A 62-year-old construction worker presents to your clinic, complaining of
almost a year of
chronic cough and occasional shortness of breath. Although he has had
worsening of symptoms
occasionally with a cold, his symptoms have stayed about the same. The
cough has occasional
mucous drainage but never any blood. He denies any chest pain. He has had
no weight gain,
weight loss, fever, or night sweats. His past medical history is significant for
high blood pressure
and arthritis. He has smoked two packs a day for the past 45 years. He
drinks occasionally but
denies any illegal drug use. He is married and has two children. He denies
any foreign travel. His
father died of a heart attack and his mother died of Alzheimer's disease. On
examination you see
a man looking slightly older than his stated age. His blood pressure is 130/80
and his pulse is 88.
He is breathing comfortably with respirations of 12. His head, eyes, ears,
nose, and throat
examinations are unremarkable. His cardiac examination is normal. On
examination of his chest,
the diameter seems enlarged. Breath sounds are decreased throughout all
lobes. Rhonchi are
heard over all lung fields. There is no area of dullness and no increased or
decreased fremitus.
What thorax or lung disorder is most likely causing his symptoms?
A) Spontaneous pneumothorax
B) Chronic obstructive pulmonary disease (COPD)
C) Asthma
D) Pneumonia
,B) Chronic obstructive pulmonary disease (COPD)
This disorder is insidious in onset and generally affects the older population
with a smoking history. The diameter of the chest is often enlarged like a
barrel. Percussing the chest elicits hyperresonance, and during auscultation
there are often distant breath sounds. Coarse
breath sounds of rhonchi are also often heard. It is important to quantify this
patient's exercise
capacity because it may affect his employment and also allows you to follow
for progression of
his disease. You must offer smoking cessation as an option.
“‘“
A 36-year-old teacher presents to your clinic, complaining of sharp, knifelike
pain on the left
side of her chest for the last 2 days. Breathing and lying down make the pain
worse, while sitting
forward helps her pain. Tylenol and ibuprofen have not helped. Her pain does
not radiate to any
other area. She denies any upper respiratory or gastrointestinal symptoms.
Her past medical
history consists of systemic lupus. She is divorced and has one child. She
denies any tobacco,
alcohol, or drug use. Her mother has hypothyroidism and her father has high
blood pressure. On
examination you find her to be distressed, leaning over and holding her left
arm and hand to her left chest. Her blood pressure is 130/70, her respirations
are 12, and her pulse is 90. On
auscultation her lung fields have normal breath sounds with no rhonchi,
wheezes, or crackles.
,Percussion and palpation are unremarkable. Auscultation of the heart has an
S1 and S2 with no S3
or S4. A scratching noise is heard at the lower left sternal border, coincident
with systole; leaning
forward relieves some of her pain. She is nontender with palpation of the
chest wall.
What disorder of the chest best describes this disorder?
A) Angina pectoris
B) Pericarditis
C) Dissecting aortic aneurysm
D) Pleural pain
B) Pericarditis
The pain from pericarditis is usually sharp and knifelike and is located over
the left side of the chest. Change of position, breathing, and coughing often
make the pain worse,
whereas leaning forward improves the pain. Pericarditis is often seen in
rheumatologic diseases such as systemic lupus and in patients with chronic
kidney disease. Patients also experience this
after a myocardial infarction.
“‘“
A 68-year-old retired postman presents to your clinic, complaining of dull,
intermittent
left-sided chest pain over the last few weeks. The pain occurs after he mows
his lawn or chops
wood. He says that the pain radiates to the left side of his jaw but nowhere
else. He has felt
, light-headed and nauseated with the pain but has had no other symptoms.
He states when he sits
down for several minutes the pain goes away. Ibuprofen, Tylenol, and
antacids have not improved his symptoms. He reports no recent weight gain,
weight loss, fever, or night sweats. He has a past medical history of high
blood pressure and arthritis. He quit smoking 10 years ago after smoking one
pack a day for 40 years. He denies any recent alcohol use and reports no
drug
use. He is married and has two healthy children. His mother died of breast
cancer and his father
died of a stroke. His younger brother has had bypass surgery. On
examination you find him
healthy-appearing and breathing comfortably. His blood pressure is 140/90
and he has a pulse of
80. His head, eyes, ears, nose, and throat examinations are unremarkable.
His lungs have normal breath sounds and there are no abnormalities with
percussion and palpation of the chest. His heart has a normal S1 and S2 and
no S3 or S4. Further workup is pending.
Which disorder of the chest best describes these symptoms?
A) Angina pectoris
B) Pericarditis
C) Dissecting aortic aneurysm
D) Pleural pain
A) Angina pectoris
Angina causes dull chest pain felt in the retrosternal area or anterior chest. It
often radiates to the shoulders, arms, neck, and jaw. It is associated with
shortness of breath, nausea, and sweating. The pain is generally relieved by
rest or medication after several minutes. This patient needs to be admitted
to the hospital for further workup for his accelerating symptoms.
almost a year of
chronic cough and occasional shortness of breath. Although he has had
worsening of symptoms
occasionally with a cold, his symptoms have stayed about the same. The
cough has occasional
mucous drainage but never any blood. He denies any chest pain. He has had
no weight gain,
weight loss, fever, or night sweats. His past medical history is significant for
high blood pressure
and arthritis. He has smoked two packs a day for the past 45 years. He
drinks occasionally but
denies any illegal drug use. He is married and has two children. He denies
any foreign travel. His
father died of a heart attack and his mother died of Alzheimer's disease. On
examination you see
a man looking slightly older than his stated age. His blood pressure is 130/80
and his pulse is 88.
He is breathing comfortably with respirations of 12. His head, eyes, ears,
nose, and throat
examinations are unremarkable. His cardiac examination is normal. On
examination of his chest,
the diameter seems enlarged. Breath sounds are decreased throughout all
lobes. Rhonchi are
heard over all lung fields. There is no area of dullness and no increased or
decreased fremitus.
What thorax or lung disorder is most likely causing his symptoms?
A) Spontaneous pneumothorax
B) Chronic obstructive pulmonary disease (COPD)
C) Asthma
D) Pneumonia
,B) Chronic obstructive pulmonary disease (COPD)
This disorder is insidious in onset and generally affects the older population
with a smoking history. The diameter of the chest is often enlarged like a
barrel. Percussing the chest elicits hyperresonance, and during auscultation
there are often distant breath sounds. Coarse
breath sounds of rhonchi are also often heard. It is important to quantify this
patient's exercise
capacity because it may affect his employment and also allows you to follow
for progression of
his disease. You must offer smoking cessation as an option.
“‘“
A 36-year-old teacher presents to your clinic, complaining of sharp, knifelike
pain on the left
side of her chest for the last 2 days. Breathing and lying down make the pain
worse, while sitting
forward helps her pain. Tylenol and ibuprofen have not helped. Her pain does
not radiate to any
other area. She denies any upper respiratory or gastrointestinal symptoms.
Her past medical
history consists of systemic lupus. She is divorced and has one child. She
denies any tobacco,
alcohol, or drug use. Her mother has hypothyroidism and her father has high
blood pressure. On
examination you find her to be distressed, leaning over and holding her left
arm and hand to her left chest. Her blood pressure is 130/70, her respirations
are 12, and her pulse is 90. On
auscultation her lung fields have normal breath sounds with no rhonchi,
wheezes, or crackles.
,Percussion and palpation are unremarkable. Auscultation of the heart has an
S1 and S2 with no S3
or S4. A scratching noise is heard at the lower left sternal border, coincident
with systole; leaning
forward relieves some of her pain. She is nontender with palpation of the
chest wall.
What disorder of the chest best describes this disorder?
A) Angina pectoris
B) Pericarditis
C) Dissecting aortic aneurysm
D) Pleural pain
B) Pericarditis
The pain from pericarditis is usually sharp and knifelike and is located over
the left side of the chest. Change of position, breathing, and coughing often
make the pain worse,
whereas leaning forward improves the pain. Pericarditis is often seen in
rheumatologic diseases such as systemic lupus and in patients with chronic
kidney disease. Patients also experience this
after a myocardial infarction.
“‘“
A 68-year-old retired postman presents to your clinic, complaining of dull,
intermittent
left-sided chest pain over the last few weeks. The pain occurs after he mows
his lawn or chops
wood. He says that the pain radiates to the left side of his jaw but nowhere
else. He has felt
, light-headed and nauseated with the pain but has had no other symptoms.
He states when he sits
down for several minutes the pain goes away. Ibuprofen, Tylenol, and
antacids have not improved his symptoms. He reports no recent weight gain,
weight loss, fever, or night sweats. He has a past medical history of high
blood pressure and arthritis. He quit smoking 10 years ago after smoking one
pack a day for 40 years. He denies any recent alcohol use and reports no
drug
use. He is married and has two healthy children. His mother died of breast
cancer and his father
died of a stroke. His younger brother has had bypass surgery. On
examination you find him
healthy-appearing and breathing comfortably. His blood pressure is 140/90
and he has a pulse of
80. His head, eyes, ears, nose, and throat examinations are unremarkable.
His lungs have normal breath sounds and there are no abnormalities with
percussion and palpation of the chest. His heart has a normal S1 and S2 and
no S3 or S4. Further workup is pending.
Which disorder of the chest best describes these symptoms?
A) Angina pectoris
B) Pericarditis
C) Dissecting aortic aneurysm
D) Pleural pain
A) Angina pectoris
Angina causes dull chest pain felt in the retrosternal area or anterior chest. It
often radiates to the shoulders, arms, neck, and jaw. It is associated with
shortness of breath, nausea, and sweating. The pain is generally relieved by
rest or medication after several minutes. This patient needs to be admitted
to the hospital for further workup for his accelerating symptoms.
