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Question 1

Why can COPD falsely elevate BNP levels?

Answer 1

BNP is primarily released from ventricular myocytes in response to increased wall tension and volume overload. In COPD, particularly during exacerbations, patients can develop pulmonary hypertension and right ventricular strain, which can lead to increased BNP production. Additionally, the hypoxia and inflammatory state associated with COPD can directly stimulate BNP release.

Question 2

Legionella infection features

Answer 2

flu-like symptoms including fever (present in > 95% of patients)
dry cough
relative bradycardia
confusion
lymphopaenia
hyponatraemia
deranged liver function tests
pleural effusion: seen in around 30% of patients