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Category Medical Specialty
Pulmonary Puzzler 340

Rapid descent

A 30 year old male presents with a 3 day history of fevers and increasing breathlessness. On presentation he is noted to be severely hypoxic with sats of 80% on room air. The following chest X-ray is obtained:
Pulmonary Puzzler 340

Collapse and recruit

A 19 year old male is admitted after a severe traumatic brain injury. Due to refractory intracranial hypertension he is intubated and receiving 20mg an hour of morphine, 20mg an hour of midazolam and 200mg an hour of propofol.
Pulmonary Puzzler 340

A Case of CO2 Narcosis

A 67 year old gentleman with a BMI of 45 was waiting for his respiratory outpatient clinic appointment. While waiting, he fell asleep. A medical emergency was called because he could not be woken up.
Pulmonary Puzzler 340

Pulmonary panic

A 17 year old female with a background history of HIV presents with a 3 day history of fevers, chills and rigors. Her admission chest X-rays are shown below:
Pulmonary Puzzler 340

Ballooning Up

A 36 year-old immunosuppressed male was infected with swine-origin influenza virus requiring mechanical ventilation. Overnight the inspiratory pressures needed to maintain his tidal volume had progressively increased and his face had become markedly swollen.
Pulmonary Puzzler 340

Pneumonia gone bad

Consider a 56 year old male with no past medical history presenting with 10 days of fevers, chills, myalgia and cough followed by worsening breathlessness over the past 4 days.
Pulmonary Puzzler 340

Not just a PE

A classic respiratory case. This 25 year old female presented with worsening breathless. She has no previous medical problems.
Pulmonary Puzzler 340

Not just pneumonia

A 30 year-old male presented with 24 hours of worsening respiratory distress, following a 5-day prodrome of cough, fever, diarrhoea, lethargy and malaise.
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Pott fracture

Archaic eponym: Effectively a fracture-dislocation of the ankle, involving a fracture of the fibula, disruption of the deltoid ligaments with an intact tibiofibular ligament
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Bosworth fracture

Bosworth fracture-dislocation of the ankle. Rare injury with proximal fibular fragment trapped behind the tibia, frequently irreducible by closed methods.