12-11-2008, 08:48 PM
A 65-year-old woman is evaluated in the emergency department for an episode of syncope that occurred after she took a 24-hour plane flight home from Australia. Her medical history is noncontributory, and she has no other medical problems.
On physical examination, the patient is in moderate respiratory distress. The pulse rate is 110/min and weak, respiration rate is 16/min, and blood pressure is 90/60 mm Hg. Cardiopulmonary examination reveals soft heart sounds and clear lungs.
Which of the following physical findings will be most helpful in ruling out massive pulmonary embolism as the cause of the patient's hypotension?
A Flat neck veins
B Holosystolic murmur over the epigastrium, louder on inspiration
C Left parasternal precordial heave
D Palpable and accentuated S2 over the second left parasternal space
E Presystolic low-pitched extra sound over the subxiphoid area
On physical examination, the patient is in moderate respiratory distress. The pulse rate is 110/min and weak, respiration rate is 16/min, and blood pressure is 90/60 mm Hg. Cardiopulmonary examination reveals soft heart sounds and clear lungs.
Which of the following physical findings will be most helpful in ruling out massive pulmonary embolism as the cause of the patient's hypotension?
A Flat neck veins
B Holosystolic murmur over the epigastrium, louder on inspiration
C Left parasternal precordial heave
D Palpable and accentuated S2 over the second left parasternal space
E Presystolic low-pitched extra sound over the subxiphoid area