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Old 03-28-2012
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Surgery Post op acute onset dyspnea

A 62-year-old man is postoperative day 4 after a hemicolectomy and colostomy for adenocarcinoma of the sigmoid colon. You are called to evaluate the patient for shortness of breath. At the bedside you see an anxious-appearing man with tachypnea. The patient complains of a stabbing pain in his chest. Vital signs are temperature 38C (100.4F), blood pressure 140/80 mm Hg, heart rate beats/minute, and respiratory rate 30 breaths/minute. His chest pain is relieved by sitting up and leaning forward. Based only on the information provided, which of the following findings is most likely?

A. Distant heart sounds
B. Increased arterial-alveolar gradient
C. Increased prothrombin time and partial thromboplastin time
D. Inspiratory increase in arterial pressure greater than 10 mm Hg
E. Q waves on electrocardiography

Q. this q mentions chest pain character....does it sounds like pericarditis or pleuritis ?
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Old 03-28-2012
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is it aaaa?
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Old 03-28-2012
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yes,am also think it's pericarditis(description of pain is typicaly for it,in add to fever). ans D.
(Pulsus paradoxus also occurs in patients with severe asthma, constrictive pericarditis, and severe congestive heart failure-)
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Old 03-28-2012
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Default v/q scan

In that case you only listen to your GP his told you what to do correctly. good luck.
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Old 03-29-2012
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Originally Posted by um aala View Post
yes,am also think it's pericarditis(description of pain is typicaly for it,in add to fever). ans D.
(Pulsus paradoxus also occurs in patients with severe asthma, constrictive pericarditis, and severe congestive heart failure-)
sorry, it should be decrease with inspiration not increase, so D.incorrect.
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Old 03-29-2012
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Originally Posted by tyagee View Post
A 62-year-old man is postoperative day 4 after a hemicolectomy and colostomy for adenocarcinoma of the sigmoid colon. You are called to evaluate the patient for shortness of breath. At the bedside you see an anxious-appearing man with tachypnea. The patient complains of a stabbing pain in his chest. Vital signs are temperature 38C (100.4F), blood pressure 140/80 mm Hg, heart rate beats/minute, and respiratory rate 30 breaths/minute. His chest pain is relieved by sitting up and leaning forward. Based only on the information provided, which of the following findings is most likely?

A. Distant heart sounds
B. Increased arterial-alveolar gradient
C. Increased prothrombin time and partial thromboplastin time
D. Inspiratory increase in arterial pressure greater than 10 mm Hg
E. Q waves on electrocardiography

Q. this q mentions chest pain character....does it sounds like pericarditis or pleuritis ?
ans is B. dx given is PE. i doubt whats pericarditis doing in PE presentation.
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Old 03-29-2012
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Originally Posted by tyagee View Post
ans is B. dx given is PE. i doubt whats pericarditis doing in PE presentation.
yes its PE, bcoz post operative dyspnea and inc RR, chest pain also in PE, A-a gradient will inc.
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Old 03-29-2012
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Originally Posted by usmlepak View Post
yes its PE, bcoz post operative dyspnea and inc RR, chest pain also in PE, A-a gradient will inc.
yay, everything okay but there is pleuritic pain, not pericarditis in pe..
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Old 03-29-2012
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Default answer is B

always suspect PE in post op ptt with fever. the five Ws of complications to suspect after operation + fever:

Wind = atelectasis
Water = UTI
Walking = Thrombosis = PE = Especially since the ptt has high BP
Wound = infection
Wonder drugs = drug interactions
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um aala (03-29-2012)



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