new_n_lost
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A 15-year-old girl has a history of acute difficulty breathing when playing basketball. Her symptoms include inspiratory wheezing, increased respiratory rate, throat tightness, and chest discomfort. Premedication with albuterol has minimal effect.
What is the most likely diagnosis?
A) Exercise-induced asthma.
B) Gastroesophageal reflux disease.
C) Musculoskeletal chest pain.
D) Hyperventilation.
E) Vocal cord dysfunction
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| babydoc4usmle
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throaght tightness throws me off asthma
i bet on E
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| Diego Casali
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I think E is the correct answer.
Wheezing, cough, a feeling of tightness in the throat, hoarseness and voice change, stridor, shortness of breath, dyspnea on exertion, inspiratory difficulty, sudden episodes of shortness of breath and unresponsiveness to bronchodilators and corticosteroids are suggestive of vocal cord dysfunction.
Edited by Diego Casali on 03/09/07 - 08:42 AM
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| babydoc4usmle
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good reasoning...that throat tightness....what is the correct one
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| indidoc1
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A?
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| unique1
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E
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| new_n_lost
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The correct answer is E. One of the most common disorders that mimics asthma is vocal cord dysfunction (VCD). Patients with VCD present with hoarseness, coughing, dyspnea, and loud wheezing, along with other symptoms mentioned above. Pulmonary functions indicate airway obstruction due to an extrathoracic component. It appears that paradoxical inspiratory vocal cord adduction causes airflow restriction at the level of the larynx, thereby resulting in a flattened inspiratory loop on flow-volume diagram. VCD presents a diagnostic challenge, and often leads to unnecessary treatment for asthma. In this patient, a beta-2 agonist was ineffective, even though she displays symptoms with exertion. This argues against answer A. The distinction between VCD and asthma may be less clear in other patients, since the two disorders sometimes coexist. The clinical history does not support the diagnoses of gastroesophageal reflux disease, musculoskeletal chest pain, or hyperventilation
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FORUM RULES-- Those who believe in telekinesis, raise my hand. I get enough exercise just by pushing my luck --P4U World.." The pure and simple truth is rarely pure and never simple."
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| babydoc4usmle
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new-n-lost, i think you confused 2 differenet questions
but now i know that i answered another one correctly
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| babydoc4usmle
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and this one too
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| new_n_lost
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LOL SO U FOUND THE MISTAKE I MADE
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FORUM RULES-- Those who believe in telekinesis, raise my hand. I get enough exercise just by pushing my luck --P4U World.." The pure and simple truth is rarely pure and never simple."
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| babydoc4usmle
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no problem, we all made mistakes, and sometimes not so innocent lake this one
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| new_n_lost
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i m sorry i had seen my friend INDIdoc's Post when i answered the post, i m sorry if i have offended u cos the msg was not intended/directed towards u.
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FORUM RULES-- Those who believe in telekinesis, raise my hand. I get enough exercise just by pushing my luck --P4U World.." The pure and simple truth is rarely pure and never simple."
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