56.As you evaluate a patient with shortness of breath, you appreciate
decreased breath sounds at the left-lung base. You suspect the patient has a
small pleural effusion. Which of the following views of the chest is this
small pleural effusion most likely to be detected?
a. Supine
b. Lateral decubitus right-side down
c. Lateral decubitus left-side down
d. Lateral
e. Posterior-anterior (PA)
57.A 32-year-old firefighter presents to the ED in acute respiratory distress.
He was taken to the ED shortly after extinguishing a large fire in a warehouse.
His initial vitals include a 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 exam-
ination, 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?
a. Reactive airway disease
b. Foreign body aspiration
c. Decompression sickness
d. Thermal burns
e. Pneumothorax
58.A 76-year-old man presents to the ED in acute respiratory distress,
gasping for breath while on face mask. Paramedics state that he was found
on a bench outside of his apartment in respiratory distress. Initial vitals
include a 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?
a. Morphine sulfate only
b. Nitroglycerin only
c. Nitroglycerin and a loop diuretic
d. Aspirin
e. Antibiotics
54 Emergency Medicine