A 58-year-old woman with a history of cigarette smoking complains of shortness of breath (dyspnea). Physical examination reveals no signs of congestive heart failure. Radiological abnormalities are limited to evidence of over-inflation of the patient's lungs. Which of the following is the most likely diagnosis?
Allergic granulomatosis
Ashma
Emphysema
Hypersensitivity pneumonitis
Mesothelioma
The Correct Answer is C
A. Allergic granulomatosis: Allergic granulomatosis, or Churg-Strauss syndrome, is a rare vasculitis associated with asthma, eosinophilia, and systemic involvement. It is not typically linked to isolated over-inflation of the lungs or a smoking history, making it unlikely in this patient.
B. Asthma: Asthma involves reversible bronchoconstriction, airway inflammation, and hyperreactivity. Although it can cause episodic dyspnea, it usually presents earlier in life, and radiographs often appear normal between attacks. Chronic lung hyperinflation due to smoking history points toward a different chronic obstructive pathology.
C. Emphysema: Emphysema, a form of chronic obstructive pulmonary disease (COPD), is characterized by destruction of alveolar walls, airspace enlargement, and loss of elastic recoil. Cigarette smoking is the primary risk factor, and over-inflated lungs on imaging, along with dyspnea and absence of heart failure signs, strongly suggest emphysema.
D. Hypersensitivity pneumonitis: Hypersensitivity pneumonitis results from repeated inhalation of organic antigens, causing interstitial inflammation and fibrosis. Imaging typically shows diffuse interstitial infiltrates rather than isolated over-inflation, and a smoking history is not a primary risk factor.
E. Mesothelioma: Mesothelioma is a malignancy of the pleura, often linked to asbestos exposure. It usually presents with pleural effusions, chest pain, and restrictive lung changes, rather than over-inflated lungs, and is not primarily associated with cigarette smoking.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
A. Emphysema:Emphysema involves destruction of alveolar walls and airspace enlargement, leading to dyspnea and decreased gas exchange. While it may contribute to chronic cough, it rarely causes hemoptysis, especially in significant volumes, and is not typically a sudden cause of bloody sputum.
B. Hemothorax:Hemothorax is accumulation of blood in the pleural space, usually due to trauma or vascular injury. It presents with chest pain, hypotension, and respiratory compromise, but blood is not expectorated as sputum, distinguishing it from hemoptysis.
C. Lung cancer:In older smokers with chronic bronchitis, new-onset hemoptysis may indicate an underlying malignancy. Tumors can erode bronchial vessels, causing bleeding into the airway. This is a serious cause of hemoptysis and must be ruled out promptly with imaging and further diagnostic workup.
D. Pneumoconiosis:Pneumoconiosis refers to occupational lung diseases caused by inhalation of dust (e.g., silica, coal). It usually leads to fibrosis and chronic respiratory symptoms, but hemoptysis is uncommon and not typically acute or paroxysmal.
E. Pulmonary abscess:Pulmonary abscesses can cause hemoptysis due to necrosis of lung tissue and infection, but they are less common than lung cancer in older smokers and usually present with fever, purulent sputum, and systemic signs of infection.
Correct Answer is A
Explanation
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.
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