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

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8 Posts

prasannakumar
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Topics: 24
Posts: 55

06/27/07 - 07:05 AM

A 66-year-old Caucasian male presents to the ER with acute onset of severe chest pain and dyspnea. Pain is located in the right upper chest and is aggravated by deep breathing and coughing. His pulse is 116/min and regular, BP is 110/70 mmHg, RR is 28/min and T is 37.2 C ((99F). He is on aspirin, metoprolol, digoxin, lisinopril and furosemide for his heart failure. Examination shows very few rales at both bases of the lungs. His chest X-ray is unremarkable. EKG shows sinus tachycardia. Ventilation perfusion scan showed high probability for pulmonary embolism. Which of the following is the most likely source of his pulmonary embolism?

A) Clot in right heart

B) Clot is deep veins of the upper extremity

C) Clot in renal veins

D) Clot in calf veins

E) Clot in ileofemoral veins

Hotobhaga
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Topics: 41
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06/27/07 - 07:54 AM

Most common cause of PE is clot from the ileofemoral veins

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cirus
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06/27/07 - 08:22 AM

i'd go for D

Hotobhaga
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06/27/07 - 10:18 AM

No. refer kaplan.. Most common cause of PE is illeofemoral DVT. Calf veins are of course the most coomon lower limb dvT. But they do not break away and embolise.

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mjl1717
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06/27/07 - 10:26 AM

Hotobhaga wrote:
Most common cause of PE is clot from the ileofemoral veins

Yes and scientifically, those clots in the illiofemoral veins are simply BIGGER.. more likely to form thromboembolism..!

[Hypercoagualble states] .. As far as the right heart most clots pass right thru the heart so Ill exclude answer -a

Also how often does one hear of a clot in the renal vein??

Edited by mjl1717 on 06/27/07 - 10:34 AM

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dr in trouble
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06/27/07 - 12:08 PM

It is E

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Justice
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Topics: 106
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06/27/07 - 02:24 PM

E) Clot in ileofemoral veins

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Ivonne
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06/27/07 - 11:01 PM

E.- Proximal (above the knee) deep vein thrombosis of lower extremities is the most frequent source of PE.

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