Dyspnea Symptoms And Causes Quiz! Trivia
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Do you know what dyspnea is? Dyspnea is a common condition in which you feel like you cannot take a deep breath. Dyspnea can also be a sign that there is something more serious going on, such as heart disease or damage to the lungs. You can also experience it after a hard workout. If you are ready to take this quiz, take a deep breath and see what you know.
Questions and Answers
- 1.
A 55 year old attorney crashes his bicycle during a spirited sprint for the city limits sign. He fractures his right clavicle in the fall. Four days later, while in his clavicle strap and an arm sling, he notes that his right hand is extremely swollen, which he thinks is probably normal. The next day he suddenly becomes very short of breath and has his wife take him to the Emergency Department. While performing your respiratory examination, which of the following are you most likely to find?
- A.
Tracheal deviation
- B.
A pleural friction rub
- C.
Unilateral hyperresonance on chest percussion
- D.
Crackles localized over the right mid-axillary line
- E.
Tachypnea
Correct Answer
E. TachypneaExplanation
The most likely finding during the respiratory examination of the attorney would be tachypnea, which refers to rapid breathing. This is because the sudden shortness of breath he experiences is indicative of a respiratory issue. Tachypnea is commonly seen in conditions such as pulmonary embolism, which could be a potential complication following a fracture. Therefore, it is the most likely finding in this scenario.Rate this question:
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- 2.
A 34 yo male presents to the Emergency Department with an acute onset of SOB and the following CXR: His O2 saturation is 84%. He most likely has which type of respiratory failure?
- A.
Hypoxemic
- B.
Hypercapnic
- C.
Compensated
- D.
ARDS
- E.
Mixed hypoxemic and hypercapnic
Correct Answer
B. HypercapnicExplanation
Based on the given information, the patient presents with acute onset of shortness of breath (SOB) and a low oxygen saturation level of 84%. This indicates that the patient is experiencing hypercapnic respiratory failure, which is characterized by an elevated level of carbon dioxide (hypercapnia) in the blood. Hypercapnic respiratory failure occurs when there is inadequate ventilation or impaired gas exchange, leading to an accumulation of carbon dioxide and a decrease in oxygen levels.Rate this question:
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- 3.
A patient with a long history of asthma reports to your office with shortness of breath. She is normally maintained on a daily corticosteroid inhaler and an albuterol inhaler which she uses for “rescue” about 4 times a month. Two days ago she noted that she had to increase her albuterol inhaler use to every 4 hours. This strategy is no longer providing her with relief. Which is the most ominous sign in a patient with an acute asthma attack?
- A.
Nervousness and pressure of speech
- B.
Tachypnea and tachycardia
- C.
Wheezing audible across the exam room
- D.
A silent chest
- E.
Inspiratory stridor
Correct Answer
D. A silent chestExplanation
A silent chest is the most ominous sign in a patient with an acute asthma attack. This means that there is no audible air movement in the chest, indicating severe airway obstruction. It suggests that the patient's condition is deteriorating rapidly and immediate intervention is required.Rate this question:
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- 4.
As a country doctor in rural Kentucky, you are always ready to help. Your neighbor, a 64-year-old heavy smoker and former coal miner develops a “chest cold”. His wife calls and asks you to visit him on your way home from the office one evening. You note that he is drowsy and he has central cyanosis. As someone who is always prepared, you carry a cylinder of 100% oxygen in your SUV. You administer 100% O2 by mask and take him in your vehicle to the hospital 40 miles away. By the time you get there, he is comatose. His ABGs show severe hypercapnia, though the PaO2 is high. Why did he get worse?
- A.
High FIO2 caused CO2 narcosis
- B.
He went into type I respiratory failure
- C.
He had a cardiac arrest
- D.
He had ARDS
- E.
He had a pulmonary embolism
Correct Answer
A. High FIO2 caused CO2 narcosisExplanation
The principal result of the increased amount of dissolved CO2 is acidosis (respiratory acidosis when caused by impaired lung function); other effects include tachycardia (rapid heart rate) seizures, coma, respiratory arrest and death.
CO2 retention is a problem in various respiratory diseases, particularly chronic obstructive pulmonary disease (COPD). Patients with COPD who receive excessive supplemental oxygen can develop CO2 retention, and subsequent hypercapnia. The mechanism that underlies this state is a matter of controversy. Some authorities point to a reduction in the hypoxic "drive", a condition called carbon dioxide narcosis. When carbon dioxide levels are chronically elevated, the respiratory center becomes less sensitive to CO2 as a stimulant of the respiratory drive, and the PaO2 provides the primary stimulus for respirations. Administering excess supplemental oxygen can potentially suppress the respiratory center. However, it is unclear whether such a hypoxic drive exists in the first place. An alternative explanation is that, in patients with COPD, the administration of oxygen leads to an increase in the degree to which diseased alveoli are perfused with blood relative to other, less-diseased alveoli. As a result, a larger fraction of blood passes through parts of the lung that are poorly-ventilated, with a resulting increase in the CO2 concentration of the blood leaving the lungs.
As CO2 levels increase, patients exhibit a reduction in overall level of consciousness as well as respiratory effort. Severe increases in CO2 levels can lead to respiratory arrest.
CO2 retention is the hallmark of type II respiratory failure. While in type I any degree of hypoxia is compensated for by hyperventilation (and a decrease in CO2), this mechanism fails in type II. Mechanical ventilation (through intubation, CPAP or BIPAP) may be indicated, or infusion of doxapram.Rate this question:
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- 5.
One of your young patients develops flu like symptoms then rapidly deteriorates with increasing dyspnea and tachypnea. In the office you note diffuse wheezes on respiratory exam and her pulse oximetry is 89% on 100% O2. A STAT chest x ray shows diffuse patchy infiltrates. She is admitted to the hospital. What mechanical ventilator strategy is presently considered most appropriate for ARDS?
- A.
High tidal volume, high FIO2 to increase O2 saturations as soon as possible
- B.
High respiratory rate to facilitate lowering of CO2
- C.
Low respiratory rate to stimulate respiratory drive
- D.
Low tidal volume ventilation to reduce lung injury
- E.
Positive end expiratory pressure to prevent atelectasis
Correct Answer
D. Low tidal volume ventilation to reduce lung injuryExplanation
ARDS Treatment:
Lung protective ventilation LOW TIDAL VOLUME VENTILATION
◦ Normal tidal volume 10 ml/kg
◦ Reduce to 8-6 ml/kg
◦ Increase respirator rate to meet minute ventilationRate this question:
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- 6.
Mrs. Mulcahy presents to the emergency room with complaints of shortness of breath and generalized muscle weakness both of which have gradually worsened. She has received a recent MMR booster. Admission pO2 is 60mmHg. The most likely diagnosis would involve:
- A.
Disorder of the peripheral nervous system
- B.
Disorder of the alveoli
- C.
Disorder of the airways
- D.
Disorder of the central nervous system producing hypoventilation
Correct Answer
B. Disorder of the alveoliExplanation
ARDS Pathophysiology:
Anything that can provoke inflammation to the alveoli can cause it. The lungs are particularly susceptible to inflmamatory mediators generated else where in the body as the entire cardiac output goes through the lungs. Thus a distant inflammatory conditions such as severe pancreatitis can trigger ards. These disease state release inflammatory mediators that produce diffuse alveolar damageRate this question:
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- 7.
What is the cause of late inspiratory crackles?
- A.
Small airways, deflated during expiration, pop open during inspiration
- B.
Air flows rapidly through bronchi narrowed nearly to closure
- C.
Air bubbles flow through secretions or slightly closed small airways during respiration
- D.
Air flows through secretions in large airways
Correct Answer
A. Small airways, deflated during expiration, pop open during inspirationExplanation
Crackles, crepitations, or rales are the clicking, rattling, or crackling noises that may be made by one or both lungs of a human with a respiratory disease during inhalation Crackles that clear after a cough may indicate pulmonary edema or fluid in the alveoli due to heart failure or Acute Respiratory Distress Syndrome. 1. Crackles are caused by the "popping open" of small airways and alveoli collapsed by fluid, exudate, or lack of aeration during expiration. The word "rales" derives from the French word râle meaning "rattle". 2. Another explanation for crackles is that air bubbles through secretions or incompletely closed airways during EXPIRATION. - ARDS - asthma - bronchiectasis - chronic bronchitis - consolidation - early CHF - interstitial lung disease - pulmonary edemaRate this question:
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- 8.
Which one of the following patients has dyspnea?
- A.
A patient complaining of labored breathing
- B.
A patient with pink-colored skin, barrel chest, and tachypnea
- C.
) An unconscious patient with low blood pH and high pCO2
- D.
) A patient with fever, tachycardia, and tachypnea
Correct Answer
A. A patient complaining of labored breathingExplanation
A patient complaining of labored breathing is likely to have dyspnea. Dyspnea refers to difficulty or discomfort in breathing, which can manifest as labored breathing. This symptom may be caused by various underlying conditions such as respiratory infections, asthma, heart failure, or pulmonary embolism. It is important to assess the patient further to determine the cause and provide appropriate treatment.Rate this question:
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- 9.
Which one of the following conditions is characterized by tympany on chest percussion?
- A.
Bronchial asthma
- B.
Diaphragmatic hernia
- C.
Lung emphysema
- D.
Pulmonary embolism
Correct Answer
B. Diaphragmatic herniaExplanation
Diaphragmatic hernia is characterized by tympany on chest percussion. Tympany refers to a drum-like sound that is produced when a hollow organ, such as the stomach or intestines, is percussed. In diaphragmatic hernia, a portion of the abdominal organs protrudes through an opening in the diaphragm into the chest cavity. This can lead to air accumulation in the chest, causing the characteristic tympany sound on percussion. Bronchial asthma, lung emphysema, and pulmonary embolism do not typically result in tympany on chest percussion.Rate this question:
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- 10.
Which one of the following patients has central cyanosis?
- A.
A patient with bluish discoloration of nail beds, lips, frenulum of the tongue and helix of the ear, and SaO2 of 75mmHg
- B.
A patient with bluish discoloration of nail beds and helix of the ear, and PaO2 of 60mmHg
- C.
A patient with bluish discoloration of nail beds, pale mucous membranes, and PaO2 of 40mm Hg
- D.
A patient with bluish discoloration of nail beds, normal mucous membranes, and SaO2 of 90mmHg
Correct Answer
A. A patient with bluish discoloration of nail beds, lips, frenulum of the tongue and helix of the ear, and SaO2 of 75mmHgExplanation
Cyanosis is divided in to two main types: central (around the core and lips) and peripheral (only the extremities are affected). Cyanosis can occur in the fingers, including underneath the fingernails, as well as other extremities (called peripheral cyanosis), or in the lips and tongue (central cyanosis).
CENTRAL CYANOSIS
Central cyanosis is often due to a circulatory or ventilatory problem that leads to poor blood oxygenation in the lungs. It develops when arterial saturation of blood with oxygen is ≤85%. Cyanosis may not be detected until saturation is 75% in dark-skinned individuals.
Acute cyanosis can be a result of asphyxiation or choking, and is one of the surest signs that respiration is being blocked.
Causes
1. Central Nervous System:
• Intracranial hemorrhage
• Cerebral anoxia
• Drug overdose (e.g. Heroin)
• Tonic-clonic seizure (e.g. grand mal seizure or gran mal seizure)
2. Respiratory System:
• Bronchiolitis
• Bronchospasm (e.g. Asthma)
• Lung disease
• Pulmonary Hypertension
• Pulmonary embolism
• Hypoventilation
• COPD (emphysema and chronic bronchitis)
• Respiratory syncytial virus
3. Cardiac Disorders:
• Congenital heart disease (e.g. Tetralogy of Fallot, Right to left shunts in heart or great vessels)
• Heart failure
• Heart valve disease
• Myocardial infarction
4. Blood:
• Methemoglobinemia
• Polycythaemia
5. Others:
• High altitude
• Hypothermia
• Congenital cyanosis (HbM Boston) arises from a mutation in the α-codon which results in a change of primary sequence, H → Y. Tyrosine stabilises the Fe(III) form (oxyhaemoglobin) creating a permanent T-state of Hb.
• Obstructive sleep apneaRate this question:
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- 11.
A 40-year-old woman with leukemia is treated with chemotherapy. During treatment, she develops an increasing cough and shortness of breath. A chest x-ray shows diffuse lung infiltrates. Sputum cultures are negative, and the patient does not respond to routine antibiotic therapy. An open lung biopsy is diagnosed by the pathologist as severe viral pneumonia. Which of the following histopathologic findings would be expected in the lungs of this patient?
- A.
Clusters of epithelioid macrophages
- B.
Confluent areas of caseous necrosis
- C.
Fibrous scarring of lung parenchyma
- D.
Hyaline membranes and interstitial inflammation
- E.
Sheets of bacilli-filled macrophages
Correct Answer
D. Hyaline membranes and interstitial inflammationExplanation
The histopathologic findings of hyaline membranes and interstitial inflammation are characteristic of viral pneumonia. Hyaline membranes are formed by the accumulation of proteinaceous material in the alveolar spaces, indicating damage to the lining of the lungs. Interstitial inflammation refers to inflammation in the interstitial spaces between the alveoli. These findings are consistent with the patient's symptoms of cough and shortness of breath, as well as the diagnosis of severe viral pneumonia.Rate this question:
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- 12.
A 28 years old male was brought to the ER after a motor vehicle accident. He had a blunt injury to the left chest with extreme tenderness to the left side. The patient is dyspneic with respiratory rate 28/min, blood pressure 100/60 mm of Hg, temp 37 C. On examination you found the neck veins are prominent, the patient is having labored breathing with limited movement on the right side, palpation showed shifting of the trachea and apical impulse on the right side, percussion on the right side is hyper resonant and auscultation shows the absence of breath sound on the right side. Your management should be
- A.
Proper investigation to establish the diagnosis
- B.
Refer the patient to the trauma surgeon
- C.
Call the chest physician to examine the case
- D.
Contact the relatives and friends to take the proper past history of the patient
- E.
Put multiple wide bore needles to the right chest wall and then put a chest tube into the right pleural space
Correct Answer
E. Put multiple wide bore needles to the right chest wall and then put a chest tube into the right pleural spaceExplanation
The patient's presentation is consistent with tension pneumothorax, which is a life-threatening condition that requires immediate intervention. The prominent neck veins, tracheal shift, absent breath sounds, and hyper resonance on percussion are all indicative of a tension pneumothorax. The management of choice for tension pneumothorax is to relieve the pressure by inserting multiple wide bore needles into the affected side of the chest to allow air to escape, followed by the insertion of a chest tube to re-expand the lung and prevent recurrence. This intervention should be performed urgently to stabilize the patient's condition.Rate this question:
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- 13.
A 24 years old African American male was admitted to the hospital with acute watery diarrhea. On examination he was dehydrated with pulse rate 100/minute, regular respiration rate 20/minute, Hb 15 gm%, Total WBC 7000/cmm of blood, 170,000/cmm of blood. Old notes of the patient showed that he had some hemoglobinopathy. He was advised to have IV fluid by the attending physician, but in spite of the explanation of grave consequence of dehydration the patient refused it. He suddenly developed severe respiratory distress and the rate of respiration went up to 30/minute. Pulse oximetry showed the hemoglobin saturation 90%. The most likely diagnosis is
- A.
Acute chest syndrome or sickle chest syndrome
- B.
Acute Respiratory Distress Syndrome
- C.
Massive pleural effusion
- D.
Aortic dissection
- E.
Pulmonary embolism
Correct Answer
A. Acute chest syndrome or sickle chest syndromeExplanation
The acute chest syndrome is a noninfectious vaso-occlusive crisis of the pulmonary vasculature commonly seen in patients with SICKLE CELL ANEMIA. It is characterized by a new infiltrate on a chest x-ray. • Cause The crisis is often initiated by a lung infection, and the resulting inflammation and loss of oxygen tension leads to sickling of red cells and further vasoocclusion. Symptoms The crisis is a common complication in sickle-cell patients and can be associated with one or more symptoms including fever, cough, sputum production, dyspnea, or hypoxia. Treatment Broad spectrum antibiotics to cover common infections like strep pneumoniae and mycoplasma, pain control, and blood transfusion. Prognosis It may result in death, and it is one of the most common causes of death for sickle cell patients.Rate this question:
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- 14.
17 years old caucasian lady is escorted to the ER with complaints of dyspnoea, cough, expectoration of foul yellow-green sputum with hemoptysis. She had a neonatal surgery for bowel obstruction and at present having repeated pain epigastrium, loss of weight, a foul-smelling stool which floats on water. Presently she is having repeated respiratory infections for which she is on physiotherapy and antibiotics. What is the diagnosis?
- A.
Acute bronchitis
- B.
Recurrent attack of bronchial asthma
- C.
Bronchiectasis
- D.
Aspiration pneumonia
- E.
Pancreatic cancer with lung metastasis
Correct Answer
C. BronchiectasisExplanation
CYSTIC FIBROSIS is an autosomal recessive genetic disorder affecting most critically the LUNGS, and also the pancreas, liver, and INTESTINE. It is characterized by abnormal transport of chloride and sodium across an epithelium, leading to thick, viscous secretions Gastrointestinal Prior to prenatal and newborn screening, cystic fibrosis was often diagnosed when a newborn infant failed to pass feces (meconium). Meconium may completely block the intestines and cause serious illness. This condition, called meconium ileus, occurs in 5–10%[16][22] of newborns with CF. In addition, protrusion of internal rectal membranes (rectal prolapse) is more common, occurring in as many as 10% of children with CF,[16] and it is caused by increased fecal volume, malnutrition, and increased intra–abdominal pressure due to coughing The lack of digestive enzymes leads to difficulty absorbing nutrients with their subsequent excretion in the feces, a disorder known as malabsorption. Individuals with CF also have difficulties absorbing the fat-soluble vitamins A, D, E, and K. LUNG DISEASE results from clogging of the airways due to mucus build-up, decreased mucociliary clearance, and resulting inflammation. Inflammation and infection cause injury and structural changes to the lungs, leading to a variety of symptoms. In the early stages, incessant coughing, copious phlegm production, and decreased ability to exercise are common. Many of these symptoms occur when bacteria that normally inhabit the thick mucus grow out of control and cause pneumonia. In later stages, changes in the architecture of the lung, such as pathology in the major airways (****BRONCHIECTASIS*****) further exacerbate difficulties in breathing. Summary, Decreased fat digestion, leads to fatty stools. Increased lung infection/inflamation leads to BRONCHIECTASISRate this question:
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- 15.
The dreaded complication of a pharyngeal diverticulum in a 79 years old lady is?
- A.
Asphyxia and aspiration pneumonia by regurgitation of diverticular contents
- B.
Pulmonary embolism
- C.
Cardiac arrest due to pressure on the vagus nerve
- D.
Air embolism
- E.
Dysphagia due to pressure on the pharynx and upper esophagus
Correct Answer
A. Asphyxia and aspiration pneumonia by regurgitation of diverticular contentsExplanation
The correct answer is asphyxia and aspiration pneumonia by regurgitation of diverticular contents. In a pharyngeal diverticulum, there is an outpouching of the pharyngeal mucosa, which can collect food and saliva. If the diverticulum becomes large enough, it can cause difficulty swallowing (dysphagia) and lead to the regurgitation of its contents. This can result in asphyxia (difficulty breathing) and aspiration pneumonia (infection of the lungs caused by inhaling foreign material). Therefore, asphyxia and aspiration pneumonia are the dreaded complications of a pharyngeal diverticulum in a 79-year-old lady.Rate this question:
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- 16.
A two-year-old child is brought to the Emergency Department with acute onset of high fever and stridor. He is actively drooling and sitting very still with his neck extended. His mother admits that she had him immunized only for tetanus, diphtheria, and pertussis because she was worried he would “develop autism”. What condition does this child now have?
- A.
Peritonsillar abscess
- B.
Laryngotracheobronchitis
- C.
Epiglottitis
- D.
Croup
- E.
Bronchiolitis
Correct Answer
C. EpiglottitisExplanation
Epiglottitis:
This also presents in childhood but usually in the older child 3 to 4-years-old. It is bacterial associated symptoms include fever, stridor and drooling from the mouth. The epiglottis is swollen and “cherry-red”. Radiologic evidence is the “thumbs up sign” on lateral neck X-Ray. Do not attempt to visualize the epiglottis unless you are able to intubate, as they may go into spasm. Treatment is antibiotics.
Signs and symptoms
Epiglottitis commonly affects children, and it is associated with fever, difficulty in swallowing, drooling, hoarseness of voice, and typically no stridor. The child often appears acutely ill, anxious, and has very quiet shallow breathing with the head held forward, insisting on sitting up in bed. The early symptoms are insidious but rapidly progressive, and swelling of the throat may lead to cyanosis and asphyxiation.
Epiglottitis is an airway emergency and intubation is required initially. ***Since the introduction of the Hemophilus influenzae (Hib) vaccination**** in many Western countries, childhood incidence has decreased while adult incidence has remained the same; the disease is thus becoming relatively more common in adults than children. Modern cases in adults are most typically seen among abusers of crack cocaine, and have a subacute presentation. GEORGE WASHINGTON is one historical figure thought to have died of epiglottitis.
Cause
Epiglottitis involves bacterial infection of the epiglottis, most often caused by Haemophilus influenzae type B, although some cases are attributable to Streptococcus pneumoniae, Streptococcus agalactiae, Staphylococcus aureus, Streptococcus pyogenes, and Moraxella catarrhalis.Rate this question:
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.JPG "A 34 yo male presents to the Emergency Department with an acute onset of SOB and the following CXR:
His O2 saturation is 84%. He most likely has which type of respiratory failure?")
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Mar 20, 2023Quiz Edited by
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