A 64-year-old woman with bilateral. varicose veins of her legs developed sudden onset\ chest pain. and expectorated blood the next day (hemoptysis). What could have caused the patient’s symptoms?
Congestive heart failure
Cor pulmonale
Phlebothrombosis
pulmonary thromboembolism
Pulmonary edema
The Correct Answer is D
A. Congestive heart failure: Congestive heart failure can cause dyspnea and pulmonary congestion, but hemoptysis and sudden pleuritic chest pain are not classic presenting features. CHF-related pulmonary edema usually produces pink, frothy sputum rather than frank blood and develops in the context of volume overload rather than acute embolic events.
B. Cor pulmonale: Cor pulmonale refers to right ventricular hypertrophy and failure secondary to chronic pulmonary hypertension. It develops gradually in patients with chronic lung disease and presents with peripheral edema and fatigue, not sudden chest pain and hemoptysis.
C. Phlebothrombosis: Phlebothrombosis refers to thrombus formation in a vein, often in the lower extremities, especially in patients with varicose veins. While it is the underlying source of emboli, it does not directly cause chest pain or hemoptysis unless a clot dislodges and travels to the lungs.
D. Pulmonary thromboembolism: Pulmonary thromboembolism occurs when a thrombus, often originating from deep leg veins, embolizes to the pulmonary arteries. Sudden chest pain and hemoptysis result from pulmonary infarction and pleural irritation. Varicose veins increase venous stasis, predisposing to thrombosis and subsequent embolism.
E. Pulmonary edema: Pulmonary edema involves fluid accumulation in the alveoli, most commonly due to left-sided heart failure. It causes dyspnea and crackles but does not typically present with sudden pleuritic chest pain and hemoptysis linked to venous thromboembolic risk factors.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. Brain:Emboli originating in the brain would not travel systemically to the spleen. Instead, brain emboli cause localized cerebral infarctions or strokes.
B. Heart:Thromboemboli from the heart, particularly after a myocardial infarction, can arise from mural thrombi in the left ventricle. These emboli are released into the systemic arterial circulation and can lodge in end organs like the spleen, kidneys, or extremities, producing the characteristic wedge-shaped splenic infarcts seen in this patient.
C. Lungs:Pulmonary emboli originate from venous thrombi and lodge in the pulmonary arteries. They do not enter systemic circulation due to the filtering effect of the pulmonary capillary bed, so the spleen is not affected by emboli from the lungs.
D. Liver:The liver receives blood primarily via the portal vein, and thrombi here generally do not embolize to the systemic circulation. Hepatic thrombi do not cause splenic infarcts.
E. Spleen:While the infarcts are located in the spleen, they are the result of emboli lodging in splenic arteries rather than arising within the spleen itself. Therefore, the source of the thromboemboli is systemic, most commonly the heart.
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.
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