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  #1  
Old 02-17-2012
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Lungs Pulmonary Embolism, best next step in the management?

A 65-year-old female underwent a hip replacement two days ago for fracture neck femur. On the third postoperative day, she suddenly became anxious, dyspneic and tachycardia. She has a history of anxiety and she takes lorazepam as needed. Her vital signs BP is 100/50 mm Hg; PR is 120/min; RR is 36/min and she is afebrile She is saturating 84% on 6-lit oxygen. Lung examination is unremarkable The chest x-ray did not reveal any gross abnormalities The next step in the management is
A) Obtain a arterial blood gas
B) Order intubation
C) Order extremity venogram
D) Order a ventilation/perfusion scan
E) Give IV lorazepam
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  #2  
Old 02-17-2012
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Default what is the difference from firs q????

32-year-old woman comes to the Emergency Department complaining of sudden onset of severe shortness of breath that began four hours ago She also has a nonproductive cough and right-sided chest pain that worsens with inspiration She
denies having fever, coughing up blood, \l\iheezing, palpitations, leg pain, swelling of the lower extremities or any recent travel Past medical history reveals appendectorny at age 15 Her medication include birth control pills and over-the-counter vitamins Her famity history is Father, age 55, has had diabetes for 20 years; mother, age 58, has coronary artery disease She has never been pregnant, drinks alcohol socially and does not smoke Hervital signs are T 99 F (38C), BP 110/70 mmHg, PR 130/min and RR 30/min Pulse oximetry showed 85% on 51it oxygen Physical examination shows a slight obese, white woman in acute distress She is alert and cooperative without cyanosis or jaundice The rest of the physical examination is normal What is the most appropriate next step in this patient's management?
A) EKG
B) Echocardiogram
C) V/Q Scan
D) Angiogram
E) Doppler ultrasound of lower extremities
F) Chest-x ray and arterial blood gases
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  #3  
Old 02-17-2012
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Thumbs Up why?

first q is d as usmle world.
second one is f as usmle world.
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Old 02-17-2012
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Thumbs Up ?

anybody can explain that please?
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Old 02-18-2012
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the ans to first q is ventilation perfusion scan....n second is F in such a question where all the steps re part of management u prioritise evry step
like in first q when u ve a suspicion of pulmonary embolism n chest x ray has been done n the ans option does mention a tets tht is most accurate go for V/Q scan n in the other q th pt has just landed with dyspnea n no specific history so most initial should be chest x ray...
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Old 02-18-2012
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d ) Order a ventilation/perfusion scan

F) Chest-x ray and arterial blood gases
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  #7  
Old 02-18-2012
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Quote:
Originally Posted by qurat21 View Post
the ans to first q is ventilation perfusion scan....n second is F in such a question where all the steps re part of management u prioritise evry step
like in first q when u ve a suspicion of pulmonary embolism n chest x ray has been done n the ans option does mention a tets tht is most accurate go for V/Q scan n in the other q th pt has just landed with dyspnea n no specific history so most initial should be chest x ray...
isnt second one also very suggestive of PE? then answer should be vq scan
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Old 02-18-2012
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well V/Q or spiral CT always done after chest x ray..according to
MTB......
n we must do the basic chest x ray for dyspnea just like u do ecg first in any pt with chest pain..
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  #9  
Old 02-22-2012
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Default Second Question

Why not an EKG first for the second question. Wont take time and not an invasive procedure. I have seen MI with very bizarre presentations. Bookish answer may be CXR. But I doubt this
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  #10  
Old 02-23-2012
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Quote:
Originally Posted by abbas.rz View Post
Why not an EKG first for the second question. Wont take time and not an invasive procedure. I have seen MI with very bizarre presentations. Bookish answer may be CXR. But I doubt this
whenever we suspect pe : get cxr + ABGs then ECG
if cxr is normal then V\Q scan
if cxr abnormal then spiral ct

this is the best diagnostic workup .
or any body has any best workup?????????????
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  #11  
Old 02-23-2012
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Default seconde case why not EKG?

there is chest pain in the case, shouldnt we do EKG first? Or because it is obvious PE case, so we do CXR and ABGs first?
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  #12  
Old 02-23-2012
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for the first question, if we only did CXR, do we still need to do ABGs? Because in this case the patient only had CXR done, but the initial tests for pulmonary embolism is CXRs+ ABGs+EKG,so shoulnt our next step do ABGs as well before we do V/Q scan?







Quote:
Originally Posted by alex85 View Post
A 65-year-old female underwent a hip replacement two days ago for fracture neck femur. On the third postoperative day, she suddenly became anxious, dyspneic and tachycardia. She has a history of anxiety and she takes lorazepam as needed. Her vital signs BP is 100/50 mm Hg; PR is 120/min; RR is 36/min and she is afebrile She is saturating 84% on 6-lit oxygen. Lung examination is unremarkable The chest x-ray did not reveal any gross abnormalities The next step in the management is
A) Obtain a arterial blood gas
B) Order intubation
C) Order extremity venogram
D) Order a ventilation/perfusion scan
E) Give IV lorazepam
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  #13  
Old 02-24-2012
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Quote:
Originally Posted by missgeorge View Post
first q is d as usmle world.
second one is f as usmle world.
we know the asnwer dude, but the point is what is the difference between the questions?
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