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A 65-year-old female underwent a hip replacement two days ago for fracture neck
femur. On the third postoperative day, she suddenly became anxious, dyspneic and
tachycardia She has a history of anxiety and she takes lorazepam as needed Her
vital signs BP is 100/50 mm Hg; PR is 120/min; RR is 36/min and she is afebrile
She is saturating 84%on 6-lit oxygen Lung examination is unremarkable The chest
x-ray did not reveal any gross abnormalities The next step in the management is
A) Obtain a arterial blood gas
B) Order intubation
C) Order extremity venogram
d ) Order a ventilation/perfusion scan
E) Give IV lorazepam
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I think d answer is DD bcos chest xray has already been done which is an initial test why do AA again when u can go ahead and confirm after chest xray, more a normal CXR would make a v/q scan to be more accurate.
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32-year-old woman comes to the Emergency Department complaining of sudden
onset of severe shortness of breath that began four hours ago She also has a
nonproductive cough and right-sided chest pain that worsens with inspiration She
denies having fever, coughing up blood, liheezing, palpitations, leg pain, swelling of
the lower extremities or any recent travel Past medical history reveals appendectorny
at age 15 Her medication include birth control pills and over-the-counter vitamins
Her famity history is Father, age 55, has had diabetes for 20 years; mother, age 58,
has coronary artery disease She has never been pregnant, drinks alcohol socially
and does not smoke Hervital signs are T 99 F (38C), BP 110/70 mmHg, PR
130/min and RR 30/min Pulse oximetry showed 85% on 51it oxygen Physical
examination shows a slightG' obese, white woman in acute distress She is alert and
cooperative without cyanosis or jaundice The rest of the physical examination is
normal What is the most appropriate next step in this patient's management?
r- A) EKG
r- B) Echocardiogram
r- C) VlQ Scan
r- D) Angiogram
r- E) Doppler ultrasound of lower extremities
r- F) Chest-x ray and arterial blood gases
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first q is d in usmle world
second one is f
could any body explain that????????!!!!!!!!!!!!!!!!!!!!!!
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1 D bcoz saturation is 84 so no need for abg also chest x ray shows no abnormality which means initial measures are taken so do v/q to confirm the diagnose
2 F coz we r just suspecting PE (young obese women , OCP use) so do inital test like cxr and abg to check for abnormal signs.
PE protocol
If suspected 1 stablize ppt if unstable (ABC)
2 Anticoagulant if clear (AF ), and not contraindicated
3 CXR and ABG
4 If CXR normal v/q if abnormal (atelectasis) spiral ct
5 then treatment.
To rule out - D dimer
Thrombolytics if hemodynamicall unstable n not contraindicated.
IVF if CI to thrombolytics or ppt is already on anticoagulant. n if history says pervious DVT , AF n ppt is unstable.
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can you explain your answer dude?
