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ezetimibe
Forum Senior Topics: 11 Posts: 113 |
Hi everyone, I was solving UWorld pulmonary and came across this question. I cannot copy-paste the question, but they described a stable pt post-op with clinical symptoms and signs highly suggestive of PE. The next best step would be: 1. Chest Xray 2. ABG 3. V/Q scan 4. Pulmonary angiogram I thought it may be a good idea to get an ABG first, but they said Chest xray. Can someone justify? Also as a corollary question, if you had to choose between V/Q scan and CT angiogram for best initial test for diagnosis, which would you choose? I think the latest Harrisons says CT angiogram but I thought I will confirm.
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ripplefire
| Forum Elite  Topics: 31 Posts: 210
they have selected Xray as the correct answer in order to exclude any other pulmonary pathology, besides questions which ask for 'the next best step' usually have some basic answer like CXR as the correct one instead of some invasive one like ABG besides a normal CXR in a pt showing signs of PE will support that, abnormal ABGs can be due to many causes like asthama and COPD(although not in this case) V/Q will be the best INITIAL test for PE, they have asked for BEST INITIAL TEST and not the BEST test, just check the flow chart given in Harrison for diagnosis of PE, thing is CT angiogram cant detect emboli in small/distal pulmonary vessels, thats its disadvantage. not that V/Q scan doesnt have its drawbacks. but i would choose V/Q
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girl^interrupted
| Forum Junior  Topics: 97 Posts: 746
You always do CXR and ABGs first in any pt presenting with SOB...I dunno why CXR first but I always knew that you do CXR first...Ripplefire explained it well.. as for best initial test for PE--> SPIRAL CT...when I was prep for my CK, I was confused btw this and VQ scan. I thoroughly searched for it and asked the attending physician and the residents where I did my observership and they said hands down...spiral CT first. Reason, an intermediate VQ scan is inconclusive..It used to be a standard before but now IF given the choice it should be spiral CT. If you want to confirm this read topic 2-14 Venous thromboembolism from the red pocket medicine(massachusetts general hospital handbook that ALL medicine residents use) Page 2-14 says: VQ scan is done only if CTA-inexperienced institution OR if contraindication to CTA (CT angio, also known as CTA or spiral CT)
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egyusmler
| Forum Junior  Topics: 87 Posts: 1334
Spiral CT is the test of choice if the X ray is abnormal..For a V/Q scan to be accurate,the chest X ray must be normal..Angiography is the gold standard but invasive procedure. This is according to "Master the boards"
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girl^interrupted
| Forum Junior Topics: 97 Posts: 746
Spiral CT is also known as helical CT, CT angiography!! You inject contrast material in a pts vein and hence it's less invasive than the regular PULMONARY angiography that injects dye into arteries!! So please know that the first initial test nowadays is CT angio/spiral CT/Helical CT...But it IS angiography..Takes only a few minutes...
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