A 3-year-old girl was brought by his mother to the emergency department of the hospital because of difficulty in breathing and wheezing. So far, he has frequently been treated, but the disease always relapses. The child has a habit of lying on the carpet with his pet cat. Of the following, the most likely cause is:

Mrs. Sinta, 55 years old, came to emergency with a productive cough of yellowish sputum since last week. She also complained of chest pain and fever. She had a history of diabetes mellitus and hypertension. On physical examination found bronchovesicular with ronchi right middle and lower lung fields. Chest X-Ray show infiltrate and air bronchogram. What is your recommendation treatment for this patient?

Mr. B, a 45 years old, brought to ER because of shortness of breath after having bloody cough and decrease of consciousness. The total volume of bloody cough was approximately about 2 cup or 500 cc. He had history of chronic cough and prolonged fever since last month. From physical examination, GCS E3M5V4, BP 110/60 mmHg, HR 100 bpm, RR 30/min, T: 38°C. What is the correct classification for the bloody cough?

A 45-year-old woman came to emergency departement with shortness of breath since last month and a non productive cough. She was diagnosed with Systemic Lupus Erythematosus since last year, but because of pandemic, she did not come to hospital. This is the result of thorax CT scan: What can you find on auscultation of chest physical examination?

A 22-year-old man is admitted to the emergency department after blunt chest trauma from the steering wheel in motor vehicle accident. He is conscious and his vital signs are stable. There is no evidence of other injury. The chest radiograph shows a right pleural effusion occupying about half of the hemithorax. There are no obvious rib fractures and no pneumothorax. Pleural fluid analysis revealed bloody appearance, nucleated cells 12000 /L, Diff. count % (neutrophils 80, lymphocytes 15, macrophages 5), total protein 5.5 g/dL, LDH 500 U/L, glucose 100 mg/dL, pH 7.38, Pleural fluid/peripheral blood hematocrit ratio 60%. The most appropriate management is:

A 30-year-old woman came to clinic and presents with chest pain for the last 3 days. It is a sharp pain on the left chest which occurs in breathing. There was no history of trauma and no radiation of the pain. She has been coughing for the last 3 weeks with thick phlegm and sometimes she coughs blood. She also lost her weight 4 kg over the past month. The sputum examination shows there are acid-fast bacilli. The doctor performs pleural tap to remove the fluid. What will the most likely result?

A 25 year-old man, diagnosed with mild persistent asthma, is being treated twice daily with low doses of inhaled beclomethasone. After 3 weeks using that medication the patient hasn’t feels any shortness of breath, cough and productive sputum as before. Then the doctor reduces the dose to once daily inhaled. Which of the following is the most likely reason that patient condition improved?

A 4-month-old girl is brought to the ER due to difficulty of breathing and irritability. Two days prior consultation she developed sneezing, clear rhinorrhea, with intermittent fever. Gradually she developed dyspnea and paroxysmal wheeze cough. Her mother had minor respiratory symptoms 5 days earlier. No family history with asthma. On physical examination her respiratory rate was 35x/minute, accompanied with nasal flaring, suprasternal and intercostal retractions, auscultation revealed fine crackles, wheezes with prolongation of the expiratory phase of breathing. The white blood cell and differential counts were normal. What is the most probable diagnosis of this patient?

A 27 year old man came to the health center with a bloody cough. The patient has been diagnosed with TBC 2 months ago, was given 1st category OAT for 3 weeks and the patient didn't continue the treatment because the patient feels he has been recovered. From the sputum examination: Mtb detected medium, Rifampicin resistance not detected and the doctor planned to give OAT to the patient. What is the most suitable definition for this patient?

Male, 45 year old comes to you with joint pain after taken TB treatment for 1 month. He has no history for the symptom before. No history of trauma. The blood test showed hyperuricemia. What drug might be the cause of that?

A 75-year-old female is referred for dyspnoea on exertion and chronic cough that have worsened progressively over the past 12 months. Pulmonary function testing reveals an FVC of 72% predicted and FEV1 of 80% predicted. The chest radiograph shows bilateral patchy infiltrates, mostly at the lung bases. On HRCT, bilateral reticular opacities and clustered basal honeycombing are found. Open-lung biopsy reveals randomly distributed foci of usual interstitial pneumonia surrounded by normal lung parenchyma. What is the most appropriate therapy for this patient?

While examining a piece of lung tissue with the light microscope, you noticed a tube lined by respiratory epithelium, with several pieces of hyaline cartilage surrounding its wall. Which of the following air passages are you probably examining?

A 55-year-old man was admitted to the emergency department of hospital having a complaint of severe difficulty in breathing. Previous history shows that he suffered from chronic obstructive pulmonary disease (COPD) three weeks ago, and has had oral corticosteroid treatment until now. Ten days before admission to the hospital, he also suffered from hemoptysis dan shortness of breath, and has been given antibiotic up to now. On sputum culture were shown the budding yeasts and pseudohyphae. The most likely diagnosis is:

A 60-year-old male presents with progressive dyspnea for the past four years. He becomes cyanosed on exertion and has lung function (spirometry) results as follows: FEV1 1.38 (51% of predicted value) FVC 1.46 (54% of predicted value) FEV1/FVC ratio 95%. What is the likely diagnosis?

A 8 months old baby girl was brought to the hospital with chief complaint of shortness of breath since 6 hours before admission. There is history of fever, cough and runny nose since 3 days before admission. From physical examination revealed heart rate 160 times/minute, respiratory rate 60 times/minute, temperature 39°C, oxygen saturation 90% room air, nostril breathing, intercostal and subcostal retraction, ronchi +, wheezing -. What is the most likely diagnosis of the patient?

A 60-year-old man comes to the physician because of a 6-month history of gradual progression of fatigue and occasional shortness of breath. He is non-smoker. Crackles are heard at the lung bases. Blood Gas Analysis showed pH 7.36, pO2: 50, pCO2: 36, HCO3: 27, BE 2, SpO2 85. Which is the most proper oxygen therapy for the patient?

A pre-op patient is given 4 units of fresh frozen plasma (volume = 200 cc each) rapidly, to correct a slight elevation in a routine coagulation test, immediately before surgery. During the last infusion, the patient suddenly develops severe shortness of breath. A stat chest x-ray shows a bilateral, diffuse infiltrate. Arterial blood gases reveal a PaO2 of 50 on room air, and a Swan-Ganz catheter is placed, measuring the pulmonary capillary pressure as normal. There is no history of cardiac disease, and the now cancelled surgery was for a routine gallbladder resection. What is the likely diagnosis?

Mr. S, 35 years old male, came to ER department with chief complain of shortness of breath, cough, and chest pain. He also complains about nausea, vomiting, and diarrhea for few days. He was a cigarette smoker before but now he use vape everyday for more than 2 years because he thought vape is better than conventional smoking. His BP was 150/90 mmHg, RR 30cpm, HR 110bpm, SpO2 90%. He was admitted at high care unit and got treated with corticosteroid and antimicrobial. What is the most probable diagnosis for him?

20. Female, 24 years old came to clinic with chronic cough for 1 month and intermittent fever. She was diagnosed with Lung tuberculosis, but she is still breastfeeding her 6 months baby. What is your recommendation treatment for this patient?

A 50-year-old man without significant medical history complained of subacute non-productive cough, and exertional dyspnea at rest. Five months prior to admission, there was progression of dyspnea and paroxysmal dry cough. Chest Radiograph showed reticulonodular densities on both lung fields. There is no exposure to toxins and other environmental hazards and no exposure to birds or bird products or recent travel outside the USA. He had never used illicit drugs or tobacco and reported no allergies. Family history was unremarkable. What is the correct diagnosis of this patient?

22. Male, 60 years old, with positive COVID-19 came to emergency after self isolated for 3 days, he reported felt worsening of shortness of breath. His pulse oxygen saturation decreased significantly, up to 80% room air, his CT scans showed ground glass appearance in the bilateral lungs. What is the recommendation of the treatment for this condition :

A 68-year-old male was hospitalised for an exacerbation of newly diagnosed COPD. He was discharged 4 weeks ago and now presents to your clinic for a regular check up. You perform a spirometry test with the following results: FVC 2,52 L (77% predicted), FEV1 1,53 L (54% predicted) and FEV1/FVC 61%. He has now recovered and feels well. He has never received any vaccinations since childhood. Which preventive approach against pneumonia is appropriate at this time?

A 20-year old man with no significant past medical history presented to his primary care physician for chest discomfort and cough. His primary care physician prescribed a short course of antibiotics for empiric treatment of pneumonia with some initial improvement in symptoms. His chest discomfort returned and he developed progressive dyspnea on exertion. After checking the CXR result above, the primary care physician refer to the pulmonologist. What is the next plan to confirm diagnosis?

A 9 months old baby was brought to the emergency department with chief complaint of shortness of breath since 12 hours before admission. Patient got fever, cough and decreased appetite since 1 day before admission. From physical examination revealed febrile, tachypnea with chest retraction. Wheezing + bilateral, ronchi -. What is the most common etiology?

A mining industry worker reported to his doctor with complaints of cough, dyspnea on exertion and chest pain. His chest X-ray showed a 'snow–storm' appearance. What is the most likely diagnosis?

58 year old man came to the emergency department with shortness of breath. The patient was diagnosed with lung TB 2 months ago but has not started OAT. Physical exam showed BP 137/98, HR 92x/min, RR 28x/min, temperature 38.3, Saturation Oxygen 91% on room air, dull percussion on right lung, tactile fremitus right lung decreased, vesicular sound on right lung decreased, egophonia, no wheezing. Chest X-ray showed right lung was covered with opaque sheathing and meniscus sign. What is the diagnosis for this patient?

A 30 year-old male presented with fever, cough and haemoptysis for one month. The doctor diagnosed as lung tuberculosis. He got treatment with OAT first line drugs. After 4 weeks he develops paraesthesia of both legs. Which is the most likely offending drug?

A 63 years old male has been admitted in stroke unit due to non haemorrhage stroke for 5 days. He experienced a productive cough with greenish sputum since yesterday accompanied with fever and difficulty of breathing. The physical examination results showed BP 150/90 mmHg, HR 100bpm, RR 38cpm shallowed rapid breathing, and temperature: 38,2oC, there's crackles (+) on the right lower lung field. What is the most possible working diagnosis for this patient?

A 35 years old female came to clinic with cough, nasal congestion, muscle aches and fever. The next day her temperature is 38.5ºC. Her cough was productive with rusty sputum. For the last 24 hours she felt pain in her right chest and it worsened with deep breathing. She was sent directly to hospital. Her temperature was increase to 40ºC, respiratory rate 30 times/minutes, HR 115/minutes and BP 130/80. Her lung examination showed dullness to percussion in the right upper side, increase in fremitus, on auscultation there was rhonchi and bronchial breath sounds. What is the most probably causative agent?

Female, 67 year old came with chronic cough, productive sputum particularly in the morning after she wakes up and while she change her body position. He has recurrent respiratory infection since she was young with inadequate treatment. On the chest X ray, the doctor found honeycomb appearance. The doctor perform spirometry. What do you expect from the spirometry result?

A 35-year-old man come to emergency departement with acute shortness of breath that is worsen since yesterday, he is also complaining right chest pain. The result of chest x-ray is: As a doctor in emergency, what is the correct diagnosis:

A 30 year old male complaints with yellowish productive cough and fever. The patient was hospitalized with gastritis and in third day of hospitalization. Physical examination showed BP 110/70mmHg, HR 88x/min, RR 22x/min, temperature 39 C. From auscultation, there is rhonchi +/- but no wheezing. Laboratory findings leucositosis and from Chest X-Ray shows consolidation on right lowerlungs. What is your diagnosis?

A 60-year-old man has a 90 pack per year history of smoking. For the past 5 years, he has had a cough productive of copious amounts of mucoid sputum for months. He has had episodes of severe pneumonia complicated by shock septic and multiple organ failure and he dies. At autopsy, his bronchi microscopically demonstrate mucus gland hypertrophy. Which of the following conditions is most likely to explain his clinical course?

A 45-year-old male complained shortness of breath for 6 months. He had intermittent chest pain for 2 weeks. He had weight loss 3 kilograms in a last month. He works as asbestos factory worker for 25 years. Chest CT-scan is shown below. What is the possible diagnosis?

A 35-year-old man come to emergency departement with acute shortness of breath that is worsen since yesterday, he is also complaining right chest pain. The result of chest x-ray is: As a doctor in emergency what should you do:

Mrs. Z and her child, 3 years old (related to the previous case), have visited VCT for test and counseling, their laboratory results for anti-HIV are not reactive and they also have negative result for TB screening. What is the next management for her child?

38. Male, 55 years old, came to emergency with cough, chest pain and fever for 2 weeks. On physical examination, vesiculer breath sound decreased at upper lung field and ronchi, amphoric sound (+). His chest X-Ray show: What is diagnosis this patient?

The respiration process consist of inspiration and expiration. The most correct statement during expiration:

A 45-year-old man come to clinic to report the result of the Mtb/Rif sputum examination, it found Mtb detected medium and resistance of Rifampicin. What is the correct therapy that should be given?

A 19 year-old patient come with chronic cough and shortness of breath since 3 months with decreased of body weight and fatique. Patient said that when he is coughing there is some tissue. The examination found muscle, fat and hairy. What is your diagnosis?

A 65-year old man with congestive heart failure was admitted with weakness and shortness of breath. Auscultation revealed normal heart sound, a grade 3/6 parasternal systolic murmur, bilateral crackles, diminished breath sounds and dullness to percussion on the right side and decreased tactile fremitus. Chest radiograph revealed increase in the right effusion. The pulmonary service was consulted for diagnostic and therapeutic thoracentesis. 2 hours after thoracentesis, he complained of chest pain and shortness of breath. A hemothorax was immediately suspected. What is the name of the artery that probably lacerated in the case above?

Mr. Z, a 40 years old, come to outpatient departement complain about chronic cough for 1 month, prolonged fever and weight loss. He is an intra-venous drug user dan has history of free sexual lifestyle. His laboratory test result is anti-HIV reactive, and CD4 level is 18. The examination of AFB sputum are 2+, 2+, and 1+. What is the correct managment for this patient?

Female, 24 years old came to clinic with chronic cough for 1 month and intermittent fever. She was diagnosed with Lung tuberculosis, but she is still breastfeeding her 6 months baby. What is your recommendation treatment for the baby?

A 68 year old man came to the emergency department brought by his family due to sudden shortness of breath, cough, and mild fever 2 hours ago. The patient has no history of heart and lung disease but has a history of stroke 6 months ago, the patient can't talk, do daily activities, and often chokes. Physical examination BP 135/97, HR 82x/min, RR 26x/min, temperature 38.1, Oxygen saturation 93%, decreased vesicular, rhonchi, wheezing, regular heart sound, no murmur. What is the diagnosis for this patient?

A 50 year old man came to the emergency room with difficulty breathing and bloody cough for the first time. He had no other complaint. On physical examination, the doctor found decreased tactile fremitus on the right side of the lung and dullness on percussion. The chest x-ray showed there was a 2 cm soliter nodule. The bronchoscopy showed infiltrative stenosis on 1/3 proximal mucosa of right main bronchus. In this patient, which of this following mechanism is most appropriate causing hemoptysis?

A two year-old child has just inhaled a small metal button, 4mm in diameter, and has difficulty with breathing. The mother and child are rushed to the nearest hospital. On examination the doctor hears stridor, which is loudest over the right anterior chest wall. How can this clinical finding best be explained?

A 60 year old man has had cough and sputum for over 15 years. Now he complains that his sputum is blood tinged, particularly when he first awakens in the morning. His chest X-rays show “tram-lines” at both lung bases. What do these findings suggest?

A 4 years-old boy came to clinic because of persistent cough since 2 weeks ago. Cough is followed by whooping sound and sometimes he is vomiting. His history of immunization was incomplete. From physical examination found sub conjuctival bleeding, no hyperemic pharynx found and normal tonsil. What is the cause of pathogen of the disease?

A 4-year-old child is found to have a positive PPD test result on routine screening with transversal induction 15mm. There is no other symptoms. Which of the following is the best interpretation of the findings?

A 58-year-old male hospitalised with a hip fracture for 1 week complains about shortness of breath, fever, cough with purulent sputum production for the past 2 days. He is non smoker with history of hypertension. Vitals signs are blood pressure 130/70 mmHg, heart rate 100 beats per min, breath rate 30 breaths per min and temperatur 37.9°C and SpO2 93% room air. Rales and bronchial breath sounds are revealed on auscultation on the left chest. A complete blood count shows a white blood count of 17,000. A Chest radiograph finds infiltrate with air bronchogram at lower left hemithorax. The patient has not been on any antimicrobial therapy until now.

A male came with history of recurrent bloody cough, and the blood volume up to 100 cc, he denied any lost of weight and no fever, he also had AFB sputum examination with negative result. From Thorax CT scan examination found air crescent sign. What is the most appropriate medication?

A man 50 year old come to policlinic with unknown prolonged fever, loss body weight around 10 kg within 2 months. He has no appetite, no coughing, and no shortness of breath. He doesn’t smoke. On the chest x-ray lung field is normal. There are multiple cervical lymphadenopathy. As a doctor, what examination will you suggest to establish the definitive diagnosis of the patient?

Male, 23 year old , weight : 52 kg; height: 166 cm; blood pressure: 130/85; came to ED with shortness of breath. He also had stabbed chest pain at the right lung. The doctor performed thoracentesis and pleural fluid analysis was performed: PMN: 68% MN: 32% Glucose pleural fluid : 50, glucose serum : 86 LDH pleural fluid : 300, LDH serum : 478 Protein pleural fluid: 3.5 , Albumin : 3 What is the possible cause of the chest pain?

A 60-year-old female came to the emergency department with acute onset shortness of breath. Symptoms began approximately 2 days before and had progressively worsened with no associated, aggravating, or relieving factors noted. She got fever, chills, cough, yellow sputum production, chest pain, palpitations, no abdominal pain. Initial physical exam reveals temperature 38 C, heart rate 120 bpm, respiratory rate 28, BP 104/54, HT 160 cm, WT 100 kg, BMI 39.1, and O2 saturation 90% on room air. Pulmonary/Chest: No respiratory status distress at this time, tachypnea present, bronchovesicular, wheezing (-/-), bilateral rhonchi (+/+). Initial arterial blood gas with pH 7.491, PCO2 27.6, PO2 63.6, HCO3 20.6, and oxygen saturation 90% on room air. What is the correct supplemental oxygen that should be given to this patient?

A 51-years old female came to ED because of worsening shortness of breath since 2 hours ago. She has high fever, non-productive cough and sore throat since last 5 days. She is a chicken farmers. Last week, she found all the poultry were dead because of disease outbreak. What is your diagnosis?

A 50 years old female, came to clinic with chest discomfort for 3 months, she is also complaining about dropping eyelids and sometimes weakness in her extremities. She was diagnosed as myasthenia gravis and under treatment by neurologist. Her chest X-Ray shows mediastinal tumor, what is the most probable diagnosis?

A 60-year-old female came to the emergency department with shortness of breath since 2 days ago. She had fever, chills, right chest pain and productive cough with greenish sputum. The physical examination reveals temperature 38 C, heart rate 112 bpm, respiratory rate 24 bpm, BP 104/54 mmHg, HT 160 cm, WT 100 kg, BMI 39.1, with O2 saturation 90% on room air. Pulmonary/Chest: No respiratory status distress at this time, tachypnea present, (+) no wheezing, bilateral rhonchi. The patient was barely able to finish a full sentence due to shortness of breath. The arterial blood gas result: pH 7.491, PCO2 27.6, PO2 53.6, HCO3 20.6, and oxygen saturation 90% on room air. Chest X-ray: What kind of sputum examination is recommended for this patient?

A 20 y.o. woman came with shortness of breath. On physical examination: inspection: right chest wall movement is diminished, percussion: hypersonor on right hemithorax, auscultation: decreased breath sound on the right side. Chest X-ray reveals: avascular appearance and pleural line on right hemithorax. Patient is currently having her menstrual period. What is the most likely diagnosis?

A 25-year-old man comes to ER with left sided chest pain and shortness of breath. The symptoms began suddenly 2 days ago while he was working. He thought that he just has strained a chest wall muscle but since the pain and dyspnea had not resolved, he decided to seek medical attention. He has no significant past medical history and no smoking history. His height is 192 cm and weight is 50 kg. The vital signs are normal. He appears in mild discomfort. Examination of chest reveals that the left hemithorax moves poorly for inspiration, decrease of vibration on tactile fremitus, hypersonorant on percussion, and decrease of breath sounds on the left side. What is the possible diagnosis?

A 13 year old girl has shortness of breath since she was 6 year old. According to her, the shortness of breath is getting worse in the early morning. Her brother has rhinitis allergy. During the time, she feels better after treated by salbutamol. What is the physiologic process which is impaired?

A 65 year-old male presents with a six month history of progressive exertional dyspnea and non productive cough. On examination, he is found to have finger clubbing. His respiratory rate is 24 breaths/minute at rest. Bilateral fine inspiratory crackles are heard during the mid to late-inspiratory phase on auscultation at the lower and mid zone of the lung fields. Below was his thorax CT scan: Which of the following investigations would be most useful in confirming the suspected diagnosis?

A 50 years old female, came to clinic with chest discomfort for 3 months, she is also complaining about dropping eyelids and sometimes weakness in her extremities. She was diagnosed as myasthenia gravis and under treatment by neurologist. Her chest X-Ray shows mediastinal tumor. In what compartment of mediastinal most likely found?

A 45-year-old man came to clinic with bloodystreak cough, fever and decreased body weight. From the Mtb/Rif sputum examination found Mtb detected low and sensitive of Rifampicin. His chest X-Ray shows minimal fibroinfiltrate on left apex of lungs. What is the new recommendation of the treatment based on WHO 2022?

A 30-years-old female patient came to policlinic with the chief complaint of shortness of breath with wheezing for one months ago. Shortness of breath is a gradual patient experience one time a week. Increases especially early morning and complains of cough. She denies fever or chest pain. The symptom worsens, especially during winter. No history of smoking. The patient came with a spirometry result: Pre-bronchodilator: FVC: 3.2 L, FEV1: 2.3 L. Post-bronchodilator: FVC 3.4 L and FEV1: 2.7 L.

Female, 67 years old came with chronic cough, chest pain, headache and decreased of body weight. From physical examination, the doctor found: edema of neck and face, increased JVP, venectasia and decreased of breath sound at the right upper area of the lung. On the chest X ray, the doctor found opacity at the upper right lung. What is the most likely diagnosis of this patient?

A 23 years old medical student came to you due to difficulty of breathing. He has smoked cigarette for 10 years ever since he was a junior high school student. He smokes 10 cigarettes daily up to now. He started to feel difficulty of breathing for the past two years. You are managing a patient who wish to stop smoking. What is the initial component that the doctor should notify to make the program successful?

A 56 year old man came to the outpatient department with a cough with phlegm 6 months ago, phlegm white green with shortness of breath while doing activities. The patient has a history of 10 years working at a freeport. Vital signs showed 127/98, HR 82x/min, RR 26x/min, temperature 37.2, Oxygen Saturation 96%, barrel chest, rhonchi, wheezing, regular S1 and S2, no murmur. What is the suitable test to confirm this patient's diagnose?

A 4-year-old boy has had a low-grade fever, runny nose, non-productive cough, and mild stridor for 2 days. He sounds like a seal when he coughs. He is non-toxic appearing and has no increased work of breathing. What is your first step?

70. Male, 45 year old came to clinic with blurred vision after taken TB treatment for 2 month. He has no history for the symptom before. The doctor said maybe he had toxic optic neuropathy. What kind of drug might be the cause of that?

A 34-year-old asthmatic female comes to the emergency room with progressive dyspnoea and non-productive cough over the past 3 days. Her best recorded peak expiratory flow is 60% of her personal best and she has a SpO2 of 90%. She has stopped taking inhaled corticosteroids because she is 27 weeks pregnant and does not feel comfortable receiving medication while she is pregnant. She has been having mild symptoms for weeks. Now the symptoms have been getting worse and she has been waking at night for the past 10 days. She feels breathless and although she has used her relief inhaler every day in the past week and 3 times in the last hour, she does not feel better. Which one of the following is the most appropriate initial treatment for this patient?

Mrs Indri, 40-year-old, BP, 110/70, came to ED with shortness of breath. On pulmonary physical examination the doctor found dullness and vesicular decrease on both side of the lung. She had edema on her legs. Pleural fluid analysis showed : Glucose: 110; Protein : 2; LDH: 160. Blood results showed: Hb: 12; WBC: 7000; Erythrocyte: 5.06; Albumin : 2.3. What is the pathophysiology of fluid accumulation on the case above?

A 20-year-old male has been experiencing attacks of sneezing, nasal pruritus, and clear rhinorrhea. During these episodes, he also experiences itchiness and watery discharge from both eyes. His symptoms are most prominent in the rainy day. Otherwise, he is healthy. Which of the following is the most appropriate pharmacological intervention?

Mrs. S, 45 years old female, came to ED with shortness of breath, sore throat, and fever since 3 days ago. She had a contact with dead poultry. From throat swab examination, she confirmed SARS-CoV1. What is the most appropriate medication?

30 years female come to hospital with shortness of breath and wheezing for the last 5 days. She has history of asthma. Physical examination found bilateral wheezing. She got nebulization of salbutamol and combination with ipratropium bromide because still not getting better. How the mechanism in action of ipratropium bromide?

20-year old man with no significant past medical history presented to his primary care physician for chest discomfort and cough. His primary care physician prescribed a short course of antibiotics for empiric treatment of pneumonia with some initial improvement in symptoms. His chest discomfort returned and he developed progressive dyspnea on exertion which led to a chest radiograph (CXR) below: What is the correct diagnosis of this patient?

A 60 year old man came to the emergency department with a productive cough 3 weeks ago, followed by fever, white yellowish sputum. The patient has no experience of bloody cough, weight loss, night sweats, loss of appetite, and has a history of incomplete antibiotics consumed since young age. Sputum exam showed 3 layers of sputum. What is the main pathogenesis of this disease?

A young woman, 27 years old, brought to ER because of shortness of breath that has been getting worse since yesterday. There is decrease of consciousness since one hour before brought to ER. She has history of high-grade fever and cough for 5 days, she is also an intra-venous drug user. From auscultation of lung, it finds bronchovesicular sound and ronchi at all area of lung. She is admitted in ICU because of ARDS. What can be found from the Chest X-Ray Examination?

Mr. B, a 45 years old, brought to ER because of shortness of breath after having bloody cough and decrease of consciousness. The total volume of bloody cough was approximately about 2 cup or 500 cc. He had history of chronic cough and prolonged fever since last month. From physical examination, GCS E3M5V4, BP 110/60 mmHg, HR 100 bpm, RR 30/min, T: 38°C. What is the life-threatening condition of this patient?

A 50-year-old man without significant medical history complained of subacute non-productive cough, and exertional dyspnea at rest. Five months prior to admission, there was progression of dyspnea and paroxysmal dry cough. Chest Radiograph showed reticulonodular densities on both lung fields. There is no exposure to toxins and other environmental hazards and no exposure to birds or bird products or recent travel outside the USA. He had never used illicit drugs or tobacco and reported no allergies. Family history was unremarkable. The pulmonary function test (Simple Spirometry) of this patient can show:

Male, 30 year old came to ED with shortness of breath. On the physical examination you found the movement of the right chest was slower than the left one, hipersonor and decreased vesicular on the right chest. What should the doctor do?

A 60 year-old man, is brought by his friend to ED because of unconsciousness. According to his friend, the patient is a heavy smoker and often to be hospitalized due to shortness of breath. On physical examination, RR: 42x/m, BP : 100/80, Heart rate : 120x/m. Blood gas analysis showed pH : 7,20 (7,35–7,45); pO2: 50 (>80); pCO2: 82,5 (35–45); HCO3: 28 (22–26); BE +3 (+ 2); SpO2: 88% (>95). Routine blood examination: Hb: 17,8; Ht:51; WBC: 11.000; Platelet 420.000, Natrium: 135 (135–145); Kalium 5 (3.5–4.5). The chest X ray showed lung hyperinflation.

A 65-year-old woman came to emergency departement with shortness of breath since last month, she was diagnosed with ca mammae since last year, but refused to do chemotherapy. On physical examination, dullness on left hemithorax and decreased breath sound on left hemithorax. From chest x-ray examination found opacities on left hemithorax. The pulmonologist perform thoracosintesis, and the pleural fluid cytology found adenocarcinoma metastasis. What is the diagnosis:

36-year-old female is admitted with vomiting and dehydration after having the flu for 3 days. Arterial blood gas (ABG) results are pH 7.31, PaCO2 50, PaO2 60, HCO3 33, BE +3, SaO2 95%. What do these values indicate?

85. Male, 55 year old, who was admitted in ICU, suddenly reveals shortness of breath with abundant mucopurulent sputum. The chest X ray showed radiopacities at the right side with trachea pulled to the right. What is the most likely diagnosis of the patient?

A 30-year-old man in hospitalization with a high fever, shortness of breath and cyanotic. On laboratory examination was found HIV antibody-positive, ESR 40 mm per hour; in bronchoalveolar lavage fluid were found thick-walled cysts and the structures like dented ping-pong ball with 5-7 micron diameter. The most likely diagnosis of this patient is:

Mr. Tumar, 65 years old came to clinic with shortness of breath and legs oedema. He had dyspnea on moderate activity for last 5 years. From physical examination found increased of JVP, barrel chest, hypersonor on percussion and wheezing +/- on auscultation, also bilateral pitting oedema on legs. From chest X-ray showed cardiomegaly and emphisematos lung. From ECG found P pulmonal. What is diagnosis this patient?

A 45-year-old man came to clinic with nausea and vomiting since 5 days ago. He has history of OAT treatment (RHZE) for Lung TB for 2 weeks. On physical examination, sklera icteric dan laboratory finds increased of Liver Function Test (AST 1200 IU/L, ALT 360 IU/L). What is your recommendation treatment for this patient?

A 50-year-old man had shortness of breath for 6 months. He had non-productive cough, loss of appetite and body weight. He smoked 20 cigarettes/day for 25 years. Chest examination shown decreased left hemithorax expansion, weak fremitus on left, dull on percussion, and diminished breath sound on left side. Chest x-ray and bronchoscopy are shown below: What is the possible condition from the case above?

A patient come to respiratory clinic to continue his COPD treatment. He is already given inhaled bronchodilator and feels fine with the medication. The latest spirometry test shows the value of VEPI 58% predicted. Which group he should be classified into?

Young asthmatic male in the emergency department. Blood pressure 160/100 mmHg, heart rate 123x/minute, respiratory rate 26/min, pO2 40 pCO2 27, SaO2 78%. Given nebulised salbutamol, and ipratropium, 200 mg IV hydrocortisone but still no improvement, yet he got decreased of consiousness. What is the further management?

Ms. A is a 30-year-old female patient who is going to be treated for active tuberculosis. She is currently taking oral contraceptives. You advise her that she may have to increase the dosage of the contraceptives because of one of the drugs she will be taking to treat the tuberculosis. The most likely anti-tubercular drug responsible for this is:

A 60 years old female brought by her family to emergency because of decreased of consciousness since yesterday, her family reported high fever since last 5 days, shortness of breath and productive cough. On physical examination, GCS E2M4V2, Bp: 70/50 mmHg, HR: 122 beat/min, RR 32/min, T: 39.5C. Auscultation finds bilateral ronchi. The doctor has performed fluid resuscitation, but the BP still 80/60. Laboratory examination show Hb: 10,8 mg/dL, leucocyte: 30.000/uL, thrombocyte: 160.000/uL. What is diagnosis this patient?

A 18 months old child was brought by his mother to the clinic with chief complaint of failure to gain weight for the last 3 months. The mother was diagnosed with AFB positive lung TB and on therapy. Anthropometric status was moderate protein energy malnutrition. Physical examination was unremarkable. What is the next step of management for this patient?

A 55-year-old man come to clinic with a history of tuberculosis, now he is having productive cough since last month, fever and decreased of body weight. From the Mtb/Rif sputum examination found Mtb detected high and resistance of Rifampicin. The result of drug sensitivity test of Mtb, is found resistance to rifampicin, amikacin and also fluoroquinolon. The most likely diagnosis is :

Mrs. U, 67 year-old female, was admitted to the hospital because of shortness of breath, frothy and blood tinged sputum. According to her husband, she always awaken at night because of sudden dyspnea, however she can sleep again after urinating. She has history of chronic uncontrolled hypertension. On the physical examination, blood pressure 170/110; Respiratory rate 40x/minutes, Heart rate 120x/min, SpO2 88%. On auscultation you can hear fine crackles and chest X-Ray found bat-wing appearance. What is diagnosis this patient?

A 8 months old baby girl was brought to the hospital with chief complaint of shortness of breath since 6 hours before admission. There is history of fever, cough and runny nose since 3 days before admission. From physical examination revealed heart rate 160 times/minute, respiratory rate 60 times/minute, temperature 39°C, oxygen saturation 90% room air, nostril breathing, intercostal and subcostal retraction, ronchi +, wheezing -. What is the most appropriate management?

Mr. Beky is diagnosed as having pleurisy, he has left lateral thoracic pain, but sometimes also complaining about left neck and shoulder pain. Assuming the diagnosis was correct, the most likely explanation for the differences in pain distribution is that the pleura is innervated by:

Male, 65 year old, heavy smoker came to your clinic with shortness of breath. He can spend 4 packs of cigarettes every day. He willing to quit but he has no ability to do that. He needs your help. According to you, what substance will make him so hard to quit?

Mr. Amin, 25 year old man came to general practitioner with complaint hemoptysis since 4th weeks ago. He has poor appetite and lost about 5 kg weight over the past month. He is smoker with 2 packs of cigarette/day since primary school. On physical examination, the blood pressure 120/80 mmHg, respiratory rate 28 times/minute, pulse rate 108x/min, temperature 37.20C. The chest X ray, find the infiltrate are spreading on both sides of the lung. Sputum smear shows >103 AFB / power field. What is staining use to view microorganism in this case?

A 21-year-old an active duty male, otherwise healthy, presented to clinic with a new frontal headache for 3 days. He works as a survival equipmentman in a busy environment and was uncertain about contact with any sick (symptomatic) people. On Day 4, he was cooking at home, when he realized he had lost the sensations of taste and smell. He got teleconsultation to doctor in the following day with a chief complaint of anosmia and ageusia. What is diagnosis this patient?

A 55-year-old South African sued his employers for compensation because of a tumour he developed in lung after working for 30 years in an asbestos mine. What type of tumor does this man most likely have?

A 67 year-old man comes to polyclinic with coughing for 4 months. He noted that cough occurred mostly in the morning when he wakes up. He has abundant yellowish sputum in the morning but become less when afternoon. He has poorly treated recurrent respiratory infection when he was young. What feature do you expect from chest x-ray?

A 21-year-old an active duty male, otherwise healthy, presented to clinic with a new frontal headache for 3 days. He works as a survival equipmentman in a busy environment and was uncertain about contact with any sick (symptomatic) people. On Day 4, he was cooking at home, when he realized he had lost the sensations of taste and smell. He got teleconsultation to doctor in the following day with a chief complaint of anosmia and ageusia. What is the next examination of this patient?

A 57 year-old, came with frank hemoptysis for 2 days. He noted weight loss around 7kg within a month, coughing and fatigue. No shortness of breath. He has severe index brinkman. On the physical examination, you can hear wheezing only at the right hilar area, whereas other field are clear. The patient looked pale and very weak so that he needs assistance in order to do all activities. You suspect it as malignancy, what is the best position of the patient to manage the condition?

The textile factory worker come to you due to difficulty of breathing that is worsening during working days started on monday. However, he doesn’t feel that while she is at home. She works as a cotton spinner in that factory. What is the most probably diagnosis for her?

Male, 13 year old, administered tuberculosis drug completely a year ago and he was totally cured. Currently, he comes with hemoptysis for 2 days. Chest x-ray showed fibrotic and honeycomb appearance on the right lung. What is the most possible structure which can cause hemoptysis in this case?

A young woman, 27 years old, brought to ER because of shortness of breath that has been getting worse since yesterday. There is decrease of consciousness since one hour before brought to ER. She has history of high-grade fever and cough for 5 days, she is also an intra-venous drug user. From auscultation of lung, it finds bronchovesicular sound and ronchi at all area of lung. She is admitted in ICU because of ARDS. What can be found from the blood gas analysis examination?

1. 25 year old man is brought by his family because of overdosed to narcotic drug. His condition is lethargic and his RR is 7x/min. What is the pathophysiology of this condition?

A radiologist assessed an X-ray photo of a 25 year old male as increased bronchovascular pattern. What does this finding means?

A traffic police consults to his doctor friend concerning his daily job in the streets. He is afraid of having respiratory problems due to polluted air such as dust, engine smokes atc. His friend assures him that most inspired particles fail to reach lungs. What is the protective mechanism to that phenomenon?

You are evaluating an 8 year old boy with fever, sore throat and cough over the past week. There has been no rhinorrhea, emesis or diarrhea. His immunizations are current and his weight was at the 25th percentile 6 months ago. Today he is at the 10th percentile for weight. He is afebrile, with clear nares and posterior oropharynx, and a normal respiratory effort. He has bilateral cervical and right supraclavicular lymphadenopathy. Beyond obtaining a chest radiograph, which of the following is the best next step?

A 65-year old man come to clinic with shortness of breath that is related to activity, he has been smoking for the last 30 years. The pulmonologist perform spirometry to this patient, and the result is VC 90%, FEV1/FVC 60%, What is the diagnosis?

Female, 25 year-old came to ED with coughing for a long time ago. Sometimes she got shortness of breath in the midnight and followed by wheezing. Her father has the same symptoms despite not smoking. She has FEV1 63% before doing salbutamol inhalation. The doctor performed salbutamol inhalation and do spirometry again afterward. The result of FEV1 78% predicted. What is the inflammatory cell that play a role on the case above?

A 65-year-old man is hospitalized because of uncontrolled diabetes mellitus, now he is having productive cough since four day after admission hospitals, fever. Respiratory rate 32 breaths per minute. Pulmonary examination showed bronchial breath sounds and signs for presence of crackles and rhonchi over the right chest. The doctor give 4 lpm nasal canulla, SpO2 95%, and still waiting for blood gas analysis results. From that data, how many oxygen fraction that is been given?

A heavy smoker man, 60 year old stated that he experienced shortness of breath and productive sputum during his rest. Chest X ray showed hyperluscent on both side of the lung, attening diaphragm and widening intercostals. Why did the patient experience shortness of breath?

A 49 years old male was diagnosed with coal pneumoconiosis recently. He had chronic cough with productive sputum nearly 3 months, shortness of breath, and chest tightness. What is the color of his sputum most probably?

A 26 year-old man developed acute respiratory distress as a consequence of viral infection. His arterial oxygen saturation decreased rapidly despite mechanical ventilation with 100% oxygen. The chest radiograph showed increase opacification in all lung fields. Which one of the following histological features is expected to be seen in transbronchial biopsy specimen from this patient?

A premature baby who is born several hours ago suddenly present shortness of breath. What is the most possible cell causing the symptoms?

A 25-year-old man come to clinic with bloody cough, the blood volume approximately 50 cc/day, fever and decreased of body weight. From the Mtb/Rif sputum examination found Mtb detected high and sensitive of Rifampicin. The cause of hemoptysis is:

A 65-year-old man come to clinic with cough, fever since 4 days ago, he has history travelling to Saudi Arabia and contact with camel. What is the most likely diagnosis?

As a medical student you are studying the muscles used for breathing. The teacher shows you external intercostal muscles and asks you what their functions is. What is the appropriate answer?

A 70-year old woman comes to the emergency department with acute shortness of breath for 3 days, unconscious, with a history of fever and productive cough since last week. On physical examination, GCS 2-3-5, BP 80/50, SpO2 70%, RR 40/min. Blood gas analysis shows pO2 50 mmHg and pCO2 50 mmHg. As a doctor in emergency, what should you do?

A 65-year old man was admitted with pain in his right chest, shortness of breath and painful breathing. Chest radiograph revealed: pleural effusion in the right lung. The pulmonologist suspected there was an inflammation in his right pleura. What might be heard during auscultation of this case?

A 65 years old man comes to emergency department for several times with severe breathless, a persistent cough that’s often worse in the morning, also a large amount of excess mucus or phlegm. He has history of smoked 2-3 packs of cigarettes a day for almost 40 years, but he stopped smoking since 2 weeks ago. Which of the following is the most appropriate type of drug should be given to this patient?

A 65-year-old man is hospitalized because of uncontrolled diabetes mellitus, now he is having productive cough since four day after admission hospitals, fever. Respiratory rate 32 breaths per minute. Pulmonary examination showed bronchial breath sounds and signs for presence of crackles and rhonchi over the right chest. What is the correct therapy that should be given to the patient?

Male, 60 year old, came to private clinic with productive cough and shortness of breath since a long time ago, however the symptoms get worsen since 3 days ago. He is a heavy smoker. On physical examination you found clubbing fingers, widening of intercostals space. On radiologic feature there was hyperlusence and hyperinflation feature on the both side of the lung. No other abnormality was seen. What is the pathology of the disease?