PE Question

Prep for USMLE Forum

» Log in | Register

Forum

Step 1

Match

Prep4USMLE Forum » USMLE Step 2 CK Forum » Internal Medicine Forum

PE Question

Author

8 Posts

Data297

12/03/06 - 03:00 PM

In the ER 34y woman, c/o difficulty breathing several hours ago. never had this before. Past history significant for rheumatoid arthritis. currently on naproxen an oral contraceptive. smokes 1 pack per day doesn't drink alcohol. bp is 110/70 pulse 105 lungs clear ekg and cxr normal. VQ scan inconclusive. Whats is the next best step in management?

1. Pulmonary angio.
2. Pulmonary function tests.
3. venous ultrasongraphy.
4. contrast phelography.
5. transesophageal echocardiography.

answer is 3

highlight are above for answer

star1
Forum Guru
avatar

Topics: 93
Posts: 827

12/03/06 - 03:23 PM

3. venous ultrasongraphy

robin082006
Forum Hero
avatar

Topics: 471
Posts: 5,125

12/03/06 - 04:16 PM

DVT complication

i go with 3 too

___________________
The Key to Succeed is Patience.

sarika
Forum Guru
avatar

Topics: 195
Posts: 1,200

12/03/06 - 07:42 PM

!. pulm angiogram. Gold standard in diagnosing pulm embolism...used after VQ scan and ct scan.

Data297

12/03/06 - 07:54 PM

I'll post the explanation tomorrow just in case anyone want to post their own reasoning

Edited by Data297 on 12/03/06 - 08:01 PM

ndspider
Forum Senior
avatar

Topics: 5
Posts: 69

12/03/06 - 08:12 PM

I am with sarika. Pulmonary Angiogram is the most specific examination availabe for establishing teh definitife dx of PE.

AAzad
Forum Guru

Topics: 55
Posts: 457

12/04/06 - 01:10 AM

Angio-.gram,is the next step after V/Q scan.with U/s you can r/o DVT but not every Dvt causes PEand also not always Dvt may be seen completly by sono.

so my best answer is Pulmunal angio.

___________________
AAzad

Data297

12/04/06 - 05:50 AM

This was an USMLE World question. Initially I also picked angiogram.
Not sure I totally agree with their explination.

The patient is undergoing workup for PE usual source is DVT. OCP use is important risk factor in DVT espically when combined with smoking. PE is difficult to diagnosis and requires the combination of several modalities. First test usually employed is the V/Q scan. if classic pattern is seen proceed with tx. In lots of people the test is inconclusive. The next best test in this case is venous U/S graphy to reveal DVT Dx DVT makes the probability of PE very high and you should proceed with TX.

Although Considered the gold standard, angio is an invasive procedure that is employed if venous u/s or CT angiography is negative.

You don't have permission to post.