QuestionSBA
QuestionChoice
This is incorrect. While a panic attack may cause shortness of breath and hyperventilation, it is not associated with a cough or with type two respiratory failure as shown on the ABG. The patient is more likely to be suffering from an exacerbation of COPD.
10027684
d
Asthma
QuestionChoice
This is incorrect. The patient presents with globally reduced breath sounds which is likely due to limitations in airflow or poor sound transmission in COPD. In pleural effusion, breath sounds are usually reduced or absent over one area and percussion would generate a stony dull note.
10027685
e
Pleural effusion
QuestionChoice
This is incorrect. While a panic attack may cause shortness of breath and hyperventilation, it is not associated with a cough or with type two respiratory failure as shown on the ABG. The patient is more likely to be suffering from an exacerbation of COPD.
10027682
b
Panic attack
QuestionChoice
This is incorrect. Although pulmonary fibrosis is also associated with a cough and shortness of breath, this is associated with restrictive rather than obstructive changes on spirometry. The lack of exposure to occupational triggers or pets is another clue that COPD is a more likely diagnosis.
10027683
c
Pulmonary fibrosis
QuestionChoice
This is correct. It is likely that the patient is suffering from an exacerbation of COPD. The ABG demonstrates a type two respiratory failure with hypoxia and hypercapnia. There is some metabolic compensation, meaning it is likely that the respiratory derangement is chronic.
10027681
a
Chronic Obstructive Pulmonary Disease (COPD)
Concept
Chapter
2693
5996
Chronic Obstructive Pulmonary Disease
Topic
132
Respiratory
Chronic Obstructive Pulmonary Disease (COPD)
17934
A 67 year old male attends A&E with worsening shortness of breath and a productive cough for one month. He has no significant medical history or medication allergies. A former smoker (10/day for 30 years), he quit at 45. He denies asbestos exposure or owning pets.

On examination, the patient uses accessory muscles to breathe, with decreased breath sounds and a loud bilateral wheeze. Percussion is resonant.




Spirometry shows an obstructive pattern of lung disease. An arterial blood gas (ABG) gives the following results:



||||
|--------------|:-------:|------------------|
|pH|7.23|7.35 - 7.45|
|PaO₂|9 kPa|11 - 15|
|PaCO₂|8.9 kPa|4.6 - 6.4|
|Bicarbonate|28 mmol/L|22 - 30|
|Base Excess|+3 mmol/L|-2 to +2|


Which of the following is the most likely underlying diagnosis?
a