2-4-8 - sunappleus

[ArchivalUser]

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

[ArchivalUser]

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

[ArchivalUser]

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.

[ArchivalUser]

PE for sure