A 45-year-old man with alcoholism is admitted with a diagnosis of acute pancreatitis. He requires large volumes of fluid to maintain blood pressure an

[Kathryn]

#march2020mccqe1

A 45-year-old man with alcoholism is admitted with a diagnosis of acute pancreatitis. He requires large volumes of fluid to maintain blood pressure and urine output, but 24 hours after admission, he appears in stable condition. On the fourth hospital day, the patient develops rapidly progressive respiratory distress, with labored breathing and tachypnea. His temperature is 37.0 C (98.6 F), pulse is 100/min, blood pressure is 128/75 mm Hg, and respirations are 24/min. Intercostal retraction and crackles are appreciated on chest examination. Blood tests show:
Hematocrit 42%
Leukocytes 9800/mm3
Glucose 110 mg/dL
BUN 20 mg/dL
AST 98U/L
ALT 60U/L
Amylase 280 U/L
Arterial blood gas (room air)
pH 7.32
Pao2 52 mm Hg
Paco2 51 mm Hg
A chest x-ray film reveals diffuse bilateral infiltrates and air bronchograms, a normal cardiac silhouette, and minimal pleural effusions. Which of the following is the most likely diagnosis?
(A) Acute bilateral bronchopneumonia
(B) Adult respiratory distress syndrome (ARDS)
(C) Cardiogenic pulmonary edema
(D) Exacerbation of acute pancreatitis
(E) Pulmonary embolism