57. DPR | History and Physical Exam of the Respiratory System

A 64-year-old male presents with progressive shortness of breath and chronic cough. On exam, he has a barrel-shaped chest, decreased breath sounds, and hyperresonant percussion bilaterally. Which of the following is the most likely diagnosis?

A. Pleural effusion
B. Pneumonia
C. COPD/emphysema
D. Pulmonary fibrosis
E. Asthma

C

• A. Pleural effusion → Dull percussion, ↓ fremitus, ↓ breath sounds. Not hyperresonant.

• B. Pneumonia → Dull percussion, ↑ fremitus, bronchial breath sounds, crackles.

• C. COPD/emphysema → Barrel chest, ↓ breath sounds, hyperresonant percussion, prolonged expiration. ✅

• D. Pulmonary fibrosis → Fine crackles, clubbing, restrictive changes, not hyperresonant.

• E. Asthma → Expiratory wheeze, prolonged expiration, but not classically hyperresonant barrel chest.

A 58-year-old male with a history of congestive heart failure presents with worsening shortness of breath. On exam, you hear bibasilar crackles and note mild lower extremity edema. Which of the following best explains the lung findings?

A. Bronchospasm from asthma
B. Alveolar consolidation from pneumonia
C. Fluid accumulation from pulmonary edema
D. Air trapping from emphysema
E. Pleural fluid collection from effusion

C

• A. Asthma → Wheezing, prolonged expiration.

• B. Pneumonia → Dullness, ↑ fremitus, egophony, bronchial sounds.

• C. Pulmonary edema (CHF) → Bibasilar crackles, dullness in dependent regions, edema. ✅

• D. Emphysema → Barrel chest, ↓ breath sounds, hyperresonant.

• E. Pleural effusion → Dullness, ↓ fremitus, ↓ breath sounds, not crackles.

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