DrVirgo
Forum Hero
Topics: 1043
Posts: 3,345
|
A 34 year old white wmoan comes to the ER complaining of difficulty breathing that started suddenly several hours ago. She has never had such symptoms before. Her past medical history is significant of rheumatiod arthritis. Her current medications include naproxen, and an oral contraceptive. She smokes 1 and a half packs a day, but does not consume alcohol. Her blood pressure is 110/70 mmHg and her HR is 105/min. Lungs are clear on auscultation. EKG and chest x-ray are normal. Ventilation/perfusion scan was performed, but the results were inconclusive. What is the best next step in the management of this patient?
A. Pulmonary angiography
B. Pulmonary function tests
C. Venous ultrasonography
D. Contrast phlebography
E. Transesophageal echocardiography
Please answer and give your EXPLAINATION. Thanks. 
___________________
Our greatest glory is not in never falling, but in rising every time we fall.
|
| Aashi
Forum Moderator
Topics: 112
Posts: 921
|
P.E s/s----->but v/q inconclusive----->do doppler u/s legs and if INITIALLY V/Q was normaL, this will rule out P.E------------>C
___________________
"Obstacles are those frightful things you see when you take your EYES off your goal."
|
| DrVirgo
Forum Hero
Topics: 1043
Posts: 3,345
|
Yes thats right...
Here is my understanding of PE Diagnosis for a case like this:
--- Do a V/Q Scan -three possibilities
-1. V/Q Mismatch --> Treat
-2. V/Q Normal ---> R/O PE
-3. V/Q Inconclusive ---> Do a Venous U/S (to find DVT) OR a CT Angio (which may show a large PE)
---If EITHER Venous U/S OR CT Angio is Negative ---> do a Pulmonary Angio (last test because invasive)
---If EITHER Venous U/S OR CT Angio is Positive --> Treat with Heparin (?) -Is this right?
___________________
Our greatest glory is not in never falling, but in rising every time we fall.
|
| Aashi
Forum Moderator
Topics: 112
Posts: 921
|
You may do a CT scan FIRST in pts with underlying lung pathology like pneumonia or COPD/bronchiectasis, coz false positive rates are higher if you ask for V/Q scans on such pts...
This pts cxray is clear, auscultation was normal------>so V/Q is the best INTITAL dx tool....
___________________
"Obstacles are those frightful things you see when you take your EYES off your goal."
|
| multifactorial
Forum Guru
Topics: 28
Posts: 546
|
transesophageal echo.for one thing that it is non invasive and we need to find evidence in the lungs first before moving to the extremites and doing Doppler etc.and then it has great sensitivity and specificity for pulmonary embolism.
|
| drduck
Forum Guru
Topics: 82
Posts: 529
|
V/Q scan, good for initial investigation or suspision of PE as it is CHEAP.
but if it is negative or inconclusive then one shud directly go for PULMONARY ANGIOGRAPHY...which is the GOLD STANDARD investigation for PE.
but it is INVASIVE and quite EXPENSIVE too.
|
| drduck
Forum Guru
Topics: 82
Posts: 529
|
also, if the hospital has spiral CT,
one can directly go for it....without a V/Q scan as it is more sensitive than the later.
but still not as much as PUL Angio
|
| multifactorial
Forum Guru
Topics: 28
Posts: 546
|
what is the right answer?
|
| neurom
Forum Senior
Topics: 2
Posts: 127
|
Venous U/S. You have to confirm DVT before putting het on heparin.
___________________
"Nature magically suits a man to his fortunes, by making them the fruit of his character".
|
|
| |
| | | | | | | | | |
