A 68-year-old lady arrives to the emergency room with a cough and shortness of breath. She has chronic obstructive lung disease and frequently coughs up clear sputum in the morning. Her cough, however, has increased substantially over the last four days, and she is now expectorating thick, yellow sputum. When walking short distances or doing light housework, the patient also feels "winded." She was a former smoker with a 40-pack-year smoking streak. The temperature is 37.2 C (99 F), the blood pressure is 130/70 mm Hg, the pulse rate is 90 beats per minute, and the respirations rate is 22 / minute. With pursed lips, the sufferer is breathing. The expiry period is extended. Auscultation of the lungs reveals vesicular breath sounds with scattered wheezes. An x-ray of the chest reveals hyperinflated lungs with a flattened diaphragm. There are no parenchymal opacities or pleural effusion. Respiratory infection with which of the following pathogens most likely triggered this patient's worsening symptoms?

Question

A 68-year-old lady arrives to the emergency room with a cough and shortness of breath. She has chronic obstructive lung disease and frequently coughs up clear sputum in the morning. Her cough, however, has increased substantially over the last four days, and she is now expectorating thick, yellow sputum. When walking short distances or doing light housework, the patient also feels "winded." She was a former smoker with a 40-pack-year smoking streak. The temperature is 37.2 C (99 F), the blood pressure is 130/70 mm Hg, the pulse rate is 90 beats per minute, and the respirations rate is 22 / minute. With pursed lips, the sufferer is breathing. The expiry period is extended. Auscultation of the lungs reveals vesicular breath sounds with scattered wheezes. An x-ray of the chest reveals hyperinflated lungs with a flattened diaphragm.   There are no parenchymal opacities or pleural effusion.  Respiratory infection with which of the following pathogens most likely triggered this patient's worsening symptoms?

Quizplus · Accepted Answer

Eductional Objective: Most chronic obstructive pulmonary disease exacerbations are caused by infection with an upper respiratory pathogen.  The leading bacterial cause is Haemophilus influenza and the leading viral cause is rhinovirus.

A 68-Year-Old Lady Arrives to the Emergency Room with a Cough