51.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 sputum. 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 sat-
uration of 94% on room air. Physical examination is noncontributory, except
for rales at the left-mid lung. Her ECG reveals sinus tachycardia with large
R waves in V 1 to V 3 and inverted T waves. Given this patient’s history and pre-
sentation, what is the most likely etiology of her symptoms?
a. Mycoplasma pneumoniae(“walking” pneumonia)
b. Q fever pneumonia
c. Pneumocystis jirovecipneumonia (PCP)
d. PE
e. Acute respiratory distress syndrome (ARDS)
52.A 24-year-old woman is brought to the ED after being found on a
nearby street hunched over and in mild respiratory distress. 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.
Scattered wheezing is heard throughout bilateral lung fields. Which of the
following medications should be administered first?
a. Corticosteroids
b. Magnesium sulfate
c. Epinephrine
d. Anticholinergic nebulizer treatment
e. β 2 -Agonist nebulizer treatment
52 Emergency Medicine