Question 153
A 29-year-old female presents to an acute care clinic with complaints of a productive cough and fever to 38.6 degrees Celsius for the past 4 days. Physical examination reveals dullness to percussion on the lower left side of the chest and crackles are heard at this location. A chest x-ray reveals consolidation of the lower lobe of the left lung. A sputum culture grows Streptococcus pneumoniae. Of the following, which is the most responsible for the physical examination findings?
A. Collapse of alveoli
B. Proteinaceous exudate on alveolar septae
C. Bacterial overgrowth
D. Lymphocytic infiltration of alveolar septae
E. Neutrophilic infiltration of alveolar airspaces
Answer for Question 153
Answer: E (Neutrophilic infiltration of alveolar airspaces)
Explanation: The presenting symptoms are consistent with a community-acquired pneumonia, and the physical examination and chest x-ray are consistent with a lobar pneumonia, which is most commonly caused by Streptococcus pneumoniae. Although atelectasis, hyaline membranes, and bacterial overgrowth could/would all be present to some degree, the cause for the consolidation of the lung tissue (i.e., the lung tissue having a more solid appearance) is due to the neutrophilic infiltrate in the alveolar airspaces, filling the airspaces in the lung. Lymphocytic infiltration of the alveolar septae would be characteristic of a viral infection.
Question 154
A 34-year-old male presents to an acute care clinic with complaints of a productive cough and fever to 38.4 degrees Celsius for the past 3 days, associated with shaking chills and some chest pain when he breaths. Physical examination reveals dullness to percussion on the left side of the chest. Crackles and a pleural rub are also heard at this location. A chest x-ray reveals consolidation of the left lung. Of the following, if untreated, which complication is he most likely to develop?
A. Bronchogenic carcinoma
B. Amyloidosis
C. Fibrosis in the left pleural cavity
D. Alzheimer disease
E. Aortic dissection
Answer for Question 154
Answer: C (Fibrosis in the left pleural cavity)
Explanation: Given the clinical presentation, a bacterial lobar pneumonia is likely. The pleural friction rub would indicate that there is pleuritis. With a bacterial infection causing pleuritis, complete resolution would be less likely, and scar formation would occur. Bacterial (and viral) pneumonias are not a significant risk factor for the other disease processes listed.
Question 155
A 26-year-old male presents to the hospital with complaints of difficulty breathing, which has severely worsened over the past day. In the five days prior, he has had a fever, productive cough, and chills. In addition, his chest has hurt when he breathed in and with exertion he was short of breath. His friends told him to come to the emergency room two days ago, but he thought that he could wait it out. He has a temperature of 101 degrees Fahrenheit, heart rate of 108 bpm, blood pressure of 105/71 mmHg, and respiratory rate of 28 breaths per minute. Physical examination reveals dullness to percussion on the left side of the chest, accompanied by decreased breath sounds, and an absence of tactile fremitus. Of the following, what is the most likely diagnosis?
A. Pulmonary thromboembolus
B. Congestive heart failure associated with bicuspid aortic valve
C. Tension pneumothorax due to ruptured bleb
D. Empyema
E. Aspiration pneumonia with abscess formation
Answer for Question 155
Answer: D (Empyema)
Explanation: The clinical presentation is consistent with a community acquired pneumonia. The dullness to percussion on the left side of the chest combined with the decreased breath sounds and absence of tactile fremitus are consistent with an empyema. While the pneumonia alone could cause the dullness to percussion associated with the consolidation of the lobe, there would not be decreased breath sounds, and there would be tactile fremitus. While a pulmonary thromboembolus could, with infarction, lead to dullness to percussion, it would not produce the other physical examination findings, and is not associated with a productive cough. Congestive heart failure due to a bicuspid aortic valve would present much later in life, and would not be associated with the productive cough The individual has no described risk factors for aspiration pneumonia.