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Old 06-12-2016
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Default Internal Question CS

Hello Everyone,

I am in the process of studying for my Step 2 and I got the following questions incorrect but I am unable to figure out why. Could anyone help me ?

Thanks in advance.

4. A 74-year-old woman has a myocardial infarction and is admitted to the intensive care unit. Her blood pressure has decreased from 148/74 mm Hg to 80/62 mm Hg. She is confused and has cool clammy skin. Arterial blood gas analysis is most likely to show which of the following?

A) l-typoxemia with normal pH
B) Primary metabolic acidosis
C) Primary metabolic alkalosis
D) Primary respiratory acidosis
E) Primary respiratory alkalosis (wrong)


17. A 77-year-old woman comes to the emergency department because of a 3-month history of shortness of breath when she climbs stairs. Her shortness of breath resolves after 5 minutes of rest. Her last episode was 3 days ago. She has not had chest pain, palpitations, orthopnea, cough, wheezing, swelling, or difficulty sleeping. She has hypertension and gastroesophageal reflux disease. Current medications include hydrochlorothiazide, omeprazole, and a multivitamin. She is 168 cm (5 ft 6 in) tall and weighs 63 kg (140 lb); BMI is 23 kg/m2. Her temperature is 37.2C (99F), pulse is 72/min, respirations are 12/min, and blood pressure is 144/92 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 98%. There are jugular venous pulsations 3 cm above the sternal angle. The remainder of the examination shows no abnormalities. An ECG shows a left bundle branch block and no primary T-wave changes, which is unchanged from an ECG 1 year ago. Which of the following is the most appropriate next step to determine the cause of this patient's dyspnea?

A) Measurement of serum troponin I concentration
B) ECG exercise stress test
C) Exercise stress echocardiography
D) Ventilation-perfusion lung scans (wrong)
E) Coronary angiography


39. A 64-year-old woman with a 4-year history of type 2 diabetes mellitus controlled with insulin comes to the emergency department because of exertional chest pressure for 3 weeks. The first episode occurred while she was walking upstairs and was relieved by 5 minutes of rest. The second episode occurred 1 week ago while she was mowing the lawn and was relieved after 10 minutes of rest. She had two episodes yesterday, each lasting 15 minutes; both occurred with exertion and were accompanied by shortness of breath and nausea. Today she had a 10-minute episode starting while she was in the shower and another while she was walking into the emergency department. Examination and an ECG show no abnormalities. Which of the following is the most appropriate next step in management?

A) Self-monitoring of blood glucose concentration during the next episode of chest pain
B) Dipyridamole-thallium-201 scintigraphy
C) Exercise stress test within 24 hours (wrong)
D) Antianginal drug therapy now and an exercise stress test in 5 days
E) Admit the patient to the hospital
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Old 06-29-2016
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Originally Posted by DocMinion View Post
17. A 77-year-old woman comes to the emergency department because of a 3-month history of shortness of breath when she climbs stairs. Her shortness of breath resolves after 5 minutes of rest. Her last episode was 3 days ago. She has not had chest pain, palpitations, orthopnea, cough, wheezing, swelling, or difficulty sleeping. She has hypertension and gastroesophageal reflux disease. Current medications include hydrochlorothiazide, omeprazole, and a multivitamin. She is 168 cm (5 ft 6 in) tall and weighs 63 kg (140 lb); BMI is 23 kg/m2. Her temperature is 37.2C (99F), pulse is 72/min, respirations are 12/min, and blood pressure is 144/92 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 98%. There are jugular venous pulsations 3 cm above the sternal angle. The remainder of the examination shows no abnormalities. An ECG shows a left bundle branch block and no primary T-wave changes, which is unchanged from an ECG 1 year ago. Which of the following is the most appropriate next step to determine the cause of this patient's dyspnea?

A) Measurement of serum troponin I concentration
B) ECG exercise stress test
C) Exercise stress echocardiography
D) Ventilation-perfusion lung scans (wrong)
E) Coronary angiography (wrong)
I was leaning towards stable angina for this patient's presentation since she has shortness of breath which resolves at rest. However, I got confused when it said she did not have chest pains.

If I was going by the stable angina diagnosis I am thinking she would need an ECG exercise stress test ( choice B). Any suggestions?

I really appreciate the help, if anyone has any ideas or other diagnosis.

Thanks,
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