunting of right costophrenic angle.
a) Write four differential diagnoses.
b) Enumerate six investigations.


A 23-year-old girl presents to Outpatient Department with complaints of gradually
progressive shortness of breath and painful nodular reddish rash over both shins.
Chest X-ray shows hilar fullness, tracheobronchial biopsy findings including large
epithelioid cells, occasional giant cells and no areas of necrosis.
a) Write down two differential diagnoses.
b) What is your treatment plan for the likely diagnosis?
Hypersensitivity Pneumonitis

A 35-year-old male who is fond of keeping pigeons presents with low grade fever
and dry cough for 3 months. On examination, he has clubbing and bilateral endinspiratory crackles and inspiratory squeaks predominantly in and around apices and
interscapular region.
a) What is your provisional diagnosis?
b) Write down a list of proposed investigations with expected findings.
c) Write down management options.

Pulmonary Embolism

A 75-year gentleman sustains fracture of neck of femur and awaiting surgery in
orthopedics ward. Two days after the hospitalization he suddenly develops profuse
sweating, central chest pain and breathlessness. His pulse is 122/min, regular and his
BP is 80/50 mm Hg with cyanosis. His JVP is elevated and he has a left parasternal
a) Give three possible diagnoses.
b) What five investigations should be immediately undertaken to reach the
c) Enumerate five immediate management steps.

Pulmonary Hypertension

A 37-year-old lady presented with progressive shortness of breath. Her cardiac
catheterization studies are as follow:
Pressure mm/Hg Saturation
RA (mean) 17 78%
RV 90/30 78%
PA 110/50 78%
LA (mean) 30 95%
LV 118/5 95%
Aorta 115/80
a) What is diagnosis?
b) Enumerate four physical signs.
c) What complications are noted from above data?


A 35-year-old thin male non-smoker, history of sudden onset of right sided pleuritic
chest pain and shortness of breath. On examination, BP 120/80 mm Hg, pulse
90/min, no cyanosis. Respiratory examination reveals hyper-resonant percussion
note and reduced breath sounds on right side of the chest. Trachea is central.
a) What is the most likely diagnosis and its etiology?
b) What are the others types of this illness?
c) Discuss the guidelines of managing such illness.

Write short note on tension pneumothorax.


An 18-year-old college student who weighs 49 kg develops fever, dry cough and pain
over the right lateral chest on coughing. On examination, he is febrile with an
appropriate tachycardia. He has decreased movements of the right lower chest with
dull percussion note and absent breath sounds.
a) Give two most likely possibilities.
b) Enumerate 5 most important investigations.
c) Write a prescription for this young boy.

A 25-year-old poultry farm worker presents to you with persistent cough and
episodic dyspnea. He complains of frequent attacks of runny nose. His symptoms
often worsen at night, when he wakes up coughing but is often unable to bring up
any sputum. He claims that ever so often. He becomes totally asymptomatic and is
able to play cricket on his Sunday holidays. His investigations show:
Hb 13.7 gm%, ESR 27 mm, TLC 7500/mm3, Polys 68% Lymphocyte 22% Monocytes
2% Eosinophils 8%, Pulmonary function show FEV/FVC: 0.63
How would you manage this patient?

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