A 67-year-old woman with a history of diabetes, systemic hypertension and recent myocardial infarction suddenly develops gangrene of her left toe. The patient's vital signs are unremarkable. Blood cultures are negative. What is the most likely cause of necrosis in this patient?
Bacterial endocarditis
Cardiogenic shock
Congestive heart failure
Embolism from mural thrombus
Hypovolemic shock
The Correct Answer is D
A. Bacterial endocarditis: Bacterial endocarditis can produce septic emboli, but it usually presents with systemic signs of infection such as fever, positive blood cultures, and a heart murmur. In this patient, the absence of infection and negative blood cultures make endocarditis less likely.
B. Cardiogenic shock: Cardiogenic shock results in global tissue hypoperfusion, affecting multiple organs simultaneously. Isolated gangrene of a single toe without systemic hypotension does not fit this presentation.
C. Congestive heart failure: Heart failure can cause chronic peripheral edema and poor perfusion, but it rarely leads to acute, localized gangrene in a single distal extremity without other systemic signs.
D. Embolism from mural thrombus: After myocardial infarction, areas of akinetic or dyskinetic myocardium can form mural thrombi in the left ventricle. Small thromboemboli can detach and travel to peripheral arteries, causing acute ischemia and necrosis in distal extremities, such as a toe. This mechanism explains isolated gangrene without systemic hypotension or infection.
E. Hypovolemic shock: Hypovolemic shock produces generalized hypoperfusion and hypotension, typically affecting multiple organ systems. Localized gangrene in a single toe without systemic compromise is inconsistent with hypovolemic shock.
Nursing Test Bank
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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