Dyspnea Flashcards
A 25-year-old male migrant worker presents with shortness of breath following a fever and cough which he has had for two weeks. On examination, there is stony dull percussion notes over the base of the right lung. Tactile fremitus over this area is decreased. Breath sounds are also diminished and there is both egophony and whispered pectoriloquy just above the area of dullness. CBC shows a leukocytosis and lymphocytosis. Chest x-ray reveals obliteration of the right costophrenic angle.
Pleural effusion
A 6-year-old child presents with recurrent bouts of shortness of breath and wheezing. There is a family history of hay fever. On examination, her respiratory rate is 28/min. Her accessory muscles of respiration are in use and there are scattered expiratory wheezes heard throughout both lungs. Chest x-ray shows hyperinflation of both lung fields and CBC shows marked eosinophilia. Sputum exam shows numerous Charcot-Leyden crystals and Curschmann’s spirals.
Asthma
A thin, 19-year-old male presents with shortness of breath. He also has polyuria, polydypsia and polyphagia. On examination, there is a fruity smell to his breath. Urinalysis shows presence of ketones and glucose. CMP shows hyperglycemia, hypokalemia and metabolic acidosis.
Diabetic ketoacidosis
A thin, 53-year-old male smoker presents with dyspnea on exertion and a dry cough. There is no fever or chest pain. On examination, he has a barrel chest with hyperresonant percussion notes and decreased breath sounds bilaterally. Chest x-ray shows a thin mediatinum and flattened diaphragm.
Emphysema
A 78-year-old male presents with chills, fever, pleuritic chest pain, cough with rust-colored sputum. On examination, percussion note is decreased on the lower left side of the chest. Tactile fremitus is present in the same area with localized bronchial breathing present. There are basal crackles over the same area. CBC shows marked elevation of his neutrophils and a leukocytosis. Chest x-ray shows consolidation in the lower lobe on the left side.
Pneumonia
A 63-year-old male presents with dyspnea worse with exertion. He also complains of swollen ankles, orthopnea and paroxysmal nocturnal dyspnea. On examination, there is jugular venous distension, bilateral basal crackles, peripheral edema and a positive hepatojugular reflex. P-A chest x-ray shows cardiomegaly, prominent pulmonary vasculature and Kerley B lines. His B-type Natriuretic Peptide is elevated greater than 500 pg/dL.
Congestive heart failure
33-year-old administrative assistant complains of sudden attacks of fear accompanied by shortness of breath, palpitations and sweating. These attacks appear out of the blue and paralyze her with fear. The attacks are over within ten minutes and leave her exhausted. Physical exam reveals no abnormalities. CBC, CMP, Thyroid function tests and chest x-ray are all normal.
Panic disorder
A 35-year-old African teacher complains of progressive shortness of breath. On examination, she has several red swollen bumps on her legs. Respiratory exam was normal. CBC shows leukopenia. CMP reveals elevated calcium levels. Bilateral hilar lymphadenopathy is present on chest film. Biopsy of an affected lymph node shows granulomas with non-caseous necrosis.
Sarcoidosis
A 49-year-old homeless male presents with progressive shortness of breath, fever, night sweats and hemoptysis. On examination, there is bronchial breathing in the apex of the left lung and there is clubbing of the fingers of both hands. Chest x-ray reveals left apical consolidation with several large cavities. Exam of sputum reveals several bacilli when examined with the Ziehl-Neelsen stain. Lowenstein-Jensen culture results are pending.
Tuberculosis
A 27-year-old scuba diver presents with sudden onset of sticking chest pain and shortness of breath. Examination reveals absent breath sounds on the left side of the chest. Tactile fremitus is decreased on the same side and the percussion note was tympanic on the same side. Chest x-ray shows absent lung markings on the let side. Trachea is centrally located.
Pneumothorax
A 5-year-old child presents with swelling around the eyes and ankles. The child has gained quite a bit of weight over the last month or so and has experienced polyuria. Urinalysis reveals frothy urine, but a biopsy of kidney tissue reveals no abnormalities detected. CBC, ESR and chest x-ray were all normal.
Nephrotic syndrome
