Not Your Normal Asthma Attack - Page #1

Author: Kevin Lyu, MD
Co Author #1: Scott Rand, MD
Co Author #2: Kevin Lisman, MD
Senior Editor: Marc Hilgers, MD, PhD, FAMSSM
Editor: Marissa Vasquez Machuca, MD, MBA

Patient Presentation:
A 20-year-old male collegiate runner with history of mild intermittent asthma presents with concerns about chest tightness on exertion.

Patient has been complaining of the discomfort since winter. He notes that at high levels of exertion and increased heart rate, he develops chest tightness which resolves rapidly upon cessation. He reports coughing after the chest pain resolves. He denies any pain at lower intensity activities. He reports increased symptoms with cold air and poor air quality. He states that his albuterol inhaler is ineffective in these situations as opposed to his asthma symptoms which does respond to treatment. He denies any fever, chills, or recent viral infections. Review of systems is otherwise negative.

Physical Exam:
General: Not in acute distress.
Throat: Oropharynx is clear and moist without erythema, good dentition.
Chest: Normal symmetry, no tenderness to palpation, normal respiratory, excursion, no intercostal retraction, no use of accessory muscles, normal diaphragmatic excursion, clear to auscultation.
Cardiac: Regular rhythm, S1 normal, S2 normal, no S3 or S4, apical impulse not displaced, no murmurs, no gallops, no rubs detected.
Abdomen: Abdomen soft, bowel sounds normal, no masses, non-tender, no bruits.
Extremities: No deformities, no clubbing, no cyanosis, no erythema, no edema, normal muscle strength and tone.
Neurologic: No gross motor or sensory deficits noted.

Click here to continue. Challenge yourself by writing down a broad differential diagnosis before moving to the next slide.

NOTE: For more information, please contact the AMSSM, 4000 W. 114th Street, Suite 100, Leawood, KS 66211 (913) 327-1415.

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4000 W. 114th Street, Suite 100
Leawood, KS 66211
Phone: 913.327.1415

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