tommyk
10-05-2006, 04:23 PM
Hy 2428 Cardiac Path and Resp. Phys….
A 35-year-old race car driver name Philip Seymour Hoffman presents to you with a known history of asthma and severe shortness of breath, cough, and wheezing. He is on a mission to make possible a win in the Indy 500. He appears extremely dyspneic. His blood pressure is 160/80 mm Hg, pulse is 110/min, and respirations are 35/min. With inspiration, his blood pressure falls to 100/70 mm Hg. On lung examination, there are loud, high-pitched wheezes and a prolonged expiratory phase. Which of the following physical examination findings is of most significance in evaluating this patient? Remember to guess first!
1-Pulsus paradoxus
2-Wheezing
3-Dyspnea
4-Elevated B.P.
5-Tachycardia
a) pick ans. #1. Very important: Do you know what PULSUS PARADOXUS is? The significant fall in systolic blood pressure with inspiration describes a patient with a pulsus paradoxus in the setting of asthma. This is a very important physical finding in that it indicates this patient is in the midst of a severe asthmatic attack. The other physical finding that indicates a severe asthmatic attack is the use of the accessory muscles of respiration, i.e., the internal intercostal muscles and the sternocleidomastoid muscles. Note that NBME loves asthma because it kills people very quickly and commonly.
A 35-year-old race car driver name Philip Seymour Hoffman presents to you with a known history of asthma and severe shortness of breath, cough, and wheezing. He is on a mission to make possible a win in the Indy 500. He appears extremely dyspneic. His blood pressure is 160/80 mm Hg, pulse is 110/min, and respirations are 35/min. With inspiration, his blood pressure falls to 100/70 mm Hg. On lung examination, there are loud, high-pitched wheezes and a prolonged expiratory phase. Which of the following physical examination findings is of most significance in evaluating this patient? Remember to guess first!
1-Pulsus paradoxus
2-Wheezing
3-Dyspnea
4-Elevated B.P.
5-Tachycardia
a) pick ans. #1. Very important: Do you know what PULSUS PARADOXUS is? The significant fall in systolic blood pressure with inspiration describes a patient with a pulsus paradoxus in the setting of asthma. This is a very important physical finding in that it indicates this patient is in the midst of a severe asthmatic attack. The other physical finding that indicates a severe asthmatic attack is the use of the accessory muscles of respiration, i.e., the internal intercostal muscles and the sternocleidomastoid muscles. Note that NBME loves asthma because it kills people very quickly and commonly.