docnikki
Forum Guru
Topics: 93
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A 66-year-old man presents to the emergency room complaining of discoloration of the toes and fingers of one week's duration. He also has had "angina-like" chest pain for the past two days. His past medical history is significant for recently diagnosed non-Hodgkin's lymphoma. He is currently on combination chemotherapy. He denies smoking and alcohol use.
He is afebrile with a blood pressure of 120/70 mm Hg and a pulse of 70/min. Cardiac examination shows a faint, holosystolic murmur, and the lungs are clear. The fingertips and toes appear necrotic. The neurologic exam is intact. The initial EKG reveals ST elevation in leads V2-V5. The complete blood count (CBC) and prothrombin (PT)/partial thromboplastin time (PTT) are normal. Troponins are elevated.
The patient soon develops an acute mental status change in the emergency department with aphasia and right-sided weakness. The CT scan of the head reveals an acute ischemic stroke with no evidence of hemorrhage.
Which is the first test to perform in diagnosing this patient?
(A) Protein C and S assays
(B) Homocysteine level
(C) Transesophageal echocardiogram
(D) Chest CT scan
[font size="2"]E) Antiphospholipid antibodies[/font]
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| dr.wad
Forum Senior
Topics: 3
Posts: 335
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C
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| sandra
Forum Guru
Topics: 180
Posts: 426
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b?
___________________
You become what you think you are!
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| sandra
Forum Guru
Topics: 180
Posts: 426
|
b?
___________________
You become what you think you are!
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| sandra
Forum Guru
Topics: 180
Posts: 426
|
b?
___________________
You become what you think you are!
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| farnsworth
Forum Newbie
Topics: 0
Posts: 165
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I agree w/ Dr. wad: (C)
the patient is obviously having multiple thrombembolic events (necrotic lesions on fingertips, and now: ischemic stroke). As the patient has signs of a myocardial infarction (ST segment elevation over anterior myocardium -> LAD, Troponin (+), angina for at least 2d!) exclusion of intracardial thrombi is of paramount importance.
All other tests can be done later if no other cause can be elicited.
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| docnikki
Forum Guru
Topics: 93
Posts: 680
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Correct!
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| guangyu
Forum Elite
Topics: 29
Posts: 308
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answer is C. the patient has chemotherapy related carditis, so the source of embolism is from heart.
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