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 Best of Five 2.22

 

   

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BOF: 2.22

Your junior calls you up to ask advice regarding a 50-year-old male who has been admitted with a history of cough and breathlessness. He has had an upper respiratory infection for a few days prior to presentation. On the day of presentation he developed a single shaking chill followed by fever. He also complained of cough productive of purulent sputum, right-sided pleuritic chest pain and breathlessness.  On examination he looked unwell, was febrile, had a tachycardia and tachypnoea.  On palpation the trachea was in the midline, respiratory movements were diminished at the right base. There were fine crepitations at the right base. Chest x-ray did not show any abnormality.

Your advice to your junior  would be:

a)      Arrange a right lateral chest x-ray

b)      Repeat the chest x-ray

c)      Arrange a ventilation perfusion scan

d)      Arrange a CT pulmonary angiogram

e)      Arrange a high resolution CT scan

 

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