USMLE® Step 1 style questions USMLE
USMLE® Step 2 style questions USMLE
A 45-year-old man comes to the emergency department after being pulled from a burning upholstery factory in the city. He is very anxious when he is being interviewed and complains of headache, nausea, and a metallic taste in his mouth. His temperature is 37.1 oC pulse is 110/min, a respiratory rate of 24/min, and blood pressure of 148/70mmHg. He is put on pulse oximetry and it shows an oxygen saturation of 96% on room air. Physical examination shows a confused man with soot visible in the nares and mouth. He also has a breath odor of bitter almonds. Respiratory examination shows decreased air entry bilaterally with some diffuse wheezes. His arterial blood gas sample shows a serum lactate of 11mmol/L. Which of the following is the most likely explanation for the patient's physical findings?