JH
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This is a Q from UW.
A 32-year-old woman comes to the Emergency Department complaining of sudden onset of severe shortness of breath that began four hours ago. She also has a nonproductive cough and right-sided chest pain that worsens with inspiration. ... Her medication include birth control pills and over-the-counter vitamins. ... Her vital signs are: T 99 F (38C), BP 110/70 mmHg, PR 130/min and RR 30/min. Pulse oximetry showed 85% on 6 lit oxygen. Physical examination shows a slightly obese, white woman in acute distress. She is alert and cooperative without cyanosis or jaundice. The rest of the physical examination is normal. What is the most appropriate next step in this patient's management?
A.EKG
B.Echocardiogram
C.V/Q Scan
D.Angiogram
E.Doppler ultrasound of lower extremities
F.Chest-x ray and arterial blood gases
G.Spiral CT-Scan
H.D-dimer
The answer is F.
I can hardly accept the answer, for I chooseC. My reason: this is a yong femail patient without other history, but is taking birth control pills.
That means PE is highly considered. Acording to the rule from Kaplan Note p285, I would prefer C instead of F.
What do you think?
Edited by JH on 09/27/06 - 11:30 AM
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| sarika
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i chose c too now im confused
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| study_ing
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well i had chosen c too, but in uw, they said u need an initial test to rule out other causes. once u'v gotten the cxr done, and its clear, our suspicion for pulmo embolism will be stronger, and we can go for the v/q scan.
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| JH
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Hi, sarika and study_ing , in real exam, which one you would choose?
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| robin082006
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I go with F at the first time seeing this q.
In practice, we have to do Xray and Arterial blood gase first for any patient with shortness of breath. These tests are rapid, may help diagnose and treatment.
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| study_ing
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in the exam, will choose F coz UW is a professionl q bank. they'll know what the correct answers for the exam ( rather than real life for example are) 
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| Sea_gull
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Well we should not forget two different situations
- Best test in case of dyspnea
- Best test in case of PE
This is a case of dyspnea with high suspicion of PE.
X-ray safely rules out certain Non PE conditions causing acute dyspnea like pneumothorax .
Best of luck
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| study_ing
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well said!!
thanx
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| JH
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Thanks guys.
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| Data297
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I know I'm real late to this topic, but was hoping you could answer this question. The O2 stat is already in the 80s so won't the ABG be abnormal? Also there was sudden onset of shortness of breath. What diseases are you hoping to exclude with a CXR and ABG?
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| AAzad
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next step is Abg and CXR, best diagnostic tool v/q scan gold standard Angio.
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| jvo_md
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An EKG is done first then XR then V/Q Scan
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