Shortness of Breath
Questions
46. A 55-year-old woman with a past medical history of diabetes walks
into the emergency department (ED) stating that her tongue and lips feel
like they are swollen. During the history, she tells you that her doctor just
started her on a new blood pressure (BP) medication. Her only other med-
ication is a baby aspirin. Her vitals at triage are: BP 130/70 mm Hg, heart
rate (HR) 85 beats per minute, respiratory rate (RR) 16 breaths per minute,
oxygen saturation 99% on room air, and temperature 98.7F. On physical
examination, you detect mild lip and tongue swelling. Over the next hour,
you notice that not only are her tongue and lips getting more swollen, but
her face is starting to swell, too. What is the most likely inciting agent?
a. Metoprolol
b. Furosemide
c. Aspirin
d. Lisinopril
e. Diltiazem
49
,50 Emergency Medicine
47. A 45-year-old woman presents to the ED immediately after landing at
the airport from a transatlantic flight. She states that a few moments after
landing she felt short of breath and felt pain in her chest when she took a
deep breath. Her only medications are oral contraceptive pills and levothy-
roxine. She is a social drinker and smokes cigarettes occasionally. Her BP is
130/75 mm Hg, HR is 98 beats per minute, temperature is 98.9F, RR is 20
breaths per minute, and oxygen saturation is 97% on room air. You send
her for a duplex ultrasound of her legs, which is positive for deep vein
thrombosis. What is the most appropriate management for this patient?
a. Place patient on a monitor, provide supplemental oxygen, and administer
unfractionated heparin.
b. Place patient on a monitor, order a chest computed tomography (CT) scan to
confirm a pulmonary embolism (PE), and then administer unfractionated
heparin.
c. Place patient on a monitor and administer aspirin.
d. Instruct the patient to walk around the ED so that she remains mobile and does
not exacerbate thrombus formation.
e. Place the patient on a monitor, provide supplemental oxygen, and administer
warfarin.
48. A 54-year-old undomiciled woman presents to the ED with severe
cough, general malaise, and subjective fevers for the last week. She also
describes coughing up “chicken livers” during this time and reports that her
symptoms are getting progressively worse. Her initial vitals include a HR
of 100 beats per minute, a BP of 145/66 mm Hg, temperature of 99.9F, and
an RR of 16 breaths per minute with an oxygen saturation of 95% on room
air. She states that she has a history of alcohol abuse, but denies tak-ing any
medications or illicit drugs. A chest radiograph shows a lobar pneu- monia.
Given this patient’s clinical presentation, which of the following is this
patient at most risk for contracting?
a. Streptococcus pneumoniae
b. Klebsiella pneumoniae
c. Mycoplasma pneumoniae
d. Legionella pneumophila
e. Haemophilus influenzae
, Shortness of Breath 51
49. A tall, thin 18-year-old man presents to the ED with acute onset of
dyspnea while at rest. The patient reports sitting at his desk when he felt a
sharp pain on the right side of his chest that worsened with inspiration. His
past medical history is significant for peptic ulcer disease. He reports taking
a 2-hour plane trip a month ago. His initial vitals include a HR of 100 beats
per minute, a BP of 120/60 mm Hg, an RR of 16 breaths per minute, and an
oxygen saturation of 97% on room air. On physical examination, you note
decreased breath sounds on the right side. Which of the following tests
should be performed next?
a. Electrocardiogram (ECG)
b. D-dimer
c. Ventilation perfusion scan (V/Q scan)
d. Upright abdominal radiograph
e. Chest radiograph
50. A 46-year-old alcoholic man presents to the ED with cough, fever, and
rigors for 2 days. He describes his sputum as rust-colored. His vital signs
are: temperature 101.1F, HR 94, BP 125/75 mm Hg, RR 20, and pulse
oxygen of 97% on room air. Auscultation reveals crackles in the left-lower
lobe. Chest radiograph is significant for a left-lower lobar infiltrate. Which of
the following organism is the most common cause of community acquired
bacterial pneumonia?
a. Haemophilus influenza
b. Streptococcus pneumoniae
c. Klebsiella pneumonia
d. Group A streptococci
e. Pseudomonas aeruginosa
Questions
46. A 55-year-old woman with a past medical history of diabetes walks
into the emergency department (ED) stating that her tongue and lips feel
like they are swollen. During the history, she tells you that her doctor just
started her on a new blood pressure (BP) medication. Her only other med-
ication is a baby aspirin. Her vitals at triage are: BP 130/70 mm Hg, heart
rate (HR) 85 beats per minute, respiratory rate (RR) 16 breaths per minute,
oxygen saturation 99% on room air, and temperature 98.7F. On physical
examination, you detect mild lip and tongue swelling. Over the next hour,
you notice that not only are her tongue and lips getting more swollen, but
her face is starting to swell, too. What is the most likely inciting agent?
a. Metoprolol
b. Furosemide
c. Aspirin
d. Lisinopril
e. Diltiazem
49
,50 Emergency Medicine
47. A 45-year-old woman presents to the ED immediately after landing at
the airport from a transatlantic flight. She states that a few moments after
landing she felt short of breath and felt pain in her chest when she took a
deep breath. Her only medications are oral contraceptive pills and levothy-
roxine. She is a social drinker and smokes cigarettes occasionally. Her BP is
130/75 mm Hg, HR is 98 beats per minute, temperature is 98.9F, RR is 20
breaths per minute, and oxygen saturation is 97% on room air. You send
her for a duplex ultrasound of her legs, which is positive for deep vein
thrombosis. What is the most appropriate management for this patient?
a. Place patient on a monitor, provide supplemental oxygen, and administer
unfractionated heparin.
b. Place patient on a monitor, order a chest computed tomography (CT) scan to
confirm a pulmonary embolism (PE), and then administer unfractionated
heparin.
c. Place patient on a monitor and administer aspirin.
d. Instruct the patient to walk around the ED so that she remains mobile and does
not exacerbate thrombus formation.
e. Place the patient on a monitor, provide supplemental oxygen, and administer
warfarin.
48. A 54-year-old undomiciled woman presents to the ED with severe
cough, general malaise, and subjective fevers for the last week. She also
describes coughing up “chicken livers” during this time and reports that her
symptoms are getting progressively worse. Her initial vitals include a HR
of 100 beats per minute, a BP of 145/66 mm Hg, temperature of 99.9F, and
an RR of 16 breaths per minute with an oxygen saturation of 95% on room
air. She states that she has a history of alcohol abuse, but denies tak-ing any
medications or illicit drugs. A chest radiograph shows a lobar pneu- monia.
Given this patient’s clinical presentation, which of the following is this
patient at most risk for contracting?
a. Streptococcus pneumoniae
b. Klebsiella pneumoniae
c. Mycoplasma pneumoniae
d. Legionella pneumophila
e. Haemophilus influenzae
, Shortness of Breath 51
49. A tall, thin 18-year-old man presents to the ED with acute onset of
dyspnea while at rest. The patient reports sitting at his desk when he felt a
sharp pain on the right side of his chest that worsened with inspiration. His
past medical history is significant for peptic ulcer disease. He reports taking
a 2-hour plane trip a month ago. His initial vitals include a HR of 100 beats
per minute, a BP of 120/60 mm Hg, an RR of 16 breaths per minute, and an
oxygen saturation of 97% on room air. On physical examination, you note
decreased breath sounds on the right side. Which of the following tests
should be performed next?
a. Electrocardiogram (ECG)
b. D-dimer
c. Ventilation perfusion scan (V/Q scan)
d. Upright abdominal radiograph
e. Chest radiograph
50. A 46-year-old alcoholic man presents to the ED with cough, fever, and
rigors for 2 days. He describes his sputum as rust-colored. His vital signs
are: temperature 101.1F, HR 94, BP 125/75 mm Hg, RR 20, and pulse
oxygen of 97% on room air. Auscultation reveals crackles in the left-lower
lobe. Chest radiograph is significant for a left-lower lobar infiltrate. Which of
the following organism is the most common cause of community acquired
bacterial pneumonia?
a. Haemophilus influenza
b. Streptococcus pneumoniae
c. Klebsiella pneumonia
d. Group A streptococci
e. Pseudomonas aeruginosa
