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2-4-8 - sunappleus - Printable Version +- USMLE Forum - Largest USMLE Community (https://www.usmleforum.com) +-- Forum: USMLE Forum (https://www.usmleforum.com/forumdisplay.php?fid=1) +--- Forum: Step 2 CK (https://www.usmleforum.com/forumdisplay.php?fid=3) +--- Thread: 2-4-8 - sunappleus (/showthread.php?tid=519040) |
2-4-8 - sunappleus - ArchivalUser - 07-15-2010 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 8. A previously healthy 62-year-old man is brought to the emergency department by paramedics 40 minutes after the sudden onset of severe shortness of breath while dressing this morning. He is unable to provide additional medical history. He is in severe respiratory distress. His temperature is 37.8 C (100 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. The lungs are clear to auscultation. Cardiac examination shows a nondisplaced and discrete point of maximal impulse and normal S1 and S2; there is an S4 and a right parasternal heave. Abdominal examination shows no abnormalities. There is no edema of the lower extremities. Laboratory studies show: Hematocrit 40% Leukocyte count 14,000/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 0 - ArchivalUser - 07-15-2010 H. I think, Sepsis, Fever n high wbc. G, also can be, sudden onset, respiratory distress, 24RR, tachycardia But no clue ab sepsis. I choose G. Pulmonary Embolism 0 - ArchivalUser - 07-15-2010 BP: low. JVP: Elevated PULSE : HiGH onset: Sudden g) pulm embolism A: CVP should not be elevated,should be low, B: no finding in exam to suggest adrenal insufficiecy like skin hyperpigmentation, dyspnea is not that much and cardiac findings dunt correlate. C: no cardiac findings to imply aortic inssuficiency D: raised JVP with clear lungs maybe, but heart sounds r not distant, E: clear lungs,so no i guess F: lungs shouldnt be clear, no fever H: hell no Pulm Embolus,large artery maybe with concomitant Acute RV failur sudden increase in RV pressure, will accentuate the atrial kick causing S4. 0 - ArchivalUser - 07-15-2010 PE for sure |