Rosh Emergency Medicine Practice Test

For a patient with asthma presenting with chest discomfort, which physical examination finding is significant?

1. A. Bilateral wheezing

2. B. Decreased breath sounds

3. C. Pulsus paradoxus

4. D. Cyanosis

The correct answer is: C. Pulsus paradoxus

In a patient with asthma presenting with chest discomfort, the presence of pulsus paradoxus is a significant physical examination finding. Pulsus paradoxus refers to an exaggerated drop in blood pressure of more than 10 mm Hg during inspiration compared to expiration. This phenomenon is commonly observed in patients with severe asthma exacerbations, specifically when there is significant airway obstruction. In the context of asthma, pulsus paradoxus can occur due to increased intrathoracic pressure during inspiration, which can impede venous return to the heart, leading to a notable decline in stroke volume and corresponding blood pressure during inhalation. Recognizing pulsus paradoxus indicates that the patient may be experiencing a severe asthma attack or respiratory distress, necessitating urgent medical intervention. Bilateral wheezing, while also a common finding in asthma, may not indicate the severity of the attack and can be present even in less severe episodes. Decreased breath sounds might point to severe obstruction or even respiratory failure, but it does not provide the same level of clinical urgency as pulsus paradoxus in this context. Cyanosis indicates hypoxia and is certainly serious; however, it is a late sign and does not give the same immediate insight into the severity of the respiratory distress as pulsus paradoxus does.