A 62-year-old chronic smoker became hoarse and after a few days could not speak at all. What pathologic finding would account for these symptoms?
Bronchial asthma
Chronic bronchitis
Goodpasture syndrome
Laryngeal cancer
Pulmonary thromboembolism
The Correct Answer is D
A. Bronchial asthma: Asthma involves reversible airway obstruction due to bronchospasm and inflammation. While it can cause wheezing and shortness of breath, it does not typically result in sudden hoarseness or loss of voice.
B. Chronic bronchitis: Chronic bronchitis is a long-standing productive cough with mucus hypersecretion. It can cause throat irritation but does not usually produce acute hoarseness or aphonia.
C. Goodpasture syndrome: Goodpasture syndrome is an autoimmune disorder affecting the kidneys and lungs, causing hematuria and pulmonary hemorrhage. It does not involve the larynx or vocal cords and would not produce hoarseness or voice loss.
D. Laryngeal cancer: Laryngeal cancer, particularly in chronic smokers, commonly presents with progressive hoarseness due to involvement of the vocal cords. Tumor growth can eventually obstruct the vocal cords, leading to aphonia. These symptoms align with the patient’s history of hoarseness progressing to inability to speak.
E. Pulmonary thromboembolism: Pulmonary embolism causes sudden dyspnea, chest pain, and hypoxia, but it does not directly affect the larynx or vocal cords and would not account for hoarseness or voice loss.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
A. Cryptococcus neoformans:Cryptococcusinfection usually affects immunocompromised patients, particularly causing meningoencephalitis. Pulmonary involvement can occur, but it typically presents with localized nodules or consolidations, not diffuse interstitial infiltrates with foamy intra-alveolar exudate.
B. Mycoplasma pneumoniae:Mycoplasma pneumoniaecauses atypical pneumonia, often in young, otherwise healthy adults. It produces mild interstitial infiltrates and dry cough but is not associated with severe immunosuppression or the foamy alveolar exudate seen in AIDS patients with low CD4+ counts.
C. Pneumocystis jirovecii:Pneumocystis jiroveciiis an opportunistic fungus causing Pneumocystis pneumonia (PCP) in immunocompromised patients, especially those with AIDS and CD4+ counts <200 cells/µL. Histologically, it produces diffuse interstitial pneumonitis with intra-alveolar foamy exudates, which can be highlighted by silver staining (Gomori methenamine silver), consistent with the biopsy findings in this patient.
D. Streptococcus pyogenes:Streptococcus pyogenestypically causes pharyngitis, skin infections, and occasionally severe bacterial pneumonia. It presents with lobar consolidation and purulent exudate rather than diffuse interstitial infiltrates and foamy alveolar material, making it unlikely in this scenario.
Correct Answer is B
Explanation
A. Left ventricle of heart:Thrombi in the left ventricle are typically associated with myocardial infarction or cardiomyopathy and can lead to systemic arterial emboli (e.g., stroke or limb ischemia). They do not travel to the pulmonary arteries, so this is unlikely.
B. Leg vein:Most pulmonary emboli originate from deep vein thromboses (DVT) in the lower extremities, particularly the femoral, popliteal, or iliac veins. Dislodged thrombi travel through the venous system to the right heart and then lodge at the pulmonary artery bifurcation, producing a saddle embolus, as seen in this patient.
C. Pulmonary artery:Thrombi do not typically form in the pulmonary arteries themselves; they usually arrive there as emboli from peripheral veins. Primary pulmonary artery thrombosis is rare.
D. Right ventricle of heart:Right ventricular thrombi are uncommon and typically occur in situ due to catheter-related injury or severe right heart dysfunction. They are not the usual source of a sudden saddle pulmonary embolus.
E. Thoracic aorta:Thrombi in the aorta are part of the systemic arterial circulation and can embolize to peripheral organs, not to the pulmonary vasculature. They cannot cause pulmonary embolism.
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