nadiabarati
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A previously healthy 25-year-old woman with no medical history presents to the ED complaining of 4 h of substernal chest pain, shortness of breath, dyspnea on
exertion, and “not feeling well” during the past few days. She denies illicit drug use or alcoholism. Vital signs are remarkable for a BP of 92/60, HR of 135, RR of 30, and temperature of 101.5°F. ECG shows normal sinus rhythm with nonspecific T-wave changes. Chest x-ray is normal. In addition to oxygen, which one of the following represents the BEST initial treatment regimen? (A) Aspirin, nitroglycerin, check troponin and myoglobin levels (B) Aspirin, beta blocker, check TSH (C) Intravenous fluids, analgesia, emergent echocardiogram (D) Aspirin, nitroglycerin, emergent ventilation
perfusion (V./Q) scan (E) Intravenous fluids, lorazepam, antacids
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| Guptashutosh
Forum Elite
Topics: 35
Posts: 354
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C... i m suspecting infective endo or mitral valve prolapse , but not sure about the ans
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| sima
Forum Senior
Topics: 11
Posts: 114
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D i want to rule out PE.
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| nadiabarati
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I also think like you sima, but the answer is C
please guptash explain it
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| Guptashutosh
Forum Elite
Topics: 35
Posts: 354
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wel i had two things in my mind
1) mitral valve prolapse: fem pt. more common , she developed sudden deterioration which reflect (inf. endocarditis) ,echo will detect it
2) even if it is a normal valve staph aureus can affect even normal valve, thus inf. endo again
but i was in doubt becoz they didnt gave any predisposing factor for inf endo.
good luck
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| Guptashutosh
Forum Elite
Topics: 35
Posts: 354
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one more thing is this pt is too young to develop mi without any predisposing condition one or two reason i found was MVP/IE
i donno if i contended you with the explanation
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| Guptashutosh
Forum Elite
Topics: 35
Posts: 354
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one more thing is this pt is too young to develop mi without any predisposing condition one or two reason i found was MVP/IE,
i donno if i contended you with the explanation
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| AAzad
Forum Guru
Topics: 57
Posts: 460
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IN REAL PRACTICE U WILL DO LIKE THIS
ASPIRRIN- TNG SL- IV LINE, SERUM TNG WITH MICROSET,& INDERAL IN SERUM, O2 WITH MASK OR NASAL,THEN ANXIOLITIC AND SERUM CHEMISTRY AND TROPONIN , GASTRIC KOKTAIL,THEN IMAGING
WAS THAT A USMLE CASE?I THINK ONLY THE QUESTION WRITER KNOWS THE CORRECT ANSWER.
___________________
AAzad
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