A 64-Year-Old Man Comes to the Emergency Department Due to 2

question 1105

Multiple Choice

A 64-year-old man comes to the emergency department due to 2 days of fever, chills, productive cough, and left-sided pleuritic chest pain.  The patient has a history of hypertension, hyperlipidemia, and type 2 diabetes mellitus.  He is a former smoker and drinks alcohol occasionally.  Temperature is 38.9 C (102 F) , blood pressure is 110/60 mm Hg, pulse is 110/min, and respirations are 22/min.  Oxygen saturation is 94% on room air when he lies on his right side but drops to 89% when he lies on his left.  Dullness to percussion and bronchial breath sounds are present on the left side.  Which of the following pathophysiologic mechanisms in the left lung is most responsible for the drop in oxygen saturation after the change in position?

• A)Dead space ventilation
• B)Decreased minute ventilation
• C)Effort-dependent hypoventilation
• D)Hypoxic pulmonary vasoconstriction
• E)Intrapulmonary shunting
• F)Low partial pressure of inspired oxygen

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