A 30-year-old man presented to the chest clinic with a chronic productive cough and increasing breathlessness. He had had a history of recurrent chest infections since childhood. He and his partner had recently been referred for fertility treatment.



On examination, he had finger clubbing and scattered crackles throughout both lung fields.



What is the most likely diagnosis?

A 60-year-old man with type 2 diabetes mellitus was admitted with a 4-day history of cough, chest pain and loss of diabetic control.



Investigations showed a right-sided empyema.



What is the most likely infecting organism?

A 56-year-old man presented with shortness of breath.



Investigations:



lung function tests:



                          actual                        % predicted                   SR*

FEV1                   0.96L                                 28                       –4.9

FVC                     2.24 L                                52                       –3.4

residual volume    3.52 L                               153                      +3.0

TLC                     5.89 L                                 84                      –1.6

transfer factor

 for CO (TLCO)   4.25 mmol/min/kPa               43                       –4.0

transfer 

coefficient (KCO)  1.00 mmol/min/kPa/L           68                       –1.7



*SR = standardised residual. Normal range for all parameters is –1.64 to +1.64.



What is the most likely diagnosis?

A 65-year-old smoker attended the outpatient clinic with a 2-week history of “pressure in the head”.



On examination, he had clinical signs of superior vena caval obstruction.



A CT scan of the chest showed that the superior vena cava was compressed by a tumour in the right upper lobe of the lung, and there was also evidence of a clot within the vessel. A bronchoscopy showed a tumour in the right upper lobe bronchus and biopsies confirmed that this was a small cell carcinoma of the bronchus.



What is the most appropriate management?