A 24-year-old woman with known asthma presents to the emergency department with severe breathlessness. She is drowsy, unable to complete sentences, and the chest is silent on auscultation. Peak expiratory flow is unrecordable. Which single finding in this patient indicates life-threatening asthma?
- A Silent chest ✓
- B Inability to complete sentences
- C Drowsiness
- D Tachycardia above 110 per minute
Correct answer: A. Silent chest
Explanation
A silent chest means airflow is so severely limited that wheeze has disappeared, marking imminent respiratory arrest; it is a feature of life-threatening asthma along with a feeble respiratory effort, cyanosis, bradycardia and exhaustion. Inability to speak in sentences, tachycardia and drowsiness indicate severe asthma, one tier below life-threatening. Drowsiness also signals rising carbon dioxide, but the classic examination sign asked for here is the silent chest.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.