A 43-Year-Old Woman on the Surgical Floor Is Being Evaluated

question 429

Multiple Choice

A 43-year-old woman on the surgical floor is being evaluated for increasing shortness of breath.  She was brought to the emergency department 8 hours ago following a high-speed motor vehicle collision.  The patient had been drinking alcohol prior to driving.  She was restrained and air bags were deployed, but her right knee smashed against the front console.  Trauma workup revealed a right femur fracture as well as bruising of the face and chest without underlying fractures.  The patient received 3 L of isotonic fluids and was admitted for observation and pain management prior to anticipated fracture fixation.  She now has increased work of breathing.  Blood pressure is 138/82 mm Hg, pulse is 102/min, and respirations are 24/min.  Pulse oximetry shows an oxygen saturation of 90% on 4 L of oxygen.  The patient is alert with no focal neurological deficits.  Diffuse rales are heard in the anterior lung fields bilaterally.  Heart sounds are normal.  There are no other changes to the clinical examination.  CT scan of the chest reveals peripheral, anterior ground-glass opacities in both lungs.  Which of the following is the most likely diagnosis in this patient?

• A)Aspiration pneumonia
• B)Bronchial rupture
• C)Fat embolism
• D)Hemothorax
• E)Myocardial contusion
• F)Pulmonary contusion

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Definitions:

Lacrimal

Relating to the tears or the tear system, including glands and ducts involved in tear production and removal.

Tailbone

The terminal end of the vertebral column in humans and certain other creatures, formally known as the coccyx.

Coccyx

The small tailbone at the lower end of the vertebral column, comprising three to five fused vertebrae.

Lumbar

Referring to the lower part of the spine or the lower back region.