MRCP2-3000

MRCP2-3000

A 67-year-old man presents with left arm pain that starts in the shoulder and spreads to the ring and little fingers. The pain has been getting worse over the past four weeks, making it difficult for him to sleep at night. Despite taking co-codamol prescribed by his GP, he has not experienced any relief.

The patient has a history of smoking for 40 pack years, hypertension, and a heart attack five years ago. He reports losing 2 stone in weight over the last three months, despite increasing his food intake. He also has a productive cough with occasional streaks of blood.

During the examination, the patient is able to move his left shoulder, elbow, and wrist without any tenderness, but he experiences pain when not moving. He has some weakness in his left biceps, with a diminished reflex and reduced sensation in the fourth and fifth fingers when touched lightly. The limb has normal pulses and capillary refill time, with no swelling. The patient has crepitations in the left upper zone and clubbing.

The patient’s blood test results show a low hemoglobin level, elevated CRP, and consolidation seen in the left upper zone on chest x-ray. Based on these findings, what is the likely diagnosis?