Hyperventilation and Other Causes of Dyspnea Practice Questions

30 multiple-choice questions on Hyperventilation and other causes of dyspnea for paramedic and EMT students, from Chapter 17 (Respiratory Emergencies). Read each question, pick your answer, then tap Show answer to check it and read the explanation.

30 practice questions

1. A 62-year-old with lung cancer has a swollen face and neck, distended veins across the upper chest, and dyspnea that worsens when he lies flat. What should you suspect?

   1. A. Superior vena cava obstruction by the tumor
   2. B. An allergic reaction with angioedema
   3. C. Right heart failure from his long-term COPD
   4. D. A tension pneumothorax
   Show answer

   Answer: A. Superior vena cava obstruction by the tumor

   A tumor compressing the superior vena cava blocks drainage from the head, neck, and arms, causing facial and neck swelling, distended chest-wall veins, and dyspnea worse when supine; keep him upright and transport. Angioedema does not distend chest veins. Right heart failure causes leg edema and JVD rather than facial swelling with chest-wall veins. Tension pneumothorax causes one-sided absent breath sounds and shock.

2. A 68-year-old has had a dry cough and worsening exertional dyspnea for 2 years. You hear fine "Velcro-like" crackles at both bases, and he has clubbing. What is most likely?

   1. A. Acute asthma
   2. B. Pulmonary fibrosis
   3. C. Acute bronchitis
   4. D. Spontaneous pneumothorax
   Show answer

   Answer: B. Pulmonary fibrosis

   Progressive dyspnea, a dry cough, fine dry bibasilar crackles that sound like Velcro being pulled apart, and clubbing are typical of pulmonary fibrosis (interstitial lung disease). Asthma causes episodic wheezing. Bronchitis is short-lived with a productive cough. A pneumothorax is sudden and one-sided.

3. A 32-year-old woman has a dry cough, mild dyspnea, and tender red nodules on her shins. An earlier X-ray showed enlarged lymph nodes in both hila. Which condition best fits?

   1. A. Pulmonary embolism
   2. B. Spontaneous pneumothorax
   3. C. Acute asthma
   4. D. Sarcoidosis
   Show answer

   Answer: D. Sarcoidosis

   Sarcoidosis is an inflammatory disease that forms granulomas, often in the lungs and the hilar lymph nodes, and can cause tender red shin nodules (erythema nodosum). A PE causes sudden symptoms without skin nodules. A pneumothorax is sudden and one-sided. Asthma causes episodic wheezing.

4. What is the preferred prehospital approach for a patient with suspected anxiety-related hyperventilation and normal SpO2?

   1. A. Paper bag rebreathing
   2. B. Calm breathing coaching
   3. C. Immediate sedation
   4. D. Withholding all assessment
   Show answer

   Answer: B. Calm breathing coaching

   Reassurance and coaching are preferred. Paper bag rebreathing is no longer recommended because it can cause hypoxia, especially if the true cause is medical.

5. After a chlorine gas leak at a pool, a worker has burning eyes, cough, and wheezing. He has been moved to fresh air and is on oxygen. What is the most useful next treatment?

   1. A. IV atropine to dry the airway secretions
   2. B. Hydroxocobalamin as a chlorine antidote
   3. C. Amyl nitrite by inhalation
   4. D. Nebulized albuterol for the bronchospasm
   Show answer

   Answer: D. Nebulized albuterol for the bronchospasm

   Chlorine is very water soluble and irritates the eyes and airways immediately; care is supportive with decontamination, oxygen, and bronchodilators for wheezing. It has no specific antidote. Atropine is for organophosphate poisoning. Hydroxocobalamin and amyl nitrite are cyanide treatments.

6. Two days after eating home-canned vegetables, a 45-year-old has drooping eyelids, double vision, slurred speech, and difficulty swallowing. He is fully alert. What is the main threat to life?

   1. A. Seizures from a high fever
   2. B. Severe dehydration from ongoing diarrhea
   3. C. Liver failure from the toxin
   4. D. Paralysis of the breathing muscles
   Show answer

   Answer: D. Paralysis of the breathing muscles

   Botulinum toxin causes symmetric, descending paralysis that starts with the cranial nerves and can progress to the diaphragm, while the patient stays alert; watch his ventilation closely and be ready to assist. Botulism does not cause fever or seizures. Diarrhea is not the main danger. The toxin acts at nerve endings, not on the liver.

7. A 50-year-old intentionally ingested a large amount of aspirin and is now tachypneic. Salicylate toxicity typically causes:

   1. A. Pure metabolic alkalosis
   2. B. A mixed acid-base disorder
   3. C. Isolated respiratory acidosis
   4. D. No acid-base disturbance
   Show answer

   Answer: B. A mixed acid-base disorder

   Salicylates stimulate the respiratory center (respiratory alkalosis) and cause metabolic acidosis, a mixed disorder.

8. A 33-year-old has progressive leg weakness that is ascending to his arms after a recent GI illness, and now has a weak cough and shallow breathing. What should you suspect?

   1. A. Multiple sclerosis
   2. B. Myasthenia gravis
   3. C. Guillain-Barré syndrome
   4. D. Lambert-Eaton syndrome
   Show answer

   Answer: C. Guillain-Barré syndrome

   Guillain-Barré syndrome is an ascending paralysis, often after infection, that can involve the respiratory muscles and lead to respiratory failure.

9. A patient with myasthenia gravis has worsening weakness, drooping eyelids, and difficulty swallowing and breathing. This emergency is called:

   1. A. Addisonian crisis
   2. B. Thyroid storm
   3. C. Myasthenic crisis
   4. D. Sickle cell crisis
   Show answer

   Answer: C. Myasthenic crisis

   Myasthenic crisis is weakness of the respiratory and bulbar muscles that can require ventilatory support.

10. What is the most important prehospital concern in a patient with a neuromuscular disease and worsening dyspnea?

    1. A. Peripheral edema
    2. B. Hypoventilation
    3. C. Rising blood pressure
    4. D. Severe hyperglycemia
    Show answer

    Answer: B. Hypoventilation

    Weak diaphragm and intercostal muscles lead to hypoventilation and CO2 retention. Watch tidal volume, cough strength, and mental status and assist ventilations as needed.

11. A woman with myasthenia gravis has a weak voice, cannot lift her head off the pillow, and runs out of breath counting to 10. Her SpO2 is 96%. How should you interpret her condition?

    1. A. Possible crisis with breathing at risk
    2. B. Stable, because her SpO2 is normal
    3. C. Anxiety, because her lungs sound clear
    4. D. A stroke, because her voice is weak
    Show answer

    Answer: A. Possible crisis with breathing at risk

    In myasthenic crisis the breathing muscles weaken, and SpO2 often stays normal until late. Neck flexor weakness, a weak voice, and being unable to count far in one breath point to impending ventilatory failure. A normal SpO2 is not reassurance here. Clear lungs are expected with muscle weakness. A weak voice with bilateral weakness and fatigue fits myasthenia rather than a stroke.

12. Two weeks after a diarrheal illness, a 35-year-old has weakness that started in his feet and is rising to his thighs, with absent knee reflexes. What respiratory concern should guide your care?

    1. A. He is at high risk of a severe asthma attack
    2. B. Rising CO2 is unlikely in his disease
    3. C. His SpO2 will fall early, warning you
    4. D. Weakness can spread to his breathing muscles
    Show answer

    Answer: D. Weakness can spread to his breathing muscles

    Ascending weakness with lost reflexes after an infection suggests Guillain-Barre syndrome, in which the weakness can reach the diaphragm; a weak cough, shallow breathing, or difficulty counting in one breath signals failure. It does not trigger asthma. SpO2 often stays normal until late, so it is not an early warning, and hypoventilation with rising CO2 is exactly the danger.

13. A 40-year-old has cut and polished engineered stone countertops for 10 years and now has progressive dyspnea and a dry cough. Which disease should you suspect?

    1. A. Asbestosis
    2. B. Viral bronchitis
    3. C. Exercise-induced asthma
    4. D. Silicosis
    Show answer

    Answer: D. Silicosis

    Cutting engineered stone releases large amounts of crystalline silica dust, which causes silicosis, a progressive scarring lung disease that also raises the risk of tuberculosis. Asbestosis comes from asbestos, such as in shipyards and old insulation. Bronchitis is short-lived. Exercise-induced asthma causes episodic wheezing.

14. A 34-year-old woman has had progressive exertional dyspnea for months and fainted while climbing stairs. She has JVD and ankle swelling, and her lungs are clear. What should you suspect?

    1. A. Pulmonary hypertension
    2. B. Exercise-induced asthma
    3. C. Panic disorder with fainting
    4. D. Left-sided heart failure
    Show answer

    Answer: A. Pulmonary hypertension

    Exertional dyspnea, syncope on exertion, JVD, leg edema, and clear lungs in a young woman suggest pulmonary arterial hypertension with right heart strain, a high-risk condition. Asthma causes wheezing, not JVD or syncope. Panic disorder does not cause JVD or edema. Left heart failure usually causes crackles and orthopnea.

15. A man who keeps racing pigeons has fever, cough, and dyspnea a few hours after each time he cleans the loft. What is the likely cause?

    1. A. A food allergy to the pigeon feed
    2. B. Tuberculosis caught from the pigeons
    3. C. Hypersensitivity pneumonitis
    4. D. Smoke exposure from a nearby fire
    Show answer

    Answer: C. Hypersensitivity pneumonitis

    Repeated inhalation of bird droppings and feather proteins can cause hypersensitivity pneumonitis ("bird fancier's lung"), with fever, cough, and dyspnea 4 to 8 hours after exposure. He is not eating the feed. Pigeons do not spread tuberculosis. There is no smoke exposure, and the timing follows each cleaning.

16. A 62-year-old smoker has weight loss, chronic cough, and hemoptysis. Which cause of respiratory symptoms is most concerning?

    1. A. Chronic bronchitis
    2. B. Lung cancer
    3. C. Hyperventilation
    4. D. Postnasal drip
    Show answer

    Answer: B. Lung cancer

    Weight loss, chronic cough, and hemoptysis in a smoker should raise concern for lung cancer. Chronic bronchitis and postnasal drip cause cough, but weight loss and hemoptysis point to cancer, and hyperventilation does not cause these findings.

17. Why do patients in late pregnancy often report dyspnea?

    1. A. Their airways narrow from edema
    2. B. Their lungs shrink in size
    3. C. Their CO2 levels rise sharply
    4. D. The uterus raises the diaphragm
    Show answer

    Answer: D. The uterus raises the diaphragm

    The enlarging uterus pushes up on the diaphragm, and progesterone increases ventilatory drive. New severe dyspnea still requires assessment for PE and other causes.

18. A 71-year-old with a stroke has a respiratory pattern of prolonged inspiratory pauses. This pattern, associated with damage to the pons, is called:

    1. A. Apneustic respirations
    2. B. Cheyne-Stokes respirations
    3. C. Agonal respirations
    4. D. Kussmaul respirations
    Show answer

    Answer: A. Apneustic respirations

    Apneustic breathing involves prolonged, gasping inspirations with pauses and indicates pontine injury.

19. Central neurogenic hyperventilation is best described as:

    1. A. Irregular gasps during cardiac arrest
    2. B. Rapid breathing from anxiety only
    3. C. Deep, rapid breaths from brain injury
    4. D. Slow, shallow breathing from opioids
    Show answer

    Answer: C. Deep, rapid breaths from brain injury

    Central neurogenic hyperventilation is sustained deep, rapid breathing from midbrain or upper pontine injury.

20. A 28-year-old has rapid breathing, chest tightness, and tingling. She is on oral contraceptives and smokes. Her SpO2 is 91%. What should you do?

    1. A. Treat it as anxiety without oxygen
    2. B. Consider PE and treat as medical
    3. C. Coach her breathing and release her
    4. D. Have her breathe into a paper bag
    Show answer

    Answer: B. Consider PE and treat as medical

    Hypoxia and risk factors for PE make anxiety an unsafe assumption. Give oxygen, monitor, and transport.

21. Which finding in a tachypneic patient points away from simple anxiety hyperventilation?

    1. A. Tingling hands
    2. B. Normal lungs
    3. C. Low SpO2
    4. D. Recent stressor
    Show answer

    Answer: C. Low SpO2

    Hyperventilation from anxiety does not cause hypoxemia. A low SpO2 suggests a medical cause such as PE, pneumonia, or pulmonary edema.

22. A febrile 70-year-old with a urinary infection is breathing 26 times a minute with clear lungs. His EtCO2 is 24 mmHg. What does this most suggest?

    1. A. A new pulmonary embolism with lung infarction
    2. B. Normal breathing for a man his age
    3. C. Compensation for a lactic acidosis
    4. D. An early asthma attack without wheezing
    Show answer

    Answer: C. Compensation for a lactic acidosis

    Tachypnea is an early sign of sepsis. A low EtCO2 with clear lungs reflects the lungs blowing off CO2 to compensate for a metabolic (lactic) acidosis, and it correlates with a higher lactate and worse outcome. PE can also lower EtCO2, but fever with a urinary source points to sepsis. A rate of 26 and an EtCO2 of 24 are not normal breathing at any age. Asthma would cause wheezing or increased effort.

23. A man drove 2 hours in a closed electric car carrying a large cooler of dry ice. He now has a headache, rapid breathing, and confusion. What is the most likely cause?

    1. A. Carbon monoxide from the car engine
    2. B. Carbon dioxide gas from the dry ice
    3. C. Low blood sugar from the long drive
    4. D. A migraine triggered by the cold
    Show answer

    Answer: B. Carbon dioxide gas from the dry ice

    Dry ice turns into carbon dioxide gas, which can build up in a closed space and cause headache, rapid breathing, confusion, and collapse. Move him to fresh air and give oxygen. An electric car produces no exhaust carbon monoxide. Hypoglycemia does not cause rapid breathing. A migraine does not explain confusion and rapid breathing from a known gas source.

24. A 55-year-old has coughed up large amounts of thick sputum every day for years and has had several pneumonias. Which chronic condition best fits?

    1. A. Asthma
    2. B. Sarcoidosis
    3. C. Pulmonary hypertension
    4. D. Bronchiectasis
    Show answer

    Answer: D. Bronchiectasis

    Bronchiectasis is permanent widening of the bronchi, where mucus pools and becomes infected, causing a daily productive cough with large volumes of sputum and repeated infections. Asthma causes episodic wheezing. Sarcoidosis usually causes a dry cough. Pulmonary hypertension causes exertional dyspnea and right heart strain without heavy sputum.

25. How does severe obesity contribute to dyspnea?

    1. A. It reduces lung volumes
    2. B. It causes airway dilation
    3. C. It raises the residual capacity
    4. D. It improves chest wall compliance
    Show answer

    Answer: A. It reduces lung volumes

    Obesity restricts chest expansion, reduces functional residual capacity, and may cause obesity hypoventilation syndrome. Obesity lowers residual capacity and chest wall compliance rather than raising them, and it narrows rather than dilates the upper airway.

26. A patient with lung cancer has a tunneled pleural catheter that her family drains at home. They have not drained it for a week, and she is more short of breath. What is the likely cause?

    1. A. The catheter has caused pneumonia
    2. B. Pleural fluid has built up again
    3. C. Her cancer has spread to the brain
    4. D. She is anxious about the catheter
    Show answer

    Answer: B. Pleural fluid has built up again

    Indwelling pleural catheters are used for malignant effusions that keep returning; when drainage is skipped, fluid reaccumulates and compresses the lung, causing dyspnea. Infection is possible but would usually bring fever and redness at the site. Brain metastases cause neurologic signs, not dyspnea. Anxiety is a diagnosis of exclusion.

27. A child with a recent viral illness develops rapid breathing, and you smell fruity breath. Which test should you perform?

    1. A. Stroke scale
    2. B. Peak flow
    3. C. Blood glucose
    4. D. Orthostatic vitals
    Show answer

    Answer: C. Blood glucose

    Fruity breath with Kussmaul breathing suggests DKA. Check blood glucose.

28. A man with ALS has a weak cough and gurgling sounds from secretions in his throat. His SpO2 is 91%. What is the most helpful first step?

    1. A. Have him lie flat to rest
    2. B. Suction his mouth and throat
    3. C. Give nebulized albuterol
    4. D. Encourage him to drink fluids
    Show answer

    Answer: B. Suction his mouth and throat

    Weak respiratory and bulbar muscles in ALS make it hard to cough and swallow, so pooled secretions block the airway. Suctioning, positioning him upright, and his cough-assist device (if available) help. Lying flat worsens pooling and aspiration. Albuterol treats bronchospasm, not pooled secretions. Drinking risks aspiration.

29. An 80-year-old with advanced dementia develops a cough and fever after choking episodes during meals. What is the most likely cause?

    1. A. Hyperventilation syndrome
    2. B. Spontaneous pneumothorax
    3. C. Acute asthma episode
    4. D. Aspiration pneumonia
    Show answer

    Answer: D. Aspiration pneumonia

    Swallowing difficulties in dementia increase aspiration risk, often leading to aspiration pneumonia.

30. A man with severe COPD and long-standing low oxygen levels has a ruddy, flushed face. What best explains his color?

    1. A. A fever from a new chest infection
    2. B. More red blood cells made due to hypoxemia
    3. C. High blood pressure from his inhalers
    4. D. Skin vasodilation caused by his albuterol inhaler
    Show answer

    Answer: B. More red blood cells made due to hypoxemia

    Chronic hypoxemia stimulates the kidneys to release erythropoietin, so more red blood cells are made (secondary polycythemia); this gives a ruddy color, thicker blood, and a higher clot risk. Inhalers do not raise blood pressure enough to cause this color. A fever would be acute rather than long-standing, and albuterol does not cause lasting facial redness.