A 22-year-old woman is brought to the emergency department after the sudden onset of shortness of breath. She has cystic fibrosis and, during the past year, has had 3 respiratory exacerbations that have required hospitalization. Current medications include an inhaled bronchodilator, an inhaled corticosteroid, inhaled N-acetylcysteine, and azithromycin. The patient appears chronically ill. Her temperature is 37.9°C (100.2°F), pulse is 96/min, respirations are 22/min and labored, and blood pressure is 106/64 mm Hg. Chest excursions and tactile fremitus are decreased on the right side. On auscultation of the chest, breath sounds are significantly diminished over the right lung field and diffuse wheezing is heard over the left lung field. Which of the following is most likely responsible for this patient's acute symptoms?

Question

Quizplus · Accepted Answer

Eductional Objective: Spontaneous pneumothorax is common in cystic fibrosis and involves alveolar rupture, leading to loss of intrapleural negative pressure.  Patients have sudden-onset shortness of breath, unilaterally decreased breath sounds, and, sometimes, subcutaneous crepitus.  Hypotension and tachycardia suggest the development of tension pathophysiology.

A 22-Year-Old Woman Is Brought to the Emergency Department After