Kamsi
Forum Guru
Topics: 103
Posts: 347
|
5.
A 52-year-old woman comes to the emergency department
6 days after knee
arthroplasty because of constant, right-sided chest
pain and shortness
of breath for 24 hours. Her blood pressure is 110/50
mm Hg, pulse is
114/min, and respirations are 24/min. Examination of
the heart, lungs,
and extremities shows no abnormalities. Arterial
blood gas analysis on
room air shows:
pH 7.49
PCO2 29 mm Hg
PO2 66 mm Hg
Ventilation-perfusion lung scans show a low
probability for pulmonary
embolus. An ECG shows sinus tachycardia; an x-ray
film of the chest
shows no abnormalities. After the evaluation, the
patient is pain-free
and wishes to go home. Which of the following is the
most appropriate
next step in management?
A
) Discharge home and reexamination in 2 weeks
B
) Exercise stress test
C
) Pulmonary function tests
D
) Echocardiography
E
) Pulmonary angiography
F
) Ibuprofen therapy
7. A 65-year-old woman has a 6-month history of
progressive
irritability, palpitations, heat intolerance, frequent
bowel movements, and a
6.8-kg (15-lb) weight loss. She has had a neck mass
for more than 10
years. 131I scan shows an enlarged thyroid gland with
multiple areas of
increased and decreased uptake. Which of the
following is the most
likely diagnosis?
A
) Defect in thyroxine (T4) biosynthesis
B
) Graves' disease
C
) Multinodular goiter
D
) Riedel's thyroiditis
E
) Thyroid carcinoma
F
) Thyroiditis
G
) Toxic adenoma
H
) Triiodothyronine (T3) thyrotoxicosis
A previously healthy 67-year-old woman is brought to
the emergency
department by paramedics 40 minutes after the sudden
onset of shortness of
breath while shopping. She is unable to provide
additional medical
history. She is in severe respiratory distress. Her
temperature is 37 C
(98.6 F), blood pressure is 90/60 mm Hg, pulse is
120/min and regular,
and respirations are 24/min. Examination shows marked
jugular venous
distention. Diffuse crackles are heard throughout all
lung fields.
Cardiac examination shows an enlarged point of maximal
impulse and normal
S1 and S2; there is an S3. Abdominal examination
shows no
abnormalities. There is no edema of the lower
extremities. Laboratory studies
show:
Hematocrit 38%
Leukocyte count 12,000/mm3
Platelet count 350,000/mm3
Arterial blood gas analysis on 5 L/min of oxygen:
pH 7.5
PCO2 16 mm Hg
PO2 64 mm Hg
A
) Acute gastrointestinal bleeding
B
) Adrenal insufficiency
C
) Aortic valve rupture
D
) Cardiac tamponade
E
) Congestive heart failure
F
) Pneumonia
G
) Pulmonary embolism
H
) Sepsis
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| dr confused
Forum Senior
Topics: 66
Posts: 107
|
E
C
E
|
| kpmle2
Forum Elite
Topics: 29
Posts: 290
|
E
C
E
|
| yasmeen
Forum Guru
Topics: 67
Posts: 936
|
pulmonary function test
toxic adenoma
ccf
|
| donjuan
Forum Junior
Topics: 9
Posts: 68
|
why can the last question not be pul embolism?
|
| hanialkhadher
Forum Elite
Topics: 16
Posts: 256
|
E
C
E
___________________
"أقرأ بأسم ربك الذي خلق,خلق الأنسان من علق,أقرأ و ربك الأكرم, الذي علم بالقلم,علم الأنسان ما لم يعلم"
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| doyoudig
Forum Guru
Topics: 144
Posts: 613
|
most commonly Pulm Enbolims has clear CXR i.e No Diffuse crackles are heard throughout all lung fields.
|
| Kamsi
Forum Guru
Topics: 103
Posts: 347
|
For the 2nd Q,can someone explain the difference btw multinodular goite and Toxic adenoma
|
| dr.wad
Forum Senior
Topics: 3
Posts: 335
|
E
C
E
in toxic adenoma ...increased uptake only in the adenoma while the rest of the gland will show decrease uptake due to inhibition of TSH by the autonomous adenoma.
in multinodular goitre.....it is the internodular tissues which secrete the hormones and so show increased uptake ....the nodules will show decrease uptake.
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| yasmeen
Forum Guru
Topics: 67
Posts: 936
|
i read that low probability vq scan rule out pe.and at times its imp to differentiate between exacerbation of copd and PE which have similar symptoms so why not pfts while she isn,t in distress
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| donjuan
Forum Junior
Topics: 9
Posts: 68
|
negative venti/perfusion scan but high clinical suspicion of pe we do a pulm. angio.
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| peter90036
Forum Elite
Topics: 28
Posts: 315
|
last Q sounds more like an acute MI -- +/- something ruptured -- acute heart failure
theres no cardiomegaly in acute tamponade
tempting for PE but S3 is for heart failure, ABGs are on oxygen, as said before clear lungs with PE.
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| aspire
Forum Senior
Topics: 24
Posts: 158
|
Pulm angio
---
Cong card failure
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| ganesha123
Forum Senior
Topics: 8
Posts: 225
|
pulm angio
multi nodular goiter
ccf
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It has never been so bad, that it couldn't be worse...”
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| Jcala
Forum Junior
Topics: 10
Posts: 44
|
1. Why not Echo ? in 6 days what do you expect to show in pulmonary function tests in this case ? 2. C 3. Can CHF present in such an Acute setting ? I would say MI, Tamponade, or valve rupture
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