Family Nurse Practitioner Exam

Which condition is suggested by fine crackles in the lung examination and symptoms of shortness of breath in an elderly patient?

1. Acute exacerbation of asthma

2. Left-heart failure

3. Right-heart failure

4. Chronic obstructive pulmonary disease

The correct answer is: Left-heart failure

Fine crackles, also known as rales, are often indicative of fluid in the alveoli and are frequently associated with conditions that affect the lungs at the level of the small airways and pulmonary interstitium. In an elderly patient presenting with shortness of breath and fine crackles, left-heart failure is a likely consideration. Left-heart failure, or congestive heart failure, leads to increased pressure in the pulmonary circulation due to the heart's inability to pump effectively. This results in fluid transudation into the lung interstitium and alveoli, causing crackles upon auscultation. The shortness of breath, or dyspnea, experienced by the patient can be attributed to pulmonary congestion and reduced oxygen exchange capacity. In contrast, conditions like acute exacerbation of asthma, right-heart failure, and chronic obstructive pulmonary disease (COPD) may also present with shortness of breath, but the pathology differs. Asthma typically presents with wheezing rather than crackles. Right-heart failure may result in systemic congestion and peripheral edema but does not usually lead to the fine crackles characteristic of pulmonary congestion unless there is simultaneous left-heart failure. COPD generally produces wheezing and with chronic changes in lung structure (such as hyperinflation) rather