USMLE Step 1 Question of the Week #8

A 68-year-old man presents to physician with complain of fever, cough, and difficulty in breathing for last three days. He mentions that his expectorations are rust-colored. He has no known medical disorder and is otherwise a healthy man. On physical examination, his temperature is 103.7ºF (39.8ºC), pulse rate is 92/minute, blood pressure is 128/82 mm Hg, and respirations are 24/minute. Auscultation of his chest reveals decreased intensity of breath sounds and presence of crepitations over right infrascapular region. The physician orders his sputum examination, which shows predominant polymorphonuclear neutrophils and a few epithelial cells. Gram staining of sputum confirms presence of Gram-positive cocci in pairs. Chest radiogram of the man shows lobar consolidation in lower zone of the right lung. Which of the following best describes pathological changes in the affected area of the lung?

A. Neutrophil-rich exudate filling bronchi, bronchioles, and adjacent alveoli

B. Widening of alveolar septa and mononuclear inflammatory infiltrate

C. Fibrin strands in alveolar spaces and extravasation of red blood cells

D. Intra-alveolar fluid and vascular engorgement

E. Fibromyxoid masses rich in fibroblasts and macrophages

QID #2309

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