try this 3 - usmlegold

[ArchivalUser]

A 69-year-old woman with a history of diabetes type 2, chronic renal insufficiency (baseline
creatinine of 2.3 mg/dL), and hypertension has shortness of breath and right-sided pleuritic
chest pain. She denies fevers, chills, or cough. Her temperature is 38.1 C (100.6 F), blood
pressure is 130/70 mm Hg, pulse is 123/min, and respirations are 29/min. Physical
examination shows a swollen and tender right calf. Lung examination is normal. Chest x-ray
reveals no active disease. At this time, which of the following is the diagnostic test of choice for
this patient?
A. D-dimer studies
B. Lower extremity venogram
C. MR angiogram
D. Spiral CT scan
E. Ventilation perfusion scan

[ArchivalUser]

ddd to detect PE

[ArchivalUser]

no its not dddd

[ArchivalUser]

aa?

[ArchivalUser]

C. MR angiogram

D-dimer is quite sensitive test for the diagnostic of DVT, but thinking answer C-MRA(though the creat=2.3 mg/dL) is the best choice diagnostic test for this patient.

What if D-dimer is negative!!

[ArchivalUser]

AAAAA

[ArchivalUser]

probably the answer is A. but I see that he scores at least 4.5>4 which makes diagnosis of PE likely. that makes one of the imaging studies indicated such as spiral CT or ventilation/perfusion scan.

[ArchivalUser]

Spiral CT has more contrast than MRA, A could be the answer, but I am asking can we rule out PE with a negative D-dimer ?

[ArchivalUser]

yes we can

[ArchivalUser]

if diagnosis of PE is not likely with clinical findings, then yes can rule out PE using negative d-dimer