A 50-year-old alcoholic man was brought to the Emergency Department in respiratory distress, complaining of stabbing chest pain on inspiration and sudden onset chills. He was running a high fever (104°F), coughing, and expectorating a thick yellow- green sputum. Which of the following is the most likely cause of his respiratory distress?
Bacterial pneumonia
Chronic bronchitis
Emphysema
Laryngitis
Metastatic lung cancer
The Correct Answer is A
A. Bacterial pneumonia: This patient presents with acute onset of fever, chills, pleuritic chest pain, productive purulent sputum, and respiratory distress, all of which are classic signs of bacterial pneumonia. Alcoholism predisposes individuals to aspiration and impaired immune defenses, increasing the risk of bacterial lung infections, particularly from anaerobic or gram-negative organisms.
B. Chronic bronchitis: Chronic bronchitis is defined by a productive cough lasting at least three months per year for two consecutive years. While it causes chronic cough and sputum production, it does not typically present acutely with high fever, chills, and severe respiratory distress.
C. Emphysema: Emphysema involves chronic destruction of alveolar walls leading to dyspnea and hyperinflated lungs. It is a chronic, progressive disease and does not present with acute febrile illness or purulent sputum.
D. Laryngitis: Laryngitis affects the upper airway, causing hoarseness, sore throat, and cough. It does not cause purulent sputum, high fever, or severe dyspnea, and it is not a primary cause of lower respiratory distress.
E. Metastatic lung cancer: Metastatic lung cancer can lead to cough, hemoptysis, or dyspnea over weeks to months but usually does not cause sudden-onset fever, chills, and thick purulent sputum. The acute presentation points toward an infectious etiology rather than malignancy.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is E
Explanation
A. Aspergillosis:Aspergillosis is a fungal infection that can produce invasive pulmonary disease or aspergillomas in pre-existing cavities. It does not produce a Ghon focus or the peripheral, well-circumscribed nodule typical of primary tuberculosis.
B. Histoplasmosis:Histoplasmosis, caused by Histoplasma capsulatum, can produce granulomatous lesions in the lungs, sometimes resembling a Ghon focus. However, the classic Ghon focus is specifically associated with Mycobacterium tuberculosisinfection.
C. Legionella:Legionella pneumophilacauses Legionnaires’ disease, a severe bacterial pneumonia with systemic symptoms. It does not form localized Ghon foci or granulomatous lesions in the lungs.
D. Pneumocystis:Pneumocystis jiroveciicauses diffuse interstitial pneumonia, especially in immunocompromised individuals. It does not form well-circumscribed peripheral nodules or granulomas.
E. Tuberculosis:A Ghon focus, localized, well-circumscribed, pale-white nodule, is the hallmark lesion of primary tuberculosis, consisting of a caseous necrosis in the lung periphery, often with involvement of regional hilar lymph nodes. This lesion represents the initial site of infection by Mycobacterium tuberculosis, making tuberculosis the correct association.
Correct Answer is D
Explanation
A. Cardiac tamponade:Cardiac tamponade occurs when fluid accumulates in the pericardial sac, compressing the heart and reducing cardiac output. Gross pathology shows pericardial effusion rather than a localized area of myocardial necrosis, making it an unlikely cause here.
B. Congestive heart failure:Congestive heart failure results from chronic ventricular dysfunction and presents with pulmonary congestion, peripheral edema, and hepatomegaly. It does not produce a well-demarcated, yellow-tan area of necrosis in the ventricular wall.
C. Hypovolemic shock:Hypovolemic shock is due to severe blood or fluid loss, leading to systemic hypotension and multi-organ hypoperfusion. The heart itself does not show a focal infarct as seen in this autopsy finding.
D. Myocardial infarction:A myocardial infarction occurs when coronary artery obstruction causes ischemic necrosis of the myocardium. The gross pathological finding of a well-defined yellow-tan area in the left ventricular wall corresponds to coagulative necrosis following MI and is the most likely cause of death in this patient.
E. Pulmonary thromboembolism:Pulmonary thromboembolism involves obstruction of pulmonary arteries by thrombus, which can cause acute right heart strain and sudden death. It does not produce a focal infarct in the left ventricular wall.
Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.
Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today
Report Wrong Answer on the Current Question
Do you disagree with the answer? If yes, what is your expected answer? Explain.
Kindly be descriptive with the issue you are facing.