Perhaps
Forum Elite
Topics: 61
Posts: 162
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A 52-year-old woman comes to the emergency department 6 days after knee arthroplasty because of constant, right-sided chest pain and shortness of breath for 24 hours. Her blood pressure is 110/50 mm Hg, pulse is 114/min, and respirations are 24/min. Examination of the heart, lungs, and extremities shows no abnormalities. Arterial blood gas analysis on room air shows:
pH 7.49
PCO2 29 mm Hg
PO2 66 mm Hg
Ventilation-perfusion lung scans show a low probability for pulmonary embolus. An ECG shows sinus tachycardia; an x-ray film of the chest shows no abnormalities. After the evaluation, the patient is pain-free and wishes to go home. Which of the following is the most appropriate next step in management?
A) Discharge home and reexamination in 2 weeks
B) Exercise stress test
C) Pulmonary function tests
D) Echocardiography
E) Pulmonary angiography
F) Ibuprofen therapy
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| HighHopes
Forum Senior
Topics: 12
Posts: 165
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tough one , I don't know what test means by : "patient is pain-free", dose it mean that the othere symptoms are gone as well? do we send her for pulmonary angiography or send her home with Ibu? I would pick angio still based on her ABG.... please comment
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| shumaila
Forum Elite
Topics: 58
Posts: 347
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no clue
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| frank100
Forum Guru
Topics: 48
Posts: 586
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I would discharge her home, but I must be sure i´m not D/C-ing a PE, angiography would make me feel more confident of her real health status and I´ve just ruled out my greates fear, wich is diffult to rule ou by the way.
sounds like PE, smells like PE, but pretty atypical. pulmonary angigraphy is in the options tempting you and I choose her
my answer is (e)
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| Perhaps
Forum Elite
Topics: 61
Posts: 162
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Thanks everyone. I have no idea. Will choose E then
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| juanma0
Forum Senior
Topics: 10
Posts: 146
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Among the few remaining indications of pulm. angio is to confirm a highly suspicous case of PE with equivocal V/Q. Remember V/Q has high sensitivty and PPV but bad NPV so we cant rule out PE yet.
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| Dragonfly
Forum Elite
Topics: 21
Posts: 322
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no missmatch? i wouldn`t release here with ibu, it`s not just the pain, she is hypoventilating. (resp alkalosis).
i think angio has to be done to rull out PE
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| jvo_md
Forum Senior
Topics: 22
Posts: 189
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I'll go with angiography before dismising her, too. Just to be sure de V/P is really a low prob.
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| loser
Forum Guru
Topics: 34
Posts: 341
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clinical suspicion high but vq low probability so angio shud b done
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| achilles
Forum Guru
Topics: 85
Posts: 1,201
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pulmonary angiography.
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