A 24-year-old woman with known asthma presents with acute breathlessness. On examination she cannot complete sentences, has a heart rate of 128/min, widespread wheeze, and peak expiratory flow is 35% of her predicted value. According to standard severity grading, which single feature in her assessment indicates LIFE-THREATENING rather than merely acute severe asthma?
- A Inability to complete sentences
- B Silent chest on auscultation ✓
- C Heart rate above 120/min
- D Peak expiratory flow 35% of predicted
Correct answer: B. Silent chest on auscultation
Explanation
A silent chest means airflow is so reduced that not even wheeze can be generated, marking imminent respiratory arrest; it defines life-threatening asthma along with cyanosis, exhaustion, feeble effort, bradycardia or hypotension, and PEF below 33% predicted. Inability to speak sentences, tachycardia above 110/min, and PEF 33 to 50% predicted belong to the acute severe category, so option D does not cross the life-threatening threshold at 35%.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.