QuestionSBA
QuestionChoice
Pulmonary embolism would rarely cause such significant pyrexia. Sudden-onset shortness of breath, pleuritic chest pain, and haemoptysis are the classic symptoms of pulmonary embolism, none of which are mentioned here.
10005302
b
Pulmonary embolism
QuestionChoice
Fibrosis would be very unlikely to make a patient so acutely unwell within 24 hours as it is usually a slowly progressive condition. Additionally, chest x-rays commonly show bilateral lower zone reticulo-nodular shadowing.
10005305
e
Idiopathic pulmonary fibrosis
QuestionChoice
Aspiration pneumonia is seen in patients with a dysfunctional or unsafe swallow. Examples include stroke (as in this case), myasthenia gravis and bulbar palsy. This patient is septic, most likely as a result of their aspiration pneumonia. On the chest x-ray, the right lower lobe is most frequently involved in aspiration pneumonia, in fitting with this case.
10005301
a
Aspiration pneumonia
QuestionChoice
Lung cancer is unlikely to cause such significant pyrexia without concomitant pneumonia. Chest malignancy would also be unlikely to cause hypotension so quickly.
10005303
c
Lung malignancy
QuestionChoice
Patients with acute pulmonary oedema usually present with dyspnoea, orthopnoea and ankle swelling. Pyrexia and hypotension are not typical features.
10005304
d
Pulmonary oedema
Concept
Chapter
2693
4389
Aspiration Pneumonia
Topic
132
Respiratory
13607
A 68-year-old female well-known to speech and language therapy for numerous swallow assessments following a recent stroke is seen by the junior doctor on the ward. The nurses were concerned as her temperature was 40 degrees, her respiratory rate was 24 with oxygen saturations of 87% on air, and her systolic blood pressure was 92mmHg. Her observations were normal 24 hours ago. The junior doctor arranged an urgent chest x-ray which has revealed new consolidation of her right middle and lower zones.

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