nbme form3 q3 - certi

[ArchivalUser]

CHF is obvious, no need to do more to establish the dx. CHF ususally causes bilateral problems in lung base, not unilateral. So letusdoit and library, I think you should think again.

A is clear to me.

[ArchivalUser]

from history and PE, patient has CHF is clinical diagnosis clearly. Echo only tell you EF is low which is consistent with clinical. It provide less value for next management than CXR.
Think about this patient has 99% chance with CHF from clinical sign and symptoms. Next you would like to give him diuretics and O2, ACEI and morphine may be, even without echo. But if you find out lung problem is more than just pleural effusion(transudate), you might think of other treatment as well.

Pneumonia in elderly does not alway with fever, beside pneumonia is not the only possibility.

[ArchivalUser]

when we are taking about a patient with h/o CAD, DM shouldnt we first rule out unstable angina??
I would go for EKG stat?
but i am not sure what ambulatory EKG monitorying means? do they mean the one which is 24 holter ekg monitoring?? if that is the case i would go for chest x ray,,,,