Respiratory

A 23-year-old tall, thin man develops sudden pleuritic chest pain and dyspnea while at rest. He is stable; CXR shows a small apical lucency without mediastinal shift.

A 64-year-old smoker with chronic cough and sputum presents with increased dyspnea, purulent sputum, and wheeze. SpO₂ 89% on room air; pH 7.31, PaCO₂ 58 mmHg.

A 28-year-old woman with episodic wheeze and nocturnal cough has reduced FEV₁/FVC on spirometry that normalizes after inhaled albuterol.

A 67-year-old man with sudden pleuritic chest pain, tachycardia, and hemoptysis after long-haul flight. Wells score intermediate; D-dimer is elevated.

A 45-year-old homeless man presents with chronic cough, weight loss, night sweats. CXR: upper lobe cavitary lesion.

A 59-year-old man with fever, productive cough, pleuritic chest pain; focal crackles and dullness. CURB-65 score 2.

A 34-year-old woman develops severe dyspnea and refractory hypoxemia 24 hours after pancreatitis onset. CXR: bilateral diffuse alveolar opacities; PaO₂/FiO₂ = 120.

A 70-year-old man with chronic cough and clubbing has daily purulent sputum and recurrent infections; CT shows tram-track dilated bronchi.

A 52-year-old obese man snores loudly, has morning headaches and daytime sleepiness; STOP-BANG high risk.

A 24-year-old man with sudden hypotension, distended neck veins, tracheal deviation, and absent breath sounds on left after stab wound.

A 38-year-old woman with nonproductive cough, dyspnea, erythema nodosum; CXR shows bilateral hilar lymphadenopathy.

A 66-year-old alcoholic with fever, foul-smelling sputum, and cavitary lesion in the right lower lobe after aspiration event.

A 72-year-old man with fever, confusion, diarrhea, and dry cough; hyponatremia present.

A 29-year-old asthmatic presents with severe dyspnea, silent chest, and SpO₂ 86% despite SABA.

A 65-year-old ex-smoker with chronic cough, weight loss, and shoulder/arm pain; exam shows ptosis and miosis.

A 54-year-old hospitalized patient on day 6 of mechanical ventilation develops fever and purulent secretions; new infiltrate on CXR.

A 47-year-old man with pleuritic chest pain; ultrasound shows large free-flowing pleural effusion. Pleural fluid: protein high, LDH high, low pH.

A 32-year-old HIV-positive man (CD4 120) has subacute dry cough, fever, dyspnea; CXR shows bilateral interstitial infiltrates; LDH elevated.

A 60-year-old diabetic with sudden pleuritic pain and hemoptysis; hemodynamically stable; Wells high probability.

A 51-year-old man presents with chronic nonproductive cough and progressive dyspnea; bibasilar “velcro” crackles; HRCT shows honeycombing.

A 68-year-old ex-smoker with 40 pack-years asks about lung cancer screening.

A 56-year-old woman with dullness to percussion and decreased breath sounds at right base; ultrasound shows loculations.

A 24-year-old man after house fire has confusion, hypotension, and lactic acidosis; SpO₂ is 100% on pulse oximetry.

A 38-year-old man with productive cough for 3 weeks after URI; afebrile, lungs clear, CXR normal.

A 30-year-old asthmatic uses SABA daily; nighttime symptoms twice a week; FEV₁ 80% predicted.

A 63-year-old man with COPD has chronic hypercapnia; now somnolent with pH 7.24, PaCO₂ 72 mmHg, using accessory muscles.

A 41-year-old woman with pleuritic pain; CXR shows small-to-moderate effusion. Thoracentesis: low protein, low LDH, high BNP.

A 52-year-old man with recent stroke develops fever, cough, and right middle lobe infiltrate; poor gag reflex.

A 36-year-old woman has recurrent sinusitis, hemoptysis, and renal impairment; c-ANCA positive.

A 26-year-old man with productive cough of thick sputum, recurrent Pseudomonas infections, and male infertility.

A 58-year-old woman with sudden chest pain, dyspnea, and syncope; hypotensive; bedside echo shows RV dilation and hypokinesis.

A 47-year-old man has hemoptysis ~300 mL in 24 hours with tachypnea and hypoxemia.

A 62-year-old ex-smoker has a 7 mm solid solitary pulmonary nodule incidentally found; low-risk features, no prior imaging.

A 35-year-old woman presents with dry cough and wheeze after starting a nonselective beta-blocker.

A 73-year-old nursing home resident with delirium, fever, and lobar infiltrate; recent broad-spectrum antibiotics.

A 50-year-old man with pleuritic pain and pericardial friction rub after recent viral URI; CXR shows small pleural effusion.

A 42-year-old woman with progressive dyspnea; PFTs show FEV₁/FVC normal, TLC normal, DLCO reduced; CT shows ground-glass opacities.

A 19-year-old college student has sore throat, dry cough, low-grade fever; CXR shows patchy interstitial infiltrates; cold agglutinins positive.

A 62-year-old man with chronic asbestos exposure presents with progressive dyspnea; CXR shows pleural plaques and lower-lobe reticular opacities.

A 48-year-old woman has repeated episodes of wheeze and cough triggered by exercise and cold air; peak flow variability documented.

A 61-year-old smoker with chronic cough and dyspnea has spirometry showing FEV₁/FVC 0.58 and FEV₁ 48% predicted. DLCO is reduced.

A 25-year-old woman with seasonal allergies has chronic cough; spirometry is normal, methacholine challenge is positive.

A 70-year-old post-op hip fracture patient becomes acutely dyspneic on day 3; tachycardia, mild hypotension, clear chest X-ray.

A 55-year-old man with fever, rusty sputum, pleuritic pain; CXR: right lower lobe consolidation; urine antigen positive for Streptococcus pneumoniae.

A 46-year-old bird breeder has cough, fever, and dyspnea; symptoms worsen at work and improve on weekends. HRCT shows ground-glass nodules.

A 63-year-old man with COPD presents with increased sputum purulence and volume with dyspnea.

A 37-year-old woman has pleuritic pain and dyspnea after starting combined oral contraceptives; D-dimer positive, CTPA contraindicated due to severe contrast allergy.

A 58-year-old man with chronic cough produces copious mucopurulent sputum; CT shows cystic bronchiectasis in lower lobes; Pseudomonas in sputum.

A 66-year-old woman with rheumatoid arthritis on methotrexate develops progressive dyspnea; PFTs show restriction and reduced DLCO; HRCT: reticulation.

A 45-year-old homeless man with hemoptysis and weight loss; sputum AFB smear positive.

A 72-year-old man with CHF develops a large right pleural effusion; thoracentesis: low protein, low LDH, pH 7.48.

A 30-year-old asthmatic requires SABA >3 times/week, nighttime symptoms weekly, FEV₁ 70% predicted.

A 64-year-old man on prolonged high-flow oxygen becomes confused; ABG: pH 7.28, PaCO₂ 68, PaO₂ 100.

A 52-year-old ICU patient develops rapidly worsening hypoxemia despite high FiO₂; P/F ratio 90; plateau pressures elevated.

A 69-year-old smoker has chronic cough with daily sputum for 3 consecutive months in each of 2 years; spirometry shows obstruction with normal DLCO.

A 26-year-old man with history of atopy has wheeze during specific workplace exposure (bakery flour); improves on holidays.

A 60-year-old man with recent thoracentesis now has acute dyspnea, tracheal deviation to the right, absent left breath sounds, hypotension.

A 33-year-old woman presents with chronic nonproductive cough; posterior pharyngeal cobblestoning and postnasal drip.

A 49-year-old man with ankylosing spondylitis develops progressive dyspnea; PFTs show restriction with normal DLCO; CT: apical fibrobullous changes.

A 40-year-old woman with HIV (CD4 40) has subacute fever, cough, weight loss; CXR diffuse interstitial pattern; LDH elevated; sputum DFA positive for cysts.

A 58-year-old man with massive hemoptysis and hypoxemia is intubated; source suspected in right lung.

A 29-year-old woman with recurrent pneumothoraces has diffuse cysts on HRCT; chylous pleural effusions intermittently present.

A 67-year-old man with chronic asbestos exposure presents with unilateral pleural-based mass and recurrent effusions; cytology shows malignant mesothelial cells.

A 22-year-old man with cystic fibrosis has worsening cough and low-grade fever; sputum grows Burkholderia cepacia complex.

A 73-year-old woman presents with confusion and headache during winter; several family members have similar symptoms at home with faulty heater; pulse ox 99%.

A 35-year-old man has pleuritic pain and dyspnea; D-dimer negative with low Wells score.

A 62-year-old ex-smoker with chronic cough and frequent infections; alpha-1 antitrypsin level is low; CT shows basilar panacinar emphysema.

A 48-year-old man with pleuritic chest pain after recent viral illness; ECG: diffuse ST elevation; CXR: small left pleural effusion.

A 59-year-old man with chronic tobacco use presents with SIADH and hyponatremia; CT shows central hilar mass.

A 27-year-old woman develops acute dyspnea post C-section; bedside echo: dilated RV, McConnell sign; hypotensive.

A 44-year-old man with asthma uses ICS/LABA but still has symptoms and ≥2 exacerbations/year; eosinophils elevated.

A 65-year-old diabetic nursing home resident aspirates; CXR: right lower lobe infiltrate; foul sputum; poor dentition.

A 38-year-old man with sudden pleuritic pain after central line placement; ultrasound shows no lung sliding on the right.

A 42-year-old woman with chronic dry cough and GERD symptoms; cough worse at night and after meals; PFTs normal.

A 56-year-old man with cavitary lesion in upper lobe and foul-smelling sputum; poor dental hygiene; anaerobes suspected.

A 69-year-old ex-smoker develops new 2.5 cm spiculated upper lobe mass; PET-CT hypermetabolic; no distant disease.

A 23-year-old man with pleuritic chest pain after viral illness; CXR normal; D-dimer mildly elevated; Wells low probability.

A 50-year-old woman with progressive dyspnea; echocardiogram shows elevated pulmonary artery pressure with normal LV function; V/Q scan reveals multiple segmental mismatches.

A 32-year-old man with hemoptysis, dyspnea, hematuria; anti-GBM antibodies positive; CXR: diffuse alveolar hemorrhage.

A 58-year-old man with COPD on home oxygen asks about target saturations.

A 55-year-old man with fever, dry cough, myalgias, and bilateral patchy ground-glass opacities on CT during a community outbreak; rapid antigen test is positive.

A 36-year-old woman with progressive dyspnea and dry cough; HRCT shows perihilar ground-glass opacities and noncaseating granulomas; serum ACE is elevated.

A 69-year-old male smoker presents with hyponatremia (Na 120), low serum osmolality, euvolemia, and a central hilar mass on CT.

A 24-year-old man with suspected PE is hemodynamically unstable; bedside echo shows RV strain; no absolute contraindications.

A 58-year-old woman with recurrent wheeze and cough has normal spirometry but FeNO is high and sputum eosinophils elevated.

A 70-year-old man with community-acquired pneumonia has CURB-65 score of 3 (confusion, BUN high, age ≥65).

A 47-year-old man presents with pleuritic pain and dyspnea; pleural fluid triglycerides 280 mg/dL, milky appearance.

A 33-year-old woman with dry cough, wheeze, and recurrent sinusitis; p-ANCA positive; CT shows bronchiectasis and transient pulmonary infiltrates.

A 59-year-old man with IPF has progressive hypoxemia on exercise; resting PaO₂ is 58 mmHg.

A 66-year-old man with pneumonia develops pleural fluid pH 7.08 and glucose 35 mg/dL, LDH high.

A 25-year-old woman presents with dyspnea after vaping; CT shows bilateral ground-glass opacities; infectious workup negative.

A 41-year-old man with asthma has frequent night awakenings and two steroid-requiring exacerbations despite medium-dose ICS/LABA.

A 50-year-old diabetic with CAP fails to improve after 72 hours; blood cultures negative; CXR shows cavitation.

A 60-year-old man with weight loss and chronic cough has a 2.2 cm spiculated nodule; PET-CT positive; EBUS shows N2 mediastinal nodes.

A 44-year-old man with silicosis (upper-lobe nodules, eggshell calcifications) presents with chronic cough.

A 29-year-old HIV patient (CD4 380) has positive IGRA but normal CXR and no symptoms.

A 63-year-old alcoholic with aspiration risk develops right lower lobe necrotizing pneumonia with air-fluid level.

A 52-year-old woman develops orange discoloration of tears and urine after starting TB therapy.

A 48-year-old man on isoniazid develops numbness and tingling in feet; LFTs are normal.

A 67-year-old COPD patient with frequent exacerbations is on LABA/LAMA; blood eosinophils 380/µL.

A 56-year-old man with pleuritic pain after pancreatitis has sterile exudative pleural effusion with high amylase.

A 31-year-old pregnant woman (24 weeks) with suspected PE is stable; D-dimer elevated.

A 45-year-old man with asthma exacerbation has normal PaCO₂ (40 mmHg) despite tachypnea and accessory muscle use.

A 61-year-old man with chronic cough and heartburn; pH monitoring shows pathologic reflux; cough improves with PPI.

A 72-year-old woman has a 1.2 cm pure ground-glass nodule persisting for 6 months without growth.

A 50-year-old man with hemoptysis and cavitary upper-lobe lesion; sputum AFB negative ×3; IGRA positive.

A 28-year-old woman with acute pleuritic chest pain and pericardial rub; small left pleural effusion; ESR elevated.

A 63-year-old ex-smoker with chronic morning sputum; CT: bronchial wall thickening; no bronchiectasis. Recurrent exacerbations despite LAMA/LABA.

A 57-year-old man with refractory OSA on CPAP has BMI 42 and large tonsils; still AHI high.

A 35-year-old woman with bronchiectasis has three exacerbations/year despite airway clearance; Pseudomonas chronic colonization.

A 46-year-old man presents with subacute cough and low-grade fever after cave exposure; CXR mediastinal adenopathy; urine antigen positive.

A 69-year-old man hospitalized for stroke develops pneumonia after 72 hours; ventilated for 3 days.

A 28-year-old man with cystic fibrosis has persistent colonization with Staph aureus; now with hemoptysis and new infiltrates.

A 61-year-old woman has recurrent exudative pleural effusion; cytology positive for adenocarcinoma; dyspnea persists.

A 52-year-old man with life-threatening asthma exacerbation is intubated; ventilator set with high tidal volume and high rate; peak pressures rise and hypotension develops.

A 66-year-old smoker with chronic cough has sputum cytology showing malignant cells but CT shows no mass.

A 48-year-old woman develops pleuritic chest pain after long flight; D-dimer elevated; CTPA negative for PE; clinical suspicion persists.

A 72-year-old man with COPD exacerbation and atrial fibrillation with RVR is started on a nonselective beta-blocker IV; bronchospasm worsens.

A 60-year-old woman with obesity hypoventilation syndrome has daytime hypercapnia and hypoxemia.

A 51-year-old man on ethambutol reports decreased visual acuity and red-green color discrimination.

A 34-year-old woman with nasal polyps and recurrent wheeze develops bronchospasm after taking ibuprofen for headache.

A 59-year-old man has subacute cough, low-grade fever, and migratory patchy alveolar opacities; no response to antibiotics. Lung biopsy shows intra-alveolar granulation tissue (Masson bodies).

A 68-year-old smoker with COPD has chronic cough and a cavitary right upper lobe lesion; sputum grows Mycobacterium avium complex (MAC).

A 71-year-old thin woman with pectus excavatum has chronic cough; CT shows nodular bronchiectasis in right middle lobe/lingula; sputum positive for MAC.

A 52-year-old man with prior TB presents with recurrent hemoptysis; CT shows fungus ball within an old upper-lobe cavity.

A 36-year-old woman with long-standing asthma has fleeting pulmonary infiltrates, brownish sputum plugs, central bronchiectasis, and total IgE 1500 IU/mL.

A 45-year-old neutropenic patient after chemotherapy develops pleuritic pain, fever, and hemoptysis; CT shows nodules with halo sign.

A 7-month-old infant has first episode of wheeze, cough, and feeding difficulty in winter; RSV antigen positive; SpO₂ 92% on room air.

A 29-year-old trekker at 3200 m develops severe dyspnea, cough with frothy sputum, and hypoxemia; crackles at bases.

A 50-year-old farmer develops cough and dyspnea hours after handling moldy hay; symptoms improve away from work; CT shows ground-glass nodules.

A 46-year-old aerospace worker presents with dry cough and dyspnea; CXR shows hilar adenopathy and interstitial infiltrates; biopsy: noncaseating granulomas; BeLPT positive.

A 58-year-old coal miner has progressive dyspnea; CXR shows small upper-lobe nodules; PFTs show restriction.

A 35-year-old silo worker develops cough, dyspnea, and chest tightness within hours of exposure; CT shows bronchiolitis pattern.

A 62-year-old man with mediastinal fullness, facial plethora, and dilated chest wall veins; CT reveals central mass compressing SVC.

A 67-year-old smoker presents with hypercalcemia, constipation, and a peripheral cavitary lung mass on CT.

A 58-year-old man has proximal muscle weakness that improves with repeated use; reduced reflexes; chest CT shows central mass.

A 64-year-old woman undergoes thoracentesis for large effusion; 2.5 L removed; within hours develops severe cough and hypoxemia; new alveolar edema on CXR.

A 57-year-old man after pneumonia has persistent pleural thickening and trapped lung with dyspnea despite drainage.

A 29-year-old man develops sudden cough and unilateral wheeze after eating peanuts; CXR normal.

A 52-year-old man has acute shortness of breath and pleuritic pain; ABG: PaO₂ 60, PaCO₂ 30, high A–a gradient; CTPA confirms segmental emboli.

A 45-year-old woman with asymptomatic stage I sarcoidosis (bilateral hilar lymphadenopathy only) asks about treatment.

A 28-year-old woman with progressive exertional dyspnea and syncope; echo shows elevated pulmonary artery pressure; V/Q normal, PFTs normal; autoimmunity negative.

A 64-year-old trauma patient has dullness to percussion on the left, hypotension, and decreased breath sounds; bedside US shows pleural fluid with echogenic debris.

A 57-year-old intubated patient for pneumonia is assessed for extubation; good mentation, adequate cough, SpO₂ 95% on FiO₂ 0.35; passed spontaneous breathing trial; cuff leak present.

A 60-year-old man with recurrent DVT/PE is anticoagulated; now has progressive dyspnea 1 year later. V/Q scan shows multiple mismatched defects; echo: pulmonary hypertension.