Persistent Defect in VQ Scan after Pulmonary Embolism - USMLE Forums
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  #1  
Old 06-06-2012
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Lungs Persistent Defect in VQ Scan after Pulmonary Embolism

A previously healthy 24-year-old man is evaluated in the emergency department after he develops shortness of breath 4 days into a cross-country automobile trip. A ventilation/perfusion scan shows unmatched perfusion defects in his right lower lobe and left lower lobe, accounting for about 25% of total perfusion. He is hospitalized and treated with intravenous heparin and warfarin. One week later, the symptoms have resolved, and the INR is in the range of 2 to 3 for 2 consecutive days. However, because of residual chest pain and shortness of breath, a repeat ventilation/perfusion scan is obtained that shows persistent localized perfusion defects, accounting for about 20% of total perfusion.

Which of the following is the most appropriate next step in the management of this patient?

A Continue heparin
B CT angiography
C Discharge on warfarin
D Measure pulmonary artery pressures
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  #2  
Old 06-06-2012
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Nice question and idont know the ans, i will pick D for unknown reasons.
may be if elevated something need to be done next
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Old 06-06-2012
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I think C,as we have achieved target INR of 2-3, we will discharge on warfarin
localized perfusion defects will take time to resolve
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Old 06-06-2012
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I go for D.

INR was already acheived so must be pathology with vessel... CT angio would reveal flow parameters which might be ok, but doesnt give much info about health.. So i guess thats my reasoning..
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Old 06-06-2012
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Quote:
Originally Posted by tyagee View Post
A previously healthy 24-year-old man is evaluated in the emergency department after he develops shortness of breath 4 days into a cross-country automobile trip. A ventilation/perfusion scan shows unmatched perfusion defects in his right lower lobe and left lower lobe, accounting for about 25% of total perfusion. He is hospitalized and treated with intravenous heparin and warfarin. One week later, the symptoms have resolved, and the INR is in the range of 2 to 3 for 2 consecutive days. However, because of residual chest pain and shortness of breath, a repeat ventilation/perfusion scan is obtained that shows persistent localized perfusion defects, accounting for about 20% of total perfusion.

Which of the following is the most appropriate next step in the management of this patient?

A Continue heparin
B CT angiography
C Discharge on warfarin
D Measure pulmonary artery pressures
C Discharge on warfarin
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tyagee (06-07-2012)



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Cardiology-, Internal-Medicine-, Pulmonology-, Step-2-Questions

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