NREMT Emergency Medical Technician (EMT) Cognitive ExamCardiology & ResuscitationMedium
A 30-year-old male is experiencing sudden onset of shortness of breath and sharp, pleuritic chest pain that worsens with inhalation. He is tachycardic (110 bpm) and tachypneic (24 bpm). Auscultation reveals diminished breath sounds on the right side. He denies any trauma. What is the MOST likely cause of his symptoms?
- APericarditis
- BAcute myocardial infarction
- CCongestive heart failure
- DSpontaneous pneumothorax
Show answer & explanationAnswer & explanation
Correct answer: D. Spontaneous pneumothorax
The patient's sudden onset of sharp, pleuritic chest pain, worsening with inhalation, shortness of breath, tachycardia, tachypnea, and diminished breath sounds on one side (right) are classic signs of a spontaneous pneumothorax. This typically occurs without trauma, often in tall, thin individuals.
Why the other options are wrong
- A. Pericarditis typically presents with sharp, stabbing chest pain that may worsen with inspiration but is usually relieved by leaning forward and would not cause diminished breath sounds.
- B. Acute myocardial infarction typically presents with crushing, substernal pain, often radiating, and not usually pleuritic or accompanied by diminished breath sounds.
- C. Congestive heart failure would present with bilateral crackles, orthopnea, and possibly pink frothy sputum, not unilateral diminished breath sounds.
Spontaneous Pneumothorax Recognition
A spontaneous pneumothorax occurs when air leaks into the space between the lung and chest wall (pleural space) without any external trauma, causing the lung to collapse.
- Sudden onset of sharp, pleuritic chest pain.
- Dyspnea (shortness of breath).
- Diminished or absent breath sounds on the affected side.
- Often seen in tall, thin males, or those with underlying lung disease.
Memory trick: Pleuritic pain, one lung's gain? Air's gone astray!