Chapter 14, Module 5; Dyspnea

Question 1

Acute-onset dyspnea, cough, mild to severe chest pain, sense of impend¬ ing doom; hemoptysis; history of DVT, recent surgery, oral contraceptive, smoker, hypercoagulabilitystates

Answer 1

Pulmonary embolus

Question 2

Restlessness, fever, tachycardia, tachypnea, diminished breath sounds, crackles, wheezing, pleural friction rub

Answer 2

Pulmonary embolus

Question 3

Diagnostic Studies of Pulmonary embolus?

Answer 3

CTPA, ABGs, chest radiograph, ECG, ventilation/ perfusion scans, D-dimer, Wells score

Question 4

Acute-onset dyspnea; history of drinking large amounts of alcohol; in children, history of putting small objects in mouth; possible cough

Answer 4

Foreign body aspiration

Question 5

Apnea or tachypnea, restlessness, suprasternal retractions, intoxication, inspiratory stridor, localized wheeze

Answer 5

Foreign body aspiration

Question 6

Diagnostic Studies of Foreignbody aspiration?

Answer 6

Lateral neck radiograph, chest radiograph, bronchoscopy

Question 7

Acute-onset dyspnea; history of insect sting, ingestion of drug, or allergen

Answer 7

Anaphylaxis

Question 8

Angioedema, tachypnea, clammy skin, hypotension, bilateral wheezes, tachycardia

Answer 8

Anaphylaxis

Question 9

Diagnostic Studies of Anaphylaxis

Answer 9

None; emergency measures necessary

Question 10

Acute-onset dyspnea; sharp, tearing chest pain; pain can radiate to ipsilateral shoulder

Answer 10

Pneumothorax

Question 11

Tachycardia, diminished breath sounds, decreased tactile fremitus, hyperresonance of lung area affected; possible hypertension and tracheal shift

Answer 11

Pneumothorax

Question 12

Diagnostic Studies of Pneumothorax?

Answer 12

Chest radiograph, ABGs

Question 13

Historyofupper respiratory tract infection

Answer 13

Croup

Question 14

Hoarse, seal-barkcough,fever (variable)

Answer 14

Croup

Question 15

Diagnostic Studies of Croup?

Answer 15

None initially; if respiratory distress increases, pulse oximeter and referral

Question 16

Positionalsittingforward; sorethroat, anxious,toxicchild

Answer 16

Acute epiglottitis

Question 17

High fever, drooling, stridor, muffled voice

Answer 17

Acute epiglottitis

Question 18

Diagnostic Studies of Acute epiglottitis?

Answer 18

None;emergency measures forairway support

Question 19

Recentviralinfection

Answer 19

Bacterial tracheitis

Question 20

Fever, stridor, purulent sputum

Answer 20

Bacterial tracheitis

Question 21

Diagnostic Studies of Bacterial tracheitis?

Answer 21

Radiography of airway, WBC increased, tracheal culture

Question 22

Recent URI, exposure to allergens, breathlessness

Answer 22

Status asthmaticus

Question 23

Wheezing, coughing, tachycardia, tachypnea

Answer 23

Status asthmaticus

Question 24

Diagnostic Studies of Status asthmaticus?

Answer 24

Peak flows, chest radiograph, ABGs

Question 25

Honey  ingestion  in  infant,  contaminated  food  ingestion

Answer 25

Botulism

Question 26

Hypoventilation,  drooling,  weak cry,  ptosis,  ophthalmoplegia, loss  of  head  control

Answer 26

Botulism

Question 27

Diagnostic Studies of Botulism?

Answer 27

Pulmonary  function  testing, chest  radiograph,  fluoroscopy,  stool  culture

Question 28

Dyspnea,  cough,  sputum  production  (green, rust,  or  red), pleuritic  chest  pain,  chills;  in infants  and  children:  irritability and feeding  problems

Answer 28

Pneumonia

Question 29

Fever, tachycardia, tachypnea, inspiratory crackles,  asynchronous breathing, vocal fremitus, percussion dull or flat over area of consolidation, bronchophony, egophony

Answer 29

Pneumonia

Question 30

Diagnostic Studies of Pneumonia?

Answer 30

Chest radiograph, sputum  cultures, ABGs,  WBC

Question 31

Dyspnea,  light-headedness, palpitations,  paresthesias (perioral  and  extremities)

Answer 31

Hyperventilation syndrome

Question 32

Restlessness,  anxiety,  normal CV  examination

Answer 32

Hyperventilation syndrome

Question 33

Diagnostic Studies of Hyperventilation syndrome?

Answer 33

Chest  radiograph, TSH

Question 34

Neonate,  infant:  history  of stridor,  history  of  URI

Answer 34

Bronchomalacia

Question 35

Inspiratory  stridor;  normal cough,  cry

Answer 35

Bronchomalacia

Question 36

Diagnostic Studies of Bronchomalacia?

Answer 36

Refer for visualization of larynx

Question 37

Infant: dyspnea, brassy cough, difficulty  swallowing

Answer 37

Vascular ring

Question 38

Inspiratory stridor with expiratory wheeze

Answer 38

Vascular ring

Question 39

Diagnostic Studies of Vascular ring?

Answer 39

Barium  swallow, echocardiography

Question 40

Chronic  progressive  dyspnea, cough,  frothy  sputum,  fatigue, lightheadedness,  syncope, weight  gain,  ankle  swelling, palpitations,  PND,  orthopnea, history  of  heart  disease;  in children:  chronic  progressive dyspnea,  sweating  above  lip and  forehead,  especially  while eating

Answer 40

Heart  failure

Question 41

Altered  level of consciousness, restlessness,  jugular  venous distention,  tachypnea, use of accessory  muscles  to  breathe, rales,  rhonchi,  wheezes, tachycardia,  decreased  peripheral pulses,  cool  extremities,  displaced  PMI,  S3,  S4,  ascites, liver enlargement

Answer 41

Heart  failure

Question 42

Diagnostic Studies of Heart  failure?

Answer 42

ECG,  chest radiograph,  ABGs, echocardiogram

Question 43

Dyspnea  on  exertion,  fatigue, palpitations,  light-headedness, history  of  chronic  disease

Answer 43

Anemia

Question 44

Pallor,  tachypnea,  cool  dry  skin  of extremities,  possible  orthostatic hypotension

Answer 44

Anemia

Question 45

Diagnostic Studies of Anemia?

Answer 45

CBC,  iron  studies

Question 46

Dyspnea  on  exertion,  weight gain,  palpitation  on  exertion, sedentary  lifestyle,  cigarette smoker

Answer 46

Poor physical conditioning

Question 47

Overweight,  tachycardia

Answer 47

Poor physical conditioning

Question 48

Diagnostic Studies of Poor physical conditioning?

Answer 48

Cardiac  stress  test

Question 49

Dyspnea,  paroxysmal  cough, audible  wheeze,  history  of asthma  or  allergies

Answer 49

Asthma

Question 50

Restlessness,  tachypnea,  use  of accessory  muscles  to  breathe, intercostal  retractions,  decreased vocal  fremitus,  decreased  breath sounds,  inspiratory  and  possibly expiratory  wheezes

Answer 50

Asthma

Question 51

Diagnostic Studies of Asthma

Answer 51

Spirometry  followed by  a  methacholine challenge,  chest radiograph,  ABGs

Question 52

Chronic progressive  dyspnea, dyspnea on exertion,  persistent cough, minimal  sputum, easy fatigue, history  of smoking

Answer 52

COPD

Question 53

Rapid shallow  respirations, reddish complexion,  increased AP diameter  of  thorax,  use  of  accessory muscles  to  breathe,  pursed-lip breathing, decreased tactile fremitus,  decreased  respiratory excursion  bilaterally, lungs hyperresonant,  distant  breath sounds,  prolonged  expiration, occasional wheezes, possible tachycardia, muffled heart sounds

Answer 53

COPD

Question 54

Diagnostic Studies of COPD?

Answer 54

Chest radiograph, spirometry, exercise tests, ABGs