MEDizzy
MEDizzy
USMLE
Respiratory medicine
A 45 year old man has returned home from a holiday in Spain with a dry cough, left-sided pleuritic chest pain and fever. He had started some amoxicillin he bought whilst in Spain. He has been sent to the medical assessment unit after a family physician visit at home where he was found to be quite muddled. He has a fever of 39.5°C and oxygen saturations of 85% on air. Respiratory rate is 26 breaths/min, BP 103/63 mmHg, pulse 112 beats/min. Examination reveals left-sided bronchial breathing with increased vocal resonance. Blood tests reveal: haemoglobin 143 g/L, WCC 12 × 109 /L (neutrophilia), platelets 435 × 109 /L, urea 9 mmol/L (54 mg/dL), creatinine 102 μmol/L (1.15 mg/dL), sodium 128 mmol/L, bilirubin 12 μmol/L (0.70 mg/dL), alanine transaminase (ALT) 243 U/L, γ-glutamyl transferase (GGT) 354 U/L, alkaline phosphatase 250 U/L, CRP 334 mg/L. Diagnosis?
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