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  #1  
Old 07-15-2013
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Arrow Question Taken from ARCHER Facebook page

A 75 year-old man with history of hypertension presents to the emergency room with complaints of shortness of breath and palpitations. His vital reveal a heart rate 142/min, blood pressure 130/86, temperature 98.6 and oxygen saturation of 89% on room air. On auscultation, there are no rhonchii or crepitations, the heart rate was irregular and rapid with out any murmurs. The patient is placed on oxygen by nasal cannula. An urgent EKG is obtained which reveals rapid atrial fibrillation with no evidence of significant ST-T changes. The patient is started on diltiazem. Chest x-ray is normal and a brain natriuretic peptide is 80ng/L. Electrolytes, TSH and complete blood count are with in normal limits. Cardiac enzymes are drawn. Arterial blood gases reveal a pH of 7.48, po2 of 58, pco2 of 20 on room air ( Fio2 of 21%). The next step in evaluating the etiology of his atrial fibrillation :
A) Cardiac catheterization
B) Spiral CT scan of the chest
C) Venos doppler of lower extremities
D) 2D Echocardiogram
E) D-Dimer


What do you guys think? Im thinking B, but the range of answers seen on the facebook page + twitter is crazy!
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  #2  
Old 07-15-2013
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Why not 2D Echocardiogram?
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Old 07-15-2013
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Quote:
Originally Posted by monsalg2502 View Post
Why not 2D Echocardiogram?
Because they are asking for the etiology of A.fib, and looking at the ABG the patient has hypoxemia with hypocapnia, which is characteristic of PE, however im not sure about the answer myself, it can easily be 2D ECHO
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Old 07-15-2013
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What is confusing is that they don't tell you for how long he has been with the rythm alteration.. More than 48 hours you should anticoagulate for 2 or 3 weeks and then performa cardio version. Depending on CHADS Score, low risk pt aspirin and high risk pt Warfarin.
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File Type: docx afib key points.docx (224.5 KB)
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  #5  
Old 07-15-2013
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It says here, Dr Red had answer the questions on his Blog

http://ccsworkshop.com/blog/usmle-st...93-answer-key/

Check the link it says

74 D

75 B
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  #6  
Old 07-15-2013
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Quote:
Originally Posted by monsalg2502 View Post
It says here, Dr Red had answer the questions on his Blog

http://ccsworkshop.com/blog/usmle-st...93-answer-key/

Check the link it says

74 D

75 B
wow nice, I was waiting for them to put the answer on facebook, looks like it is 2D echo
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  #7  
Old 07-17-2013
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i think it should be B
if there is high suspicion of PE what is the use of a 2D echo?

had the question asked most imp test before beginning Rx 2D echo would be the answer - cos it'd help rule out a thrombus. (since duration of Afib is not specified)

The question asks for investigation that would help point out the etiology of Afib.
so I would go with B
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  #8  
Old 10-18-2014
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D. Because it says investigating etiology of atrial fibrillation? CT scan may show PE but will not give away cardiac abnormalities. ECHO can show acute cor pulmonale of right ventricle in PE and can show pulmonary hypertension. ECHO can also show chamber abnormalities. So ECHO is a win-win situation.
No, I am not so smart .... ...I just did archer cardiology so, I knew this answer the moment I saw this question.
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  #9  
Old 03-16-2016
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Quote:
Originally Posted by XpaezX View Post
A 75 year-old man with history of hypertension presents to the emergency room with complaints of shortness of breath and palpitations. His vital reveal a heart rate 142/min, blood pressure 130/86, temperature 98.6 and oxygen saturation of 89% on room air. On auscultation, there are no rhonchii or crepitations, the heart rate was irregular and rapid with out any murmurs. The patient is placed on oxygen by nasal cannula. An urgent EKG is obtained which reveals rapid atrial fibrillation with no evidence of significant ST-T changes. The patient is started on diltiazem. Chest x-ray is normal and a brain natriuretic peptide is 80ng/L. Electrolytes, TSH and complete blood count are with in normal limits. Cardiac enzymes are drawn. Arterial blood gases reveal a pH of 7.48, po2 of 58, pco2 of 20 on room air ( Fio2 of 21%). The next step in evaluating the etiology of his atrial fibrillation :
A) Cardiac catheterization
B) Spiral CT scan of the chest
C) Venos doppler of lower extremities
D) 2D Echocardiogram
E) D-Dimer


What do you guys think? Im thinking B, but the range of answers seen on the facebook page + twitter is crazy!
I think it is B ..the guy is hypoxic and may be PE or may be D is more comprehensive. Nice question concept
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  #10  
Old 03-16-2016
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Quote:
Originally Posted by XpaezX View Post
A 75 year-old man with history of hypertension presents to the emergency room with complaints of shortness of breath and palpitations. His vital reveal a heart rate 142/min, blood pressure 130/86, temperature 98.6 and oxygen saturation of 89% on room air. On auscultation, there are no rhonchii or crepitations, the heart rate was irregular and rapid with out any murmurs. The patient is placed on oxygen by nasal cannula. An urgent EKG is obtained which reveals rapid atrial fibrillation with no evidence of significant ST-T changes. The patient is started on diltiazem. Chest x-ray is normal and a brain natriuretic peptide is 80ng/L. Electrolytes, TSH and complete blood count are with in normal limits. Cardiac enzymes are drawn. Arterial blood gases reveal a pH of 7.48, po2 of 58, pco2 of 20 on room air ( Fio2 of 21%). The next step in evaluating the etiology of his atrial fibrillation :
A) Cardiac catheterization
B) Spiral CT scan of the chest
C) Venos doppler of lower extremities
D) 2D Echocardiogram
E) D-Dimer
What do you guys think? Im thinking B, but the range of answers seen on the facebook page + twitter is crazy!
I think it is B since the guy is hypoxic and PE is likely cause. But then 2D echo is more comprehensive...so D ?? Nice question concept
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