CCS Practice Test 5

Discharge summary (attending physician)

A 69-year-old woman with COPD presented with 3 days of increasing dyspnea and wheezing. She does not use home oxygen and has no history of chronic respiratory failure. In the ED, SpO2 was 82% on room air and arterial PO2 was 51 mm Hg. She was admitted to the ICU for acute hypoxic respiratory failure due to an acute exacerbation of COPD and required BiPAP for 36 hours, plus systemic steroids and scheduled nebulizers.

An indwelling urinary catheter was placed in the ICU on day 1 for strict intake and output. On day 4 she developed fever of 38.4 °C and dysuria; urinalysis was positive and the urine culture grew more than 100,000 CFU/mL. Catheter-associated urinary tract infection; catheter removed and IV antibiotics started.

Chest x-ray: hyperinflation, no infiltrate.

Final diagnoses: 1. Acute hypoxic respiratory failure due to acute exacerbation of COPD. 2. Catheter-associated urinary tract infection (not present on admission). 3. Hypoxemia.