63.An 82-year-old woman becomes acutely short of breath while at rest
on the rehabilitation unit. She is brought into the ED with an oxygen satu-
ration of 86% on room air and in acute respiratory distress. Her initial ECG
is within normal limits and unchanged from a recent previous examina-
tion. Her initial chest x-ray is also negative. Upon chest auscultation, there
are equal bilateral breath sounds with some scattered rhonchi. Her nurse
tells you that 2 days ago she underwent internal fixation of a right-femur
fracture and has been on anticoagulant therapy. Given the history and pre-
sentation of this patient, what is the most likely etiology of her symptoms?
a. Venous thromboembolism
b. Air embolism
c. Fat embolism
d. Pulmonary hemorrhage
e. Rib fracture
64.A 72-year-old man presents to the ED with worsening dyspnea. His
initial vitals include a HR of 93 beats per minute, BP of 110/50 mm Hg, and
RR of 20 breaths per minute with an oxygen saturation of 88% on room air.
The patient appears thin and anxious. He is using accessory muscles to
breathe. Despite distant breath sounds, you hear end-expiratory rhonchi
and a prolonged expiratory phase. An ECG shows peaked P waves in leads
II, III, and aVF. Given this patient’s history and physical examination,
which of the following conditions does this patient most likely have?
a. Chronic bronchitis
b. Asthma
c. Emphysema
d. Congestive heart failure (CHF)
e. Pneumothorax
Shortness of Breath 57