Respiratory Question Set 2

A 7-month-old girl presents with fever for 1 week. Her mother also complains of failure to thrive. She is found to have a consolidation of the right lower lobe. While checking the chest x-ray, a notable adenopathy in her chest nodules is observed. Gastric aspirates are positive for acid-fast bacilli; however, cultures are still pending. Which of the following is the appropriate life-saving maneuver and according to the choices provided, what is the most important public health intervention?

A 2-year-old baby girl is brought to Emergency Room by her mother because of audible wheezing. The baby has had no previous problems and her immunizations are up-to-date. She looks well; the rectal temperature is 37.8°C, clear nasal discharge is noticed with intercostal retraction. High pitched wheezes are heard over both lung fields. What is the most probable diagnosis?

A 20-year-old man presented with history of recurrent episodes of cough, wheezing and breathlessness since early childhood. He was diagnosed as having bronchial asthma. He was prescribed inhaled corticosteroids for regular use and salbutamol inhaler as a rescue inhaler. Considering pathophysiology, which of the following statements is most appropriate regarding management of bronchial asthma?

A 40-year-old obese man presented with a history of excessive daytime somnolence and easy fatigability. Upon detailed history taking, it was found that his sleep hours were adequate during the night still, he did not have a refreshing sleep. His wife complained that he had troublesome snoring during sleep. After ruling out medical disorders and drug intake, he was advised overnight polysomnogram, which recorded 12 episodes of apnea and 30 episodes of hypopnea during 7 hours of sleep. Which of the following is a most appropriate sentence for the patient?

A 74-year-old man, a known case of small cell lung cancer, presented with acute onset of encephalomyelitis and chorea. As he had painless loss of vision, an ophthalmologist was consulted who diagnosed optic neuritis along with uveitis. Which of the following antibodies is most likely to be present in the serum of the patient?

A 61-year-old man presents with gradually increasing shortness of breath and productive cough for many years. Since last two years, he is having productive cough for most of the days. He is known smoker and smokes 32 pack a year. He has tried nicotine patches and bupropion, but still unable to stop smoking. Physical exam reveals bilateral wheezes. Pulmonary function tests show FEV1/FVC of 55 % with no change in FEV1 after albuterol inhalation. Which of the following is the most likely pathology?

A 57-year-old construction worker presents with gradually worsening shortness of breath for last several months and left pleuritic chest pain for 2 weeks. He denies fever, cough, night sweats, wheezing or smoking. He is recently diagnosed with hypertension and started amlodipine 10 days back. He has been working in construction company for last 25 years and before that he worked at ship dry-dock for 15 years. Physical exam reveals bilateral clubbing and crackles at lung bases bilaterally. Chest x-ray reveals bilateral infiltrates at the lung bases. Pulmonary function tests show slightly increased FEV1/FVC ratio, but total lung volume is decreased. CT scan shows pleural scarring. What of the following conditions is the most likely explanation in this case?

A 72-year-old man presents with shortness of breath and lower chest pain on right side. Physical exam reveals decreased breath sounds and dull percussion at right lung base. Chest X-ray reveals a right-sided pleural effusion. Thoracocentesis was performed. Pleural fluid analysis reveals: Pleural fluid to serum protein ratio = 0.4 Pleural fluid to serum LDH ratio = 0.35 Lactate dehydrogenase (LDH) level = 105 IU (Reference: 100-190). Which of the following disorders is most likely in this patient?

A 29-year-old man presents for the evaluation of infertility. He has history of recurrent lower respiratory tract infections, productive cough, abdominal pain and diarrhea. Physical exam reveals clubbing and bilateral crackles on chest auscultation. Chest x-ray reveals increased pulmonary markings and bronchiolar dilations. High resolution-CT confirms the dilated bronchi with tram track appearances. Which of the following pathophysiology is responsible for the patient’s condition?

A 24-year-old female presents with episodic shortness of breath, chest tightness and wheezing. She has noticed increased frequency of such episodes in the spring season. She also has history of urticaria. She smokes half pack of cigarettes daily for last five years. Her mother also has the similar symptoms. Physical exam is within normal limits. Which of the following findings is characteristic of her condition? (FVC = Forced vital capacity; FEV1 = Forced expiratory volume in 1 second; HRCT = High resolution computed tomography)

A 62-year-old man presents with multiple episodes of hemoptysis since one week. It is associated with generalized weakness, decreased appetite, and 12 pounds weight loss in two months. He has a smoking history of 47 packs in a year. Physical exam reveals pallor; rest is within normal limits. Laboratory studies reveal decreased hemoglobin and a serum sodium value of 115 mEq/L. Chest x-ray shows a 3-cm rounded opaque shadow. Patient is most likely suffering from which of the following conditions?

A baby is born after 32nd gestational week by cesarean delivery. Pregnancy was controlled regularly. Mother suffered from gestational diabetes. She had no other pregnancy related diseases and was otherwise healthy. The child has tachypnea, subcostal and intercostals retraction, nasal flaring and cyanosis. Cyanosis is responding well to initial administration of oxygen. Nasogastric tube was positioned without problems. What is the most likely diagnosis?

A 28-year-old man comes to emergency room because he had difficulty breathing during an exercise session. He is observing a wheezing. Other than that, his physical examination is completely normal. He has always been healthy, he doesn’t suffer any chronic conditions and his family history is unremarkable. He had similar breathing problems before, only during exercise, never during rest. He is not fatigued, doesn’t have fever or respiratory infection signs and symptoms. What is the most likely diagnosis?

A 28-year-old man comes to his GP for a regular checkup. He has had trouble breathing lately with cough, shortness of breath and wheezing. Problems first started when he went running (outside), but he is also observing the problems when he is taking a light walk or is resting. As a child he suffered from atopic dermatitis, just like his father and sister. He also has hay fever since he was 14 years old. What is the most likely cause of bronchospasm he suffers from?

A slender, tall, 32-year-old man comes to emergency room because of sudden chest pain, cough and shortness of breath. On his physical examination, decreased breath sound is noticeable on his right chest. Chest radiography shows translucency on the right side of the chest. His PCO2 is elevated and PO2 is decreased. What is the most likely cause of his symptoms?

A 72-year-old man with heart failure is hospitalized because of respiratory problems. He shows signs of peripheral edema. He has history of hypertension and has had two myocardial infarctions in the last 5 years. What would be expected histopathological finding in his lungs?

A 32-year-old man comes to emergency room because of severe dyspnea, with significantly longer exhalation than inhalation. His forced expiratory time is longer than 6 seconds. He has slight hepatomegaly. Over the course of few years, he has been treated for asthma by several physicians, but his symptoms continue to progress. He doesn’t smoke and never did. His father died early of chronic obstructive pulmonary disorder, as well as his uncle (father’s brother). What could be the cause of his pulmonary disease?

A baby is born after 31st gestational weeks by cesarean delivery. The child has tachypnea, nasal flaring, subcostal and intercostals retraction. Nasogastric tube was positioned without problems. Chest radiography shows bilateral, diffuse, ground-glass appearance, air bronchograms and poor lung expansion. What is the best treatment plan in the present case?

A 26-year-old woman comes to emergency room because she had difficulty breathing during an exercise session. She also has cough. She has end expiratory wheezing, but other than that has normal physical. She had similar breathing problems before, only during exercise, never during rest. She doesn’t have fever or respiratory infection signs and symptoms. What is the best treatment in this case?

A 25 year old woman reports of dyspnea and mild chest pain on exertion which increases gradually if she continues to exert. She had this very same problem last year and her medical history record showed arterial blood gas testing, which revealed pH 7.51, PO2 77 mmHg, and PCO2 32 mmHg. The previous year ECG showed a right axis deviation. Current Chest x-ray shows enlarged pulmonary arteries but no parenchymal infiltrates, and a lung perfusion scan reveals sub-segmental defects that rule out pulmonary thromboembolism. Current ECG shows right heart strain but no evidence of primary cardiac disease. What will be the most logical diagnostic test for this patient?

A 35-year-old male comes to the emergency room due to shortness of breath that started an hour ago while playing football with some friends. He has had such episodes in the past when he had to be rushed to the hospital. On physical examination, his temperature is 37.2 °C (98.96 °F), pulse is 100/min, respirations are 28/min, blood pressure is 110/60 mmHg and decreased breath sounds on both sides. Peak expiratory flow rate is 200 L/min, SpO2 is 89 % on room air. He is given an initial treatment with nebulization using an inhaled short-acting beta agonist. An arterial blood gas analysis shows: pH: 7.48 PaO2: 59 mmHg PaCO2: 26 mmHg HCO3: 26 mEq/L After administering oxygen by mask his PaO2 increases to 75 mmHg. Which of the following is the most likely cause?

A 28-year-old woman consults her doctor for recurrent shortness of breath and coughing up blood for the past three weeks. She also complains of feeling progressively weak during this period. She has been previously healthy and has no relevant past medical history. Her pulse is 80/min, blood pressure is 120/85 mmHg, respirations are 28/min, and temperature is 37 °C (98.6 °F). There are no significant findings in the physical exam. Urinalysis shows: Color: yellow Appearance: clear Glucose: negative Bilirubin: negative Ketone: negative Specific gravity: 1.010 Blood: trace pH: 6.0 protein: negative Urobilinogen: 0.4 mg/dL Nitrite: negative Leukocyte esterase: negative Red blood cells: 5/HPF White blood cells: none seen/HPF Epithelial cells: 2 squamous/HPF Bacteria: Nil Blood test shows: Hemoglobin: 6 mg/dL Hematocrit: 19 % Leukocyte count: 9000/mm^3 Neutrophils: 67 % Lymphocytes: 30 % Monocytes: 3 % Mean corpuscular volume: 85 fl Platelet count: 300,000/mm^3 Creatinine: 3.2 mg/dL Urea: 65 mg/dL Antinuclear antibodies: negative Anti-cytoplasmic antibodies C-ANCA: positive (52U) Plain radiograph of the chest reveals an homogeneous lesion in middle third of left hemithorax. Which is the most likely diagnosis?

A 70-year-old male comes to the office with right sided chest pain and difficulty breathing for the last 10 days. The pain in the beginning was mild but as the days passed by it increased to a level where he started having difficulty breathing. He was diagnosed with clear cell carcinoma of kidney 2 years ago. Vital signs include : blood pressure of 122/80 mmHg, pulse of 72/min, respiratory rate of 16/min and temperature of 37 °C (98.6 °F). On physical examination the trachea appears to be deviated to the left, respiratory movements are diminished, there is decreased resonance on percussion and there is absence of breath sounds over the right hemithorax. Which of the following is the most likely clinical diagnosis?

A 60-year-old woman comes to the emergency room due to progressive shortness of breath and dry cough for the past one week. She says the difficulty in breathing and cough are exacerbated with physical activity and relieved by rest. She was diagnosed with chronic kidney disease two years back and recently had to be started on regular dialysis. Her vitals are temperature: 37.8 °C, blood pressure: 110/70 mmHg, pulse: 105/min and respiratory rate: 30/min. On the examination of the respiratory system, there is dullness on percussion, decreased vocal tactile fremitus and decreased breath sounds over the right lung base. The rest of the physical exam is within normal limits. Which of the following is the most likely cause of this patient’s symptoms?

A six-month-old infant is brought to the physician’s office by his parents due to fever, cough and shortness of breath. The cough is dry and both it and the shortness of breath have been continuously increasing for the past 48 hours. His fever is of low grade and never exceeded 100 °F at home. The parents say that he has also had abundant nasal drainage and loss of appetite. He is irritable and vomited twice during this period. He has no relevant medical or family history. His vitals are: Pulse rate 165/min, Respiratory rate 77/min, Temperature 38 °C (100.4 °F). On physical examination there is nasal congestion with thick secretions with nasal flaring. On chest examination intercostal retractions are seen and diffuse wheezing on both sides are heard on auscultation. What is the most likely cause?

A 14-year-old Latin-American boy is brought to the office by his mother with the complaint of increasing bilateral nasal obstruction for the past five months. He also complains of continuous bilateral nasal discharge. He adds that he no more has any sense of smell of foods. Past medical history is significant for growth retardation and chronic bronchitis at the age of 6. Anterior rhinoscopy reveals multiple semi-transparent, soft and mobile masses in the middle meatus. Which of the following is the most likely etiology of the this patient’s condition?

A 12-year-old boy is brought to the office by his mother with the complaints of clear nasal discharge and cough for past two weeks. The mother adds by saying that her son has pain during swallowing. Also, the boy often complaints of headaches with a mild fever. Although his mother gave him some over the counter medication there was only a slight improvement. Five days ago his nasal discharge became purulent with an increase in the frequency of his cough. He has no relevant medical history. His vitals are a heart rate of 95/min, respiratory rate of 17/min, temperature 37.9 °C (100.22 °F). On physical exploration, he has hyperemic pharynx with purulent discharge on the posterior wall, halitosis, and nostrils with copious amount of pus. Which of the following is the most likely cause?

A 55-year-old Chinese male comes to the office with the complaint of progressive unilateral nasal obstruction for 10 months. Though he was able to tolerate his symptoms at the beginning, he can’t breathe properly through the obstructed nostril anymore. Also, a bloody nasal discharge has started recently through the occluded nostril. He also complaints of double vision during the past two months but did not pay attention to it until now. Past medical history is insignificant except for occasional sore throats. His vitals include a blood pressure of 120/88 mmHg, respiratory rate of 14/min, a pulse of 88/min and a temperature of 37 °C. Blood analysis is as follows: Hemoglobin: 15 g/dL Hematocrit: 46 % Leukocyte count: 15000/mm^3 Neutrophils: 72 % Lymphocytes: 25 % Monocytes: 3 % Mean corpuscular volume: 95 fl Platelet count: 350,000/mm^3 Which of the following viral etiology is most likely associated with the development of this patient’s condition?

A 45-year-old male visits an urgent care clinic as he coughed up blood this morning. Although he had a persistent cough for the past three weeks he had never coughed up blood. His voice is hoarse and admits that it has been like that for the past few month. Both his past medical history and family history are insignificant. He has smoked a packet of cigarettes a day since the age of 20 and drinks wine every night before bed. His vitals are heart rate: 78/min, respiratory rate: 14/min, temperature: 36.5 °C (97.8 °F) and blood pressure: 140/88 mmHg. An indirect laryngoscopy reveals a rough vegetating lesion on the free border of the right vocal cord. Which of the following is the most likely diagnosis?

A newborn born at 33 weeks of gestation has a respiratory rate of 70/min and a heart rate of 148/min two hours after birth. He is grunting and has intercostal and subcostal retractions. He has peripheral cyanosis as well. An immediate chest radiograph is taken which shows a fine reticular granulation with ground glass appearance on both lungs. Which of the following is the most likely diagnosis?

A 30 year-old patient comes to emergency with a chief complaint of left thoracic pain, with cough and purulent sputum for the past week. He also complaints of shortness of breath. He said he had been previously diagnosed with influenza but did not follow the doctor’s instructions. His vitals are: heart rate of 70/min, respiratory rate of 22/min, temperature of 38.7 °C (101.66 °F), blood pressure of 120/60 mmHg and SO2 of 80 %. Hemogram is as follows: Hemoglobin: 14 mg/dL Hematocrit: 45 % Leukocyte count: 12000/mm^3 Neutrophils: 82 % Lymphocytes: 15 % Monocytes: 3 % Platelet count: 270,000/mm^3 Chest x-ray: alveolar infiltrate in the left base with air bronchogram. What is the most likely diagnosis?

A 40-year-old male, comes to the office complaining of chills, fever and productive cough for the past 24 hours. He has a history of smoking since he was 18 years old. His vitals are: heart rate of 85/min, respiratory rate of 20/min, temperature of 39 °C (102.20 °F) and blood pressure of 110/70 mmHg. On physical examination there is dullness on percussion on the upper right lobe, as well as bronchial breath sounds and egophony. The plain radiograph reveals an increase in density with an alveolar pattern in the upper right lobe. Which one is the most common etiologic agent of the suspected disease?

A 20-year-old male military recruit comes to the office with the complaints of a fever and a non-productive cough that started five days ago. He also states having pain during swallowing. He has a mild headache and pain in his left ear. He doesn’t have any relevant past medical history. Vitals include a blood pressure of 120/78 mmHg, a pulse of 100/min, temperature of 100F and respiratory rate for 14/min. Physical exam reveals a congested left tympanic membrane and rhonchi on auscultation of the right lung base. The blood test results are given below: Hemoglobin: 15 mg/dL Hematocrit: 50 % Leukocyte count: 7500/mm^3 Neutrophils: 61 % Bands: 5 % Eosinophils: 1 % Basophils: 0 % Lymphocytes: 28 % Monocytes: 5 % Platelet count: 265,000/mm^3 Low titers of cold agglutinins are detected. His chest radiograph shows poorly defined nodular opacities in the right lower lung zone.Which of the following is the most likely organism responsible for this patient’s condition?

A 62-year-old man presents to the emergency department because of a two-year history of increasing shortness of breath. He also has an occasional nonproductive cough. His symptoms get worse with exertion. His medical history is significant for hypertension and takes chlorthalidone. He is a smoker with a 40-pack-year smoking history. On physical examination, the patient is afebrile, blood pressure is 125/78 mm Hg, pulse rate is 90/min, and respiration rate is 18/min; BMI is 31 kg/m2. Oxygen saturation at rest, breathing ambient air is 94 %. Pulmonary examination reveals decreased breath sounds bilaterally but is otherwise normal with no wheezes or crackles. The remainder of the examination is unremarkable. Chest radiograph shows hyperinflation of both lungs with mildly increased lung markings but no focal findings. Based on this patient's clinical presentation, which of the following is most likely to be found in this patient?

A 27-year-old woman presents to the emergency room with a rash over her shins for the last 3 months. She also has swelling in her knee and wrist joints for a few days. The rash is painful and erythematous. She had an episode of uveitis 6 months ago that was treated with topical therapy. She is not on any medication currently. On further questioning, she says that three weeks ago she went on hiking with her family and found a tick attached to her left thigh. Her blood pressure is 135/85 mmHg, pulse is 85/min, respiratory rate is 12/min. Physical examination shows swelling of ankle, knees and wrists on both sides and well demarcated papules over the anterior aspect of both legs. A chest X-Ray is performed which reveals bilateral hilar lymphadenopathy. Which of the following is the pathophysiologic mechanism behind this patient’s condition?

A 64-year old male presents to his primary care physician for follow up of a severe, unrelenting, and productive cough which he has been having on and off for the last 2 years. His past medical history includes diabetes mellitus type II that is well controlled on insulin. He has a 25 pack-year smoking history and is an active smoker. His blood pressure is 135/88 mmHg, pulse rate is 94/min, temperature is 98.5 F, and respiratory rate is 18/min. Bilateral wheezes and crackles are heard upon auscultation. A Chest X-Ray reveals cardiomegaly, increased lung markings and flattened diaphragm. Which of the following is most likely to be found in this patient?

A 68-year-old male presents to the emergency department due to difficulty in breathing for the past 2 days. He has had recurrent episodes of bacterial pneumonia during the last 6 months in the right lower lobe. His last episode of pneumonia started 7 days ago for which he is being treated with antibiotics. He has a 35-pack year smoking history. Past medical history is significant for hypertension for which he takes lisinopril. Physical examination reveals decreased breath sounds and dullness to percussion in the right lung base. Chest X-Ray reveals a pleural effusion. Cytologic examination of pleural fluid shows evidence of malignancy. Which of the following is the most likely diagnosis of this patient?

A 72-year-old man presents to your office with a caregiver for a follow up after a CT of the chest revealed numerous lesions to the lung parenchyma bilaterally. The CT was ordered after the patient experienced persistent cough with hemoptysis with multiple episodes of pneumonia over the past year. The patient has a history of dementia and is a poor historian. The caregiver states that the patient has no history of smoking and that he was a lawyer before he retired 10 years ago. The caregiver can give a limited medical history but states that the patient sees another doctor “to monitor his prostate.” Which of the following is true regarding the pathogenesis of the tumors seen in this patient?

A 27-year-old woman presents to your office complaining of difficulty swallowing due to feeling “there is something in there” and an “achy” chest pain that has been getting progressively worse of the last few weeks. She denies fever, shortness of breath, cough, abdominal pain, heartburn, nausea, or vomiting. The patient has a history of wrist fracture as a child, migraines, and a recent diagnosis of myasthenia gravis. Which of the following is the most likely diagnosis?

A 36-year old man presents with increasing shortness of breath since last month. This issue gets worse while walking and climbing upstairs. He also complains of pain and stiffness in both wrists and the distal Interphalangeal and metacarpophalangeal joints of both hands. He was diagnosed with rheumatoid arthritis six months ago and was started on methotrexate with some success. He is a lifetime non-smoker and has no drug abuse history. His family history is not significant for any chronic disease. Blood pressure is 135/85 mmHg, pulse rate is 90/min, the temperature is 98.5 F, and respiratory rate is 22/min. Physical examination reveals short rapid breathing and fine end-inspiratory rales, but the patient reports no distress. Chest X-Ray shows diffuse bilateral reticular markings and pulmonary nodules. Which of the following is the most likely cause of this patient’s lung condition?

A 50-year-old man is evaluated for a 2-year history of intermittent, nonproductive, chronic cough, as well as mild dyspnea with exertion. He has a 20-pack-year history of smoking and is a current smoker. His medical history is significant for hypertension and diabetes mellitus type 2 which he has controlled with diet and exercise. He also takes lisinopril. On physical examination, blood pressure is 125/76 mmHg, pulse rate is 78/min, respiration rate is 15/min, oxygen saturation is 98%, breathing room air and his BMI is 25. There is no jugular venous distention. Heart sounds are normal, and there is no murmur. The lungs are clear. No peripheral edema is noted. The remainder of the examination is normal. Which of the following is most likely to confirm the diagnosis in this patient?

A 60-year old man presents with a two-day history of increasingly difficulty breathing with a productive cough. He reports of having shortness of breath over the last six months but he has felt worse since he contracted a cold that has been traveling around his office. Today he reports body aches, headache and fever along with this chronic cough. His past medical history is significant for prediabetes which controls with exercise and diet. He has 30 pack year smoking history. His blood pressure is 130/85 mm Hg, pulse rate is 90/minute, temperature is 98.5 F, and respiratory rate is 18/minute. Physical examination reveals diminished breath sounds bilaterally, a barrel-shaped chest, and measured breathing through pursed lips. A chest X-Ray reveals a flattened diaphragm and no signs of consolidation, pulmonary function test reveals FEV1/FVC of 60 %. Arterial blood gases (ABG) of this patient are most likely to reveal which of the following?

A 56-year-old man comes to the clinic for a check-up. A brief records review shows a 1-year history of worsening shortness of breath and weight loss. He is a former construction worker and worked in a steel mill when he was in high school. He is an active smoker with a 36-pack-year smoking history. On physical exam, the patient is afebrile, blood pressure is 130/78 mmHg, pulse rate is 90/min, and respiratory rate is 17/min; BMI is 31. Oxygen saturation at rest is 95 % on room air. Pulmonary examination reveals a mildly prolonged expiratory phase, no wheezes or crackles are auscultated. You recommend a pulmonary function test. Two weeks later he returns with a report that shows an FEV1/FVC ratio of 60% and FEV1 of 50 % of predicted value. Lung volumes show a total lung capacity of 110 % of predicted value, a residual volume of 115 % of predicted value, and a DLCO of 60 % of predicted value. Which of the following is the most likely diagnosis?

A 51-year-old woman is brought to the emergency department due to an aggressive cough with lots of thick, foamy yellow-green sputum. She says she has had this cough for about 11 years with exacerbations, like today. Also, she reports that the cough is worse in the morning. She was evaluated multiple times in the past several years because of recurrent bouts of bronchitis that have required treatment with antibiotics. She is a non-smoker. On physical exam, her blood pressure in 125/78 mm Hg, pulse rate is 80/min, respiratory rate is 16/min, and the temperature is 98 F. Chest auscultation reveals crackles and wheezing over the right middle lobe and the rest of physical examination shows normal findings. Chest X-Ray shows irregular opacities in the right middle lobe and diffuse airway thickening. Based on this history and physical exam, which of the following is the most likely diagnosis?

A 70-year-old Caucasian woman presents to the emergency department complaining of blood tinged sputum on several occasions during last two weeks. She also complains of unintentional weight loss of 15 lbs in the last five months. Her past medical history is significant for peptic ulcer disease for which she even underwent triple drug therapy. She is a lifetime non-smoker and worked as a teacher before retiring at the age of 60. Her temperature is 98.5° F, blood pressure is 128/82 mm Hg, pulse is 67/min, respiratory rate is 15/min, and oxygen saturation breathing room air is 90%. The cardiac and pulmonary examination does not reveal any abnormal finding. CT scan of the lungs shows an irregular mass in the peripheral region of inferior lobe of the right lung and a CT guided biopsy is positive for malignant tissue architecture and gland formation with significant amount of mucus. Which of the following risk factors most likely predisposed this patient to her condition?

A 65- year old man is admitted to the hospital with a five-week history of a progressive cough with blood mixed sputum and worsening shortness of breath. He also complains of difficulty climbing stairs and rising up from a chair. Before the onset of these symptoms, he felt fatigued all day long for the past six months. He has a 40 pack-year smoking history. His past medical history is insignificant and he is not taking any medication currently. His blood pressure is 135/85 mmHg, temperature is 99.8 F, pulse is 95/min, and respiratory rate is 18/min. Physical examination reveals proximal muscle weakness in both upper and lower limbs. Chest radiograph shows a right hilar mass. CT Scan of the chest confirms an eight-centimeter right hilar mass adjacent to the mediastinum. A biopsy of the mass reveals chromogranin positive oval cells. Which of the following is the most likely diagnosis?

A 28-year-old woman consults her doctor for recurrent shortness of breath and coughing up blood for the past three weeks. She also complains of feeling progressively weak during this period. She has been previously healthy and has no relevant past medical history. Her pulse is 80/min, blood pressure is 120/85 mmHg, respirations are 28/min, and temperature is 37°C (98.6°F). There are no significant findings in the physical exam. Urinalysis shows: Color: Yellow Appearance: Clear Glucose: Negative Bilirubin: Negative Ketone: Negative Specific gravity: 1.010 Blood: Trace pH: 6.0 protein: Negative Urobilinogen: 0.4 mg/dL Nitrite: Negative Leukocyte esterase: Negative Red Blood Cells: 5/hpf White Blood Cells: None seen/hpf Epithelial cells: 2 squamous/hpf Bacteria: Nil Blood test shows: Hemoglobin: 6 mg/dL Hematocrit: 19 % Leukocyte count: 9000/mm^3 Neutrophils: 67 % Lymphocytes: 30 % Monocytes: 3 % Mean corpuscular volume: 85 fl Platelet count: 300,000/mm^3 Creatinine: 3.2 mg/dL Urea: 65 mg/dL Antinuclear antibodies: Negative Anti-cytoplasmic antibodies C-ANCA: Positive (52U) Plain radiograph of the chest reveals an homogeneous lesion in middle third of left hemithorax. Which is the most likely diagnosis?