A 65-year-old woman presents to the Emergency Department with shortness of breath after being sat at home.
An arterial blood gas (ABG) is performed and shows the following results:
Investigation Result Normal value
pH 7.48 7.35–7.45
pO2 7.3 kPa 10.5–13.5 kPa
pCO2 3.9 kPa 4.6–6 kPa
HCO3 24 mmol/l 24–30 mmol/l
Which one of the following conditions is most likely to account for these investigation results?
A 65-year-old man with rheumatoid arthritis has been on long term therapy to manage his condition. He complains of worsening shortness of breath and a chest x-ray reveals ‘bilateral interstitial shadowing’. Which medication is the probable culprit for his symptoms?
You are on call in the Emergency Department when an ambulance brings in an elderly man who was found unconscious in his home, clutching an empty bottle of whiskey. On physical examination, he is febrile with a heart rate of 110 bpm, blood pressure of 100/70 mmHg and pulse oximetry of 89% on room air. You hear crackles in the right lower lung base and note dullness to percussion in those areas. His breath is intensely malodorous, and there appears to be dried vomit in his beard.
What is the most likely organism causing his pneumonia?
A previously fit 36-year-old man presents to his general practitioner (GP) with a 4-day history of shortness of breath, a productive cough and flu-like symptoms. There is no past medical history of note. He is a non-smoker and exercises regularly. On examination, he appears unwell. There is reduced chest expansion on the left-hand side of the chest and a dull percussion note over the lower lobe of the left lung. The GP suspects a lobar pneumonia.
Which organism is likely to be responsible for this patient’s symptoms?
After a tennis match, a thin 25-year-old woman complains of left-sided chest pain that radiates into her abdomen. The physical examination reveals reduced air entry at the left base of the lung with hyper-resonant percussion sounds at the left side of the chest. The abdominal examination shows generalised tenderness. A few minutes later she develops cyanosis.
What is the diagnosis?
A 55-year-old woman presents with 6 months of recurrent episodes of shortness of breath. She describes it as ‘coming on suddenly without warning’. They have woken her at night before. She describes the attacks as a ‘tightness’ in the chest and says that they are associated with tingling in her fingers. The episodes resolve in a few minutes by themselves. She is otherwise medically fit and well. She smokes 15 cigarettes per day and has a family history of asthma. Examination is normal, and the peak expiratory flow rate is normal for her age and height.
Which of the following is the most likely diagnosis?
A 30-year-old woman with asthma presented with rapidly developing asthma and wheezing. She was admitted, and during her treatment, she coughed out tubular gelatinous materials. A chest X-ray showed collapse of the lingular lobe.
What is this clinical spectrum better known as?
A 28-year-old Afro-Caribbean lady undergoes a routine chest X-ray during a career-associated medical examination. The chest X-ray report reveals bilateral hilar lymphadenopathy. On closer questioning the patient admits to symptoms of fatigue and weight loss and painful blue-red nodules on her shins.
What is the most likely diagnosis in this case?
A 45-year-old male patient complains of worsening breathlessness and weight loss over the past two months. During examination, scattered wheezing, coughing, and fever are observed. A chest x-ray reveals pneumonic shadowing, and there are several tender subcutaneous nodules and a purpuric rash. What is the most probable diagnosis?
What condition is typically linked to obstructive sleep apnea?