new_n_lost
Politically InCorrect
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A 59-year-old woman comes to the emergency department 45 minutes after the onset of chest discomfort that is not relieved by three nitroglycerin tablets. Over the past 3 months, she has had similar episodes characterized by non-radiating pain and a feeling of heaviness; the episodes were exacerbated by exertion of heavy meals and were slowly relieved by rest. Sublingual nitroglycerin has provided rapid relief of symptoms in the past. She has hypercholesterolemia, type 2 diabetes mellitus, and peptic ulcer disease. She smoked two packs of cigarettes daily for 25 years but quit 5 years ago. She appears anxious and diaphoretic and is nauseated. Examination shows no other abnormalities except for an S4. Which of the following is the most likely diagnosis?
A) Acute aortic dissection
B) Angina pectoris
C) Esophageal spasm
D) Myocardial infarction
E) Pulmonary embolism
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FORUM RULES-- Those who believe in telekinesis, raise my hand. I get enough exercise just by pushing my luck --P4U World.." The pure and simple truth is rarely pure and never simple."
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| epica
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C- Esophagus involved?
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| doc179
Forum Guru
Topics: 67
Posts: 1,217
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I had opted for C but it looks like MI...as she is also diabetic she might not have pain because of neuropathy!
So i go for MI
Edited by doc179 on 03/21/07 - 04:28 AM
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| keepgoing
Forum Guru
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d?
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"chhak de phhatte"
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| epica
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MI
Ans please?
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| usmle4me
Forum Elite
Topics: 6
Posts: 283
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S4 is more related to compliance problem. So B or D. but not relevied by nitro. So shall pick D
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| girl^interrupted
Forum Elite
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should b D
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| new_n_lost
Politically InCorrect
Topics: 652
Posts: 6,089
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This was a Diagnosis of Exclusion :-
1: Acute aortic dissection--severe pain (tearing) here in this case its chest discomfort
2. Angina--relieved by nitroglycerin and do not last more than 5 to 10 min
3. Esophageal spasms: episodic and do not think that there is any relation to food intake and relief by rest
4.Pulmonary embolism: Here there is no respiratory distress.
Hence MI is the only condition in which she can be without typical signs as she is Diabetic.
___________________
FORUM RULES-- Those who believe in telekinesis, raise my hand. I get enough exercise just by pushing my luck --P4U World.." The pure and simple truth is rarely pure and never simple."
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