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Question 1

A 68-year-old patient presents to Accident and Emergency following a two week history of productive cough, fever and shortness of breath. The patient has had a similar episode of these symptoms two years ago, which required a hospital admission.

Observations are taken and are recorded as follows:

HR: 104bpm
RR: 25
BP: 100/72 mmHg
SpO2: 91% on air
Temp: 38.5C
What is the next best investigation to carry out?

Answer 1

Arterial Blood Gas (ABG)

This is the correct answer. The patient has presented with a pneumonia. However, when assessing unwell patients as a doctor a DR ABCDE approach must be adopted. The Airway and Breathing must be seen to as hypoxia kills. Therefore, as the patient has an oxygen saturation of <92% they require an ABG to be done prior to ordering any further investigations. This will allow us to assess their oxygenation and plan any further airway management from high flow oxygen mask, to invasive ventilation in serious cases.

NOT FBC/SPUTUM

Question 2

Gold standard test for sarcoidosis

Answer 2

Bronchoscopy with a transbronchial lung biopsy.

Definitive diagnosis of sarcoidosis is achieved through a biopsy showing non-caseating granulomas.