Review Question - QID 102984

This patient is wheezing in all lung fields with a normal chest radiograph which is most concerning for an asthma attack given his age and risk factors. Asthma is typically caused by environmental antigens.

Asthma typically presents with wheezing, dyspnea, and hypoxia. It is typically seen in patients with the "atopic triad" of seasonal allergies, eczema, and asthma. It is caused by hyperreactive airways which are usually triggered by environmental antigens like dust, mold, and animal hair. The treatment of asthma depends on the severity and can involve albuterol, fluticasone, or other long-acting beta-2 agonists.

Incorrect Answers:
Answer 1: Aspiration event could cause aspiration pneumonitis or an aspiration pneumonia; however, this would not cause diffuse wheezing in all lung fields and the chest radiograph would likely show an infiltrate.

Answer 2: Bacterial infection corresponds to a bacterial pneumonia which would present with a fever, cough, and lobar consolidation on radiography. Increased breath sounds over the pneumonia would be heard on physical exam.

Answer 3: Clot in pulmonary vasculature describes a pulmonary embolism which would present with pleuritic chest pain, hypoxia, and sinus tachycardia. Though this is possible, his diffuse wheezing suggests otherwise.

Answer 4: Elastic tissue destruction describes COPD which would present with diffuse wheezing in the setting of a long smoking history. This patient is too young to have COPD as the explanation of his symptoms. Similarly, his liver enzyme elevation is in the pattern of alcoholic liver injury (with AST > ALT in a 2:1 ratio) thus making alpha-1 antitrypsin deficiency rather unlikely.

Bullet Summary:
Asthma presents with bilateral wheezing and is exacerbated by environmental antigens.