53.An 81-year-old woman presents to the ED with acute onset of short-
ness of breath just before arrival. She refuses to answer questions for the
interview, but repeatedly states that she is feeling short of breath. Her ini-
tial vitals include a HR of 89 beats per minute, a BP of 168/76 mm Hg, and
an RR of 18 breaths per minute with an oxygen saturation of 89% on room
air. A portable chest x-ray appears normal. Her physical examination is unre-
markable, except for a systolic ejection murmur. Intravenous (IV) access is
successfully obtained. After placing the patient on oxygen and a monitor,
which of the following should be performed first?
a. Evaluation of troponin level
b. Evaluation of D-dimer level
c. Rectal temperature
d. Repeat chest x-ray
e. ECG
54.A 30-year-old man is brought to the ED by emergency medical service
(EMS) in respiratory distress. His initial vitals include a HR of 109 beats per
minute, a BP of 180/90 mm Hg, and an RR of 20 breaths per minute with
an oxygen saturation of 92% on room air. A chest x-ray shows a bilateral
diffuse infiltrative process. A subsequent toxicologic screen is positive.
Which of the following agents is most likely responsible for this patient’s
presentation?
a. Cannabis
b. Opioid
c. Crack cocaine
d. Methamphetamine
e. Ethanol
55.A 26-year-old woman presents to the ED with an acute onset of dysp-
nea after falling down a few steps. The patient denies any loss of conscious-
ness and reports feeling short of breath. Her initial chest x-ray appears
normal; however she continues to be symptomatic with stable vital signs.
Which of the following procedures should be performed next?
a. Repeat upright chest x-ray
b. Inspiratory and expiratory chest radiographs
c. Chest CT scan
d. Chest thoracostomy
e. Chest thoracotomy
Shortness of Breath 53