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Old 07-10-2012
tyagee's Avatar
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Lungs most likely cause of this nocturnal wheezing ?

A 56-year-old Caucasian male complains of chronic exertional dyspnea for the past several years that has
progressively worsened. He cannot remember the last time that he saw a doctor, and does not take any
medications regularly. It is difficult for him to climb two flights of stairs without having to rest. His dyspnea
has gotten so bad that it has severely limited his activity level, and he now spends most of his time on the
couch. He also describes recurrent episodes of nocturnal dyspnea, during which he wakes up at around 2:
00 AM with difficulty breathing, coughing, and wheezing that improve when he sits up. He usually coughs up
some yellowish sputum before being able to go back to sleep. He has had no fever, chills, or chest
pain W hich of the following is the most likely cause of this patient's complaints?
A. Left ventricular failure
B. Bronchial asthma
C. Chronic bronchitis
D. Pulmonary thromboembolism
E. Pulmonary fibrosis
F. Right ventricular failure
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  #2  
Old 07-10-2012
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Im confused between LVF and Bronchial Asthma.
However I would go with LVF because-
orthopnea-classic finding for LVF

Also asthma for several years in a 56 year old doesn't make sense. It would have presented much earlier.
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Old 07-10-2012
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A, this is the classic presentation of paroxistical nocturnal dyspnea/ortopnea
By being suppine gravity is the same and there is backup of more blood back to the lungs, the pressure exceeds the 30mmhg that the lungs can handle and edema follows.

I dont think neither asthma non PE are correct as we would have be given a different story, also this guy hasnt seen an MD for years, probably he has HTN and now his left heart is giving up.
By the looks of his heart failure he is NYHA grade IV
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Old 07-11-2012
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Quote:
Originally Posted by tyagee View Post
A 56-year-old Caucasian male complains of chronic exertional dyspnea for the past several years that has
progressively worsened. He cannot remember the last time that he saw a doctor, and does not take any
medications regularly. It is difficult for him to climb two flights of stairs without having to rest. His dyspnea
has gotten so bad that it has severely limited his activity level, and he now spends most of his time on the
couch. He also describes recurrent episodes of nocturnal dyspnea, during which he wakes up at around 2:
00 AM with difficulty breathing, coughing, and wheezing that improve when he sits up. He usually coughs up
some yellowish sputum before being able to go back to sleep. He has had no fever, chills, or chest
pain W hich of the following is the most likely cause of this patient's complaints?
A. Left ventricular failure
B. Bronchial asthma
C. Chronic bronchitis
D. Pulmonary thromboembolism
E. Pulmonary fibrosis
F. Right ventricular failure
guys, ans is C !!!!
this is from uworld.
primary reason this is not PND orthopnea is this. even though he wakes up middle of night with dyspnea, he gets relief by coughing "yellowish" sputum. this is not feature of PND. PND patient do not cough sputum , if they do [ because of frank pulmonary edema] it would be frothy pink. sounds anal to me but they have point !

it is not asthma because ??? i cant make up....
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Cardiology-, Internal-Medicine-, Pulmonology-, Step-2-Questions

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