doyoudig
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A 56-year-old woman is brought to the emergency room, after having an acute onset of difficulty breathing. The breathing difficulty started suddenly 6 hours ago, while she was enjoying her favorite television show. She also reports simultaneous onset of sharp left sided chest pain. Her previous medical history includes diabetes mellitus for the past 10 years and hypertension for the past 6 years. Her family history is significant for heart disease in her father, who died at the age of 40. Her medications include enteric-coated aspirin, captopril and glipizide. She has a 30-pack year smoking history. On examination, she is in distress and is profusely sweating. Her Temperature is 38C(100.5F); Pulse: 180/min and irregular; Respiratory Rate: 40/min; Blood Pressure: 110/60 mm of Hg; and Jugular Venous Pulse is not elevated. Oxygen saturation is 88% at room air by pulse oximetry. Chest x-ray is unremarkable. ECG revealed irregular RR interval, with no definite P waves and narrow QRS complexes.
Labs revealed:
Hematocrit 40%
ESR 40 mm/hour
WBC count 11, 600/cmm
Platelet count 190,000/cmm
What is the most appropriate diagnosis?
A. Myocardial infarction
B. Mitral stenosis
C. Cardiac tamponade
D. Pulmonary septic emboli
E. Pulmonary vascular disease
what us Dx accoding to facts???
I think it's MS............
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| dr in trouble
Forum Guru
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E--Pulmonary embolism.
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| Justice
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Hey doyoudig,
I do not think this is MS because there is no diastolic murmur or opening click specific for MS... In addition, I am not sure it may start that suddenly and with pain... Finally, on CXR an augmented vascularity of the lungs would be seen...
I don't not think this is (E) because the Pt is on aspirin for quite a while... And, PE is not Pulmonary vascular disease, like Wegener's granulomatosis, for example...
I think this is (D) Pulmonary septic emboli... Note temperature 38C(100.5F)... I know that I once chose (E) for this same Q, but now I am not confident about it and offer another idea...
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| elitoki
Forum Guru
Topics: 54
Posts: 508
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E . P.E
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| tamerbashir
Forum Elite
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PE
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| dr19
Forum Senior
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Posts: 110
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MI
why not?
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| Korotkoff
Forum Senior
Topics: 14
Posts: 164
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What are you guys talking about? Isn't this atrial fibrillation? I will go with MS. The question doesn't say cardiac auscultation is normal either.
Answer: B.
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| ILoveMedicine
Forum Newbie
Topics: 2
Posts: 12
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The answer is E
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| nyimalay
Forum Elite
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Answer: E
Not PE. Its pulmonary hypertension leading to Rt heart strain and atrial fibrillation.
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| Korotkoff
Forum Senior
Topics: 14
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Nope. I changed my mind. It is MI! AF complicates AMI in 5-10% of the cases.
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| sherry39
Forum Junior
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Posts: 105
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MS...as ecg shows AFib
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