A patient has the following arterial blood gasses (ABGs): pH 7.30, PaCO$_2$ 50, HCO$_3$ 26. Which diagnosis do these ABGs correlate with?

Choice A rationale

The assertion that persons between 30 and 40 years old are at high risk is incorrect. Shingles is caused by the reactivation of the varicella-zoster virus (VZV), which lies dormant in nerve cells after a person has had chickenpox. The risk of reactivation increases significantly with age, particularly in adults over 50. The immune system's ability to suppress the virus wanes with age, making older adults more susceptible.

Choice B rationale

This statement is inaccurate because the zoster vaccine (Zostavax) is not recommended for all ages. The CDC recommends Zostavax for immunocompetent adults 50 years and older. The newer Shingrix vaccine is now the preferred vaccine for adults aged 50 years and older. It is not approved for use in individuals under 18 years of age and is not a universal recommendation for all ages.

Choice C rationale

This statement is correct because individuals with compromised immune systems, such as those with leukemia, are at significantly higher risk for developing shingles. Leukemia impairs the function of the immune system's T-cells, which are critical for controlling the dormant varicella-zoster virus. The weakened immune response allows the virus to reactivate, leading to a shingles outbreak.

Choice D rationale

The claim that it is only possible to have one episode of the disease is false. While it is less common, recurrent episodes of shingles can occur. The varicella-zoster virus can reactivate multiple times throughout a person's life, especially in individuals with chronic illness or those who are immunocompromised. The risk of recurrence is higher in people with weakened immune systems.

Choice A rationale

Flail chest is the paradoxical movement of a section of the chest wall, caused by multiple rib fractures in two or more places. It is characterized by paradoxical chest wall motion, where the injured segment moves in during inspiration and out during expiration. While it is a severe chest injury, it does not typically involve a large accumulation of blood in the pleural space, which is the defining characteristic mentioned in the patient's presentation.

Choice B rationale

A tension pneumothorax is a life-threatening condition where air enters the pleural space but cannot exit, causing a rapid increase in intrathoracic pressure. This leads to tracheal deviation, hypotension, and profound respiratory distress. While it can cause a collapsed lung and dyspnea, the defining characteristic is air trapping, not blood accumulation in the pleural space, making this diagnosis inconsistent with the patient's specific presentation of hemothorax.

Choice C rationale

A simple pneumothorax is the presence of air in the pleural space, causing the lung to collapse, but without the one-way valve effect seen in a tension pneumothorax. It presents with dyspnea and asymmetrical chest expansion. While it causes a collapsed lung, the defining feature of this patient's case is the presence of a blood accumulation in the pleural space, which is not a hallmark of a simple pneumothorax.

Choice D rationale

A hemothorax is a medical condition characterized by the accumulation of blood in the pleural cavity, which is the space between the lungs and the chest wall. The presence of a collapsed lung, blood accumulation in the pleural space, dyspnea, and asymmetrical chest expansion directly corresponds to the classic presentation of a hemothorax. This diagnosis accurately and completely accounts for all the symptoms described in the patient's clinical scenario. .