Acute Shortness of Breath:
A 36 year old male is rushed to the ER with severe respiratory distress. He is agitated and gasping for breath. He has been in the ER several times before for difficulty breathing, food intolerances and skin allergies. Physical examination is notable for excessive accessory respiratory muscle use, retraction of the sublavicular fossae during inspiration, and scattered urticarial over the upper body. What is the most likely diagnosis?
A ) Pneumothorax
B ) Eosinophil pneumonia
C ) Upper airway obstruction
D ) Asthma exacerbation
E ) Leukocytoclastic vasculitis
–USMLEWORLD,LLC QBank ver 2009.02
Correct answer is C. This is a patient with acute onset dyspnea and clinical features suggestive of upper respiratory obstruction. Given his history of food allergies and urticarial, laryngeal edema is likely the cause of his respiratory symptoms. Patients with laryngeal edema typically present with acute onset dyspnea. There is usually an identifiable precipitating event, e.g. peanut ingestion in a patient with a history of peanut allergies. Physical examination will reveal stridor and harsh respiratory sounds from the trachea. Wheezing is generally absent on lung auscultation.