[MCQs] Shortness of Breath Quiz (21 test)

I. Start the exam by click the “Start” button

II. Preview all questions below

1. 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 During the history, she tells you that her doctor just started her on a new blood pressure (BP) medication. Her only other medi- cation 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 98.7°F. 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?

1. Metoprolol
2. Furosemide
3. Aspirin
4. Lisinopril
5. Diltiazem

2. A 45-year-old woman presents to the ED immediately after landing at the airport from a transatlantic 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 levothyroxine. She is a social drinker and smokes cigarettes occasionally. Her BP is 130/75 mm Hg, HR is 98 beats per minute, temperature is 98.9°F, 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?

1. Place patient on a monitor, provide supplemental oxygen, and administer unfractionated heparin.
2. Place patient on a monitor, order a chest computed tomography (CT) scan to con- firm a pulmonary embolism (PE), and then administer unfractionated heparin.
3. Place patient on a monitor and administer aspirin.
4. Instruct the patient to walk around the ED so that she remains mobile and does not exacerbate thrombus formation.
5. Place the patient on a monitor, provide supplemental oxygen, and administer warfarin.

3. A tall, thin 18-year-old man presents to the ED with acute onset of dyspnea while at 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 an 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 exami- nation, you note decreased breath sounds on the right side. Which of the following tests should be performed next?

1. Electrocardiogram  (ECG)
2. D-dimer
3. Ventilation perfusion scan (V/Q scan)
4. Upright  abdominal radiograph
5. Chest radiograph

4. A 30-year-old obese woman with no significant past medical history presents to the ED complaining of shortness of breath and coughing up blood-streaked The patient states that she traveled to Moscow a month ago. Upon returning to the United States, the patient developed a persistent cough associated with dyspnea. She was seen by a pulmonologist, who diagnosed her with bronchitis and prescribed an inhaler. However, over the following weeks, the patient’s symptoms worsened, and she devel- oped pleuritic chest pain. In the ED, she lets you know that she smokes half a pack per day. Her vitals include a temperature of 99°F, BP of 105/65 mm Hg, HR of 124 beats per minute, RR of 22 breaths per minute, and an oxygen saturation of 94% on room air. Physical examination is non- contributory, except for rales at the left-mid lung. Her ECG reveals sinus tachycardia with large R waves in V1 to V3 and inverted T waves. Given this patient’s history and presentation, what is the most likely etiology of her symptoms?

1. Mycoplasma pneumoniae (“walking” pneumonia)
2. Q fever pneumonia
3. Pneumocystis jiroveci pneumonia (PCP)
4. PE
5. Acute respiratory distress syndrome (ARDS)

5. A 24-year-old woman is brought to the ED after being found on a nearby street hunched over and in mild respiratory Upon arrival, she is tachypneic at 24 breaths per minute with an oxygen saturation of 97% on face mask oxygen administration. Upon physical examination, the patient appears to be in mild distress with supraclavicular retractions. Scat- tered wheezing is heard throughout bilateral lung fields. Which of the fol- lowing medications should be administered first?

1. Corticosteroids
2. Magnesium sulfate
3. Epinephrine
4. Anticholinergic  nebulizer treatment
5. b2-Agonist  nebulizer treatment

6. An 81-year-old woman presents to the ED with acute onset of short- ness of breath just before She refuses to answer questions for the interview, but repeatedly states that she is feeling short of breath. Her initial vitals include an HR of 89 beats per minute, a BP of 168/76 mm Hg, and an RR of 18 breaths per minute with an oxygen saturation of 89% on room air. A portable chest x-ray appears normal. Her physical examination is unremarkable, except for a systolic ejection murmur. Intravenous (IV) access is successfully obtained. After placing the patient on oxygen and a monitor, which of the following should be performed first?

1. Evaluation of troponin level
2. Evaluation of D-dimer level
3. Rectal temperature
4. Repeat chest x-ray
5. ECG

7. As you evaluate a patient with shortness of breath, you appreciate decreased breath sounds at the left-lung You suspect the patient has a small pleural effusion. In which of the following views of the chest is this small pleural effusion most likely to be detected?

1. Supine
2. Lateral decubitus right-side down
3. Lateral decubitus left-side down
4. Lateral
5. Posterior-anterior (PA)

8. A 32-year-old firefighter presents to the ED in acute respiratory dis- He was taken to the ED shortly after extinguishing a large fire in a warehouse. His initial vitals include an HR of 90 beats per minute, a BP of 120/55 mm Hg, and an RR of 18 breaths per minute with an oxygen saturation of 98% on 2-L nasal cannula. An ECG shows a first-degree heart block. Upon physical examination, there are diffuse rhonchi bilaterally. The patient is covered in soot and the hairs in his nares are singed. Given this clinical presentation, which of the following may be responsible for this patient’s respiratory distress?

1. Reactive airway disease
2. Foreign body aspiration
3. Decompression sickness
4. Thermal burns
5. Pneumothorax

9. A 76-year-old man presents to the ED in acute respiratory distress, gasping for breath while on face Paramedics state that he was found on a bench outside of his apartment in respiratory distress. Initial vitals include an HR of 90 beats per minute, a BP of 170/90 mm Hg, and an RR of 33 breaths per minute with an oxygen saturation of 90%. Upon physical examination, the patient is coughing up pink, frothy sputum, has rales two-thirds of the way up both lung fields, and has pitting edema of his lower extremities. A chest radiograph reveals bilateral perihilar infiltrates, an enlarged cardiac silhouette, and a small right-sided pleural effusion. After obtaining IV access and placing the patient on a monitor, which of the following medical interventions is most appropriate?

1. Morphine sulfate only
2. Nitroglycerin only
3. Nitroglycerin and a loop diuretic
4. Aspirin
5. Antibiotics

10. A 67-year-old man is brought to the ED in respiratory His initial vitals include an HR of 112 beats per minute, a BP of 145/88 mm Hg, and an RR of 18 breaths per minute with an oxygen saturation of 92% on room air. He is also febrile at 102°F. After obtaining IV access, placing the patient on a monitor, and administering oxygen via nasal cannula, a chest radiograph is performed and shows patchy alveolar infiltrates with consolidation in the lower lobes. On review of systems, the patient tells you that he had five to six watery bowel movements a day for the last 2 days with a few bouts of emesis. Which of the following infectious etiologies is most likely respon- sible for the patient’s presentation?

1. Streptococcus pneumoniae
2. Haemophilus  influenzae
3. Mycoplasma  pneumoniae
4. Chlamydophila  pneumoniae
5. Legionella  pneumophila

11. A 32-year-old woman presents to the ED with a 1-month history of general malaise, mild cough, and subjective She states that she is human immunodeficiency virus (HIV) positive and her last CD4 count, 6 months ago, was 220. She is not on antiretroviral therapy or any other medications. Initial vitals include an HR of 88 beats per minute, a BP of 130/60 mm Hg, and an RR of 12 breaths per minute with an oxygen satu- ration of 91% on room air. Her chest radiograph shows bilateral diffuse interstitial infiltrates. Subsequent laboratory tests are unremarkable except for an elevated lactate dehydrogenase level. Given this patient’s history and physical examination, which of the following is the most likely organism responsible for her clinical presentation?

1. Coccidioides  immitis
2. Mycobacterium  tuberculosis
3. Pneumocystis  jiroveci
4. Mycoplasma  pneumoniae
5. Haemophilus  influenzae

12. A 27-year-old woman presents to the ED complaining of an intensely pruritic rash all over her body, abdominal cramping, and chest She states that 1 hour ago she was at dinner and accidentally ate some shrimp. She has a known anaphylactic allergy to shrimp. Her BP is 115/75 mm Hg, HR is 95 beats per minute, temperature is 98.9°F, RR is 20 breaths per minute, and oxygen saturation is 97% on room air. She appears anxious, and her skin is flushed with urticarial lesions. Auscultation of her lungs reveals scattered wheezes with decreased air entry. Which of the following is the most appropriate next step in management?

1. Administer oxygen via non-rebreather, place a large-bore IV, begin IV fluids, and administer methylprednisolone intravenously.
2. Administer oxygen via non-rebreather, place a large-bore IV, begin IV fluids, and administer methylprednisolone and diphenhydramine  intravenously.
3. Administer oxygen via non-rebreather, place a large-bore IV, begin IV fluids, administer methylprednisolone and diphenhydramine intravenously, and give intramuscular epinephrine.
4. Administer oxygen via non-rebreather, place a large-bore IV, begin IV fluids, and start aerosolized albuterol.
5. Administer oxygen via non-rebreather, place a large-bore IV, begin IV fluids, and start aerosolized epinephrine.

13. A 72-year-old man presents to the ED with worsening His initial vitals include an HR of 93 beats per minute, BP of 110/50 mm Hg, and RR of 20 breaths per minute with an oxygen saturation of 88% on room air. The patient appears thin and anxious. He is using accessory muscles to breathe. Despite distant breath sounds, you hear end-expiratory rhonchi and a prolonged expiratory phase. An ECG shows peaked P waves in leads II, III, and aVF. Given this patient’s history and physical examina- tion, which of the following conditions does this patient most likely have?

1. Chronic bronchitis
2. Asthma
3. Emphysema
4. Congestive heart failure (CHF)
5. Pneumothorax

14. A 71-year-old woman presents to the ED after a reported mechanical fall 2 days Her initial vitals include an HR of 55 beats per minute, a BP of 110/60 mm Hg, an RR of 14 breaths per minute, and an oxygen saturation of 96% on room air. The patient does not appear to be taking deep breaths. Her physical examination is significant for decreased breath sounds bilaterally and tenderness to palpation along the right side of her chest. After initial stabilization, which of the following is the diagnostic test of choice for this patient’s condition?

1. Chest x-ray
2. Chest CT scan
3. ECG
4. Rib radiographs
5. Thoracentesis

15. A 29-year-old woman presents to the ED for Her initial vitals include an RR of 28 breaths per minute with an oxygen saturation of 100% on room air. She is able to speak in full sentences and tells you that she cannot breathe and that her hands and feet are cramping up. She denies any trauma, past medical history, or illicit drug use. Chest ausculta- tion reveals clear breath sounds bilaterally. A subsequent chest radiograph is normal. Upon reevaluation, the patient reports that she is breathing better. Her vitals include an RR of 12 breaths per minute with an oxygen satura- tion of 100% on room air. Which of the following conditions is most likely the etiology of this patient’s symptoms?

1. Pneumothorax
2. Hemopneumothorax
3. Pleural effusion
4. Anxiety attack
5. Asthma exacerbation

16. A 42-year-old man presents to the ED via ambulance after activat- ing EMS for He is currently on an oxygen face mask and was administered one nebulized treatment of a b2-agonist by the paramedics. His initial vitals include an RR of 16 breaths per minute with an oxygen saturation of 96% on room air. The patient appears to be in mild distress with some intercostal retractions. Upon chest auscultation, there are mini- mal wheezes localized over bilateral lower lung fields. The patient’s symp- toms completely resolve after two more nebulizer treatments. Which of the following medications, in addition to a rescue b2-agonist inhaler, should be prescribed for outpatient use?

1. Magnesium sulfate
2. Epinephrine injection (EpiPen)
3. Corticosteroids
4. Cromolyn sodium
5. Ipratropium

17. A 22-year-old woman is brought to the ED by paramedics who state that they found the patient hunched over on a park bench barely breath- ing. The patient is rousable only to painful Her initial vitals include an HR of 78 beats per minute, a BP of 125/58 mm Hg, and a respiratory rate of 6 breaths per minute with an oxygen saturation of 94% on 2-L nasal cannula. Upon physical examination, the patient has clear breath sounds bilaterally and no signs of trauma. Her pupils are 2 mm bilaterally and reactive to light. Which of the following agents may be used to restore this patient’s respirations?

1. Oxygen
2. Flumazenil
3. Anticholinergic inhaler treatment
4. b2-Agonist nebulized treatment
5. Naloxone

18. A 43-year-old undomiciled man is brought to the ED after being found intoxicated on the He is currently rousable and expresses a request to be left alone. Initial vitals include an HR of 92 beats per minute, a BP of 125/80 mm Hg, and an RR of 14 breaths per minute with an oxygen satura- tion of 93% on room air. His rectal temperature is 101.2°F. A chest radio- graph shows infiltrates involving the right lower lobe. Given this clinical presentation, what initial antibiotic coverage is most appropriate for this patient?

1. Gram-negative coverage only
2. Gram-positive coverage only
3. Broad-spectrum with anaerobic coverage
4. PCP coverage
5. Antifungal therapy

19. A 32-year-old man is brought into the ED by EMS with fever, shortness of breath, and The patient was treated yesterday in the ED for a viral syndrome. His BP is 90/50 mm Hg, HR is 110 beats per minute, temperature is 101.2°F, and his RR is 28 breaths per minute. A chest radiograph reveals a widened mediastinum. The patient is endotracheally intubated, given a 2-L bolus of normal saline, and started on antibiotics. His BP improves to 110/70 mm Hg and he is transferred to the intensive care unit (ICU). You see a friend that accompanied the patient to the hospital and ask him some questions. You find out that the patient is a drum maker and works with animal hides. What is the most likely organism that is responsible for the patient’s presentation?

1. Streptococcus pneumoniae
2. Corynebacterium  diphtheriae
3. Coxiella burnetii
4. Haemophilus  influenzae
5. Bacillus anthracis

20. A 62-year-old man presents to the ED with gradual dyspnea over the last few He reports that he is a daily smoker and has not seen a physician in years. Upon physical examination, there are decreased breath sounds on the right as compared to the left. A chest radiograph indicates blunting of the right costophrenic angle with a fluid line. A thoracentesis is performed. Given this patient’s history, which of the following most likely describes his effusion?

1. Transudative effusion
2. Exudative effusion
3. Transudative and exudative effusion
4. Lactate dehydrogenase < 200 units
5. Fluid-to-blood protein ratio < 0.5

21. A 40-year-old man with a history of untreated HIV for 8 years comes into the ED complaining of cough, fever, and malaise for 3 He is tachypneic and diaphoretic. Chest radiograph reveals bilateral infiltrates. Arterial blood gas (ABG) analysis is significant for a PaO2 of 62 on room air. His chest radiograph is seen below. Which of the following is the most appropriate initial management?

1. Treat with corticosteroid prior to antibiotic therapy.
2. Treat  immediately with IV trimethoprim/sulfamethoxazole   (TMP/SMX).
3. Administer antibiotics after a rapid sputum Gram stain is obtained.
4. Treat with nebulizer.
5. Treat with racemic epinephrine.