A 67-Year-Old Woman Comes to the Emergency Department Due to Increased

question 93

Multiple Choice

A 67-year-old woman comes to the emergency department due to increased dyspnea on exertion.  Her chronic medical problems include obesity, obstructive sleep apnea, moderate chronic obstructive pulmonary disease, coronary artery disease, congestive heart failure, hypertension, hyperlipidemia, rheumatoid arthritis, and hypothyroidism.  She was treated with antibiotics and a steroid taper for a "lung infection" 1 month ago.  Her cough productive of thick yellowish sputum improved, but she has been feeling increasingly dyspneic when walking up stairs and doing her grocery shopping over the past week.  She took some extra doses of furosemide with minimal relief.
The patient denies increased orthopnea but says, "I always sleep on 3 pillows so I can avoid using that PAP mask."  She has no fever, chills, or night sweats.  She smokes half a pack of cigarettes a day.  Surgical history is significant for a 3-vessel coronary artery bypass graft 5 years ago.
Her blood pressure is 160/96 mm Hg, pulse is 78/min, and respirations are 20/min.  Pulse oximetry shows 96% on room air.  Her BMI is 36 kg/m².  Physical examination shows mild respiratory distress.  Lung examination reveals decreased breath sounds on the right with dullness to percussion almost halfway up.  There is 1+ pitting edema up to the knees bilaterally.
Laboratory results are as follows:

Chest x-ray reveals blunting of the costophrenic angle on the left and a moderate right-sided pleural effusion.  Thoracentesis is performed on the right and 750 mL of serous fluid is removed.  The results of pleural fluid analysis are as follows:

Which of the following is the most likely cause of her pleural effusion?

• A)Congestive heart failure
• B)Malignant pleural effusion
• C)Parapneumonic effusion
• D)Pulmonary embolism
• E)Rheumatoid pleurisy

---

Definitions:

Postconventional Morality

A stage in moral development characterized by an understanding that laws and rules are relative and moral reasoning is based on abstract principles and the welfare of others.

Parenting Practices

Parenting practices involve the strategies and methods used by caregivers in the raising and guidance of children, with variations influenced by cultural, social, and individual factors.

Emerging Adulthood

A phase of the life span between adolescence and full-fledged adulthood, characterized by exploration of identity, instability, self-focus, and feeling in-between, typically ranging from ages 18 to 25.

College Completion Rates

The percentage of students who complete their college or university degree programs within a specified period.