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Old 09-30-2012
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Lungs Pulmonary Embolism; Next step of management

A 27-year-old woman is 7 months pregnant with her first child. Her pregnancy has been uncomplicated to date. She presents to the emergency department complaining of sudden-onset, right-sided chest pain that is exacerbated with deep breathing and shortness of breath, which began 1 hour ago. She denies leg pain and notes that her legs began swelling during the sixth month of her pregnancy but the swelling has not worsened. Her temperature is 37.9°C (100.3°F), blood pressure is 130/87 mm Hg, pulse is 107/min and regular, respiratory rate is 24/min, and oxygen saturation is 90% on room air, increasing to 98% with 4 L oxygen via nasal cannula. Physical examination is significant for crackles at the lower right lung field and a negative Homans’ sign bilaterally. X-ray of the chest appears normal. The D-dimer level is elevated. ECG shows sinus tachycardia, right-axis deviation, S wave in lead I, Q wave in lead III, and an inverted T wave in lead III. Which of the following is the most appropriate next step in diagnosis?

(A) Arterial blood gas analysis
(B) Doppler ultrasound of the lower extremity
(C) MRI of the lower extremity
(D) Pulmonary angiography
(E) Ventilation/perfusion scan
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Old 09-30-2012
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Originally Posted by K06100 View Post
A 27-year-old woman is 7 months pregnant with her first child. Her pregnancy has been uncomplicated to date. She presents to the emergency department complaining of sudden-onset, right-sided chest pain that is exacerbated with deep breathing and shortness of breath, which began 1 hour ago. She denies leg pain and notes that her legs began swelling during the sixth month of her pregnancy but the swelling has not worsened. Her temperature is 37.9°C (100.3°F), blood pressure is 130/87 mm Hg, pulse is 107/min and regular, respiratory rate is 24/min, and oxygen saturation is 90% on room air, increasing to 98% with 4 L oxygen via nasal cannula. Physical examination is significant for crackles at the lower right lung field and a negative Homans’ sign bilaterally. X-ray of the chest appears normal. The D-dimer level is elevated. ECG shows sinus tachycardia, right-axis deviation, S wave in lead I, Q wave in lead III, and an inverted T wave in lead III. Which of the following is the most appropriate next step in diagnosis?

(A) Arterial blood gas analysis
(B) Doppler ultrasound of the lower extremity
(C) MRI of the lower extremity
(D) Pulmonary angiography
(E) Ventilation/perfusion scan
Would go with E as the pt has normal Xray which makes the V/Q scan most appropriate test
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(E) Ventilation/perfusion scan
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Correct Answer is E
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Why would this not be a (duplex) Doppler USG of lower extremities? and instead be a v/q scan. for a pul embolism arent d-dimer(quick way to reule out)/duplex usg and v/q scan kinda similar in efficacy and the most accurate is the angio. So how would you know to do one over the other?

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

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