Respiratory disease
Case 8: A Smoker with Dyspnoea
CASE
An 84‐year‐old male with a 40 pack year history of smoking is admitted with dyspnoea. He has had a fever with green sputum for the last 5 days. The patient is a little confused and unable to give a coherent history. However, his daughter says that he is normally independent. There is no significant past medical history and he is on no medication. The patient enjoys going out and walks about 5 km each morning before breakfast. He has not done this for the last week. He is never normally breathless.
On examination the patient is disorientated in time and place. He has a fever of 39.2°C, respiratory rate of 32 breaths/min and oxygen saturations of 80%. There is reduced expansion of the right base, where crackles and a pleuritic rub are audible. There is no evidence of wheeze and expiration is not prolonged. His heart rate is 110 beats/min and blood pressure 120/65 mmHg. Routine blood tests show a normal haemoglobin and platelet count. White blood cells are raised at 18.1 × 109/L (90% neutrophils), the urea is raised at 15 mmol/L, but the creatinine is within the normal range.
QUESTION 1
Your score this session: 0 of 0
What is the likely diagnosis?