A chronic smoker with Hemoptysis

45 years old male smoker presented with Exertional Breathlessness, cough, wheeze . Examination revealed HR 76/min, BP 120/70 mmhg, Mild darkish fingertips, he has short systolic murmur . Lung few scattered rhonchi. ECG& X Ray taken. What is your impression and how do you approach

A 58 year old male chronic smoker 2 pack on monthly basis, smoking more than 12 years ago with hypertension and gastroesophageal reflux. His presenting symptoms are dyspnea for the past 6 months, dry cough for 2 and half years, and fatigue. He denies sputum, hemoptysis, or wheezing. In addition, he says that he has no fever, chills, chest pain, ankle swelling, or weight loss. Previous treatments taken antibiotics, bronchodilators, antacid Current medications: omeprazole 20 mg daily, lisinopril 20 mg daily Work history: He works as a assistant manager in a local bank. No chemical or welding exposures. Family history: He does not have any history of lung disease in his family. Physical examination: Breath sounds bilateral crackles at the bases. No rhonchi, no wheezing was heard. Cardiac and abdominal exams are normal. Very light clubbing of fingertips, normal coloration, no rashes and no joints swelling was seen. In office spirometry FEV1/FVC ratio 86%, FVC 53% and FEV1 58%. On 5 minutes walking patient experiences some dyspnoea. Chest X ray PA and lateral views show bilateral decreased lung volume with increased linear markings in peripheral lower lung areas. No vascular crowding. Cardiac stress test was found normal. Please make diagnosis and management.

40 yr old male uncontrolled diabetic , non smoker with h/o fever 2 months , on and off cough , weight loss . No h/o chest pain/ hemoptysis/dyspnea. No significant past h/o respiratory illness .

50/F C/0 Chest pain left side on & off x 4months. No h/o fever, cough, dyspnea, hemoptysis.

### 65 years old lady was brought to OPD with the chief complaint of chest pain on and off since 2 years, associated with burning sensation. Fever is present more or less all the time. No history of cough, hemoptysis, weight loss. No other significant history. In CT Thorax, it has been found that patchy consolidation is present in all the lines in both lungs along with subpleural consolidation in both lungs. What should be the next step ???