Which of the following is a sign associated with ARDS?

• A. Productive cough with clear lungs
• B. Nasal congestion only
• C. Shortness of breath without hypoxemia
• D. Bilateral crackles or rales

Answer: (D)

Bilateral crackles or rales reflect the diffuse alveolar edema that ARDS causes. When the alveolar-capillary barrier is damaged, fluid leaks into both lungs, leading to scattered fluid-filled airways that produce crackling sounds on both sides. This auscultatory finding fits the pattern of widespread, noncardiogenic edema seen in ARDS and commonly accompanies rapid breathing and hypoxemia. The other options don’t align with ARDS: a productive cough with clear lungs points to a different process, nasal congestion is unrelated, and shortness of breath without hypoxemia contradicts the hypoxemia that ARDS typically involves.