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A Previously Healthy 35-Year-Old Man Is Evaluated in the Hospital

question 523

Multiple Choice

A previously healthy 35-year-old man is evaluated in the hospital for new-onset fever. He was admitted 9 days ago following a motorcycle collision that resulted in severe traumatic brain injury and multiple extremity fractures. The patient initially required mechanical ventilation and multiple interventions to lower his intracranial pressure. He has since stabilized and underwent fracture fixation and tracheostomy, with subsequent weaning off of mechanical ventilation. Yesterday, while receiving a sponge bath, the patient was noted to be diaphoretic as well as hypertensive and tachycardic; his symptoms improved after morphine administration. Today, during routine repositioning and vital sign measurement, he again becomes diaphoretic. Temperature is 38.8 C (101.8 F) , blood pressure is 194/110 mm Hg, pulse is 146/min, and respirations are 40/min. Oxygen saturation is 98% on room air. On examination, heart sounds and lung sounds are normal. Neurologic examination shows eye opening and withdrawal of all 4 extremities in response to painful stimuli, which is unchanged from previous examinations. Which of the following is the most likely cause of this patient's abnormal vital signs?

Definitions:

Archegonia

The female reproductive structure in ferns, bryophytes, and some gymnosperms, containing the egg cell.

Egg-Producing Structures

Organs or parts of organisms specialized in producing eggs, significant in the reproduction of various animals and some plants.

Fern

Member of a group of land plants that have large fronds; in the sexual life cycle, the independent gametophyte produces flagellated sperm, and the vascular sporophyte produces windblown spores.

Prothallus

The gametophyte stage of ferns and some other non-seed vascular plants, typically small, green, heart-shaped, and bears the reproductive organs.