A 35-year-old man had a left femur fixation. On day 2 after surgery he develops sudden breathlessness and pleuritic chest pain. BP 120/80, HR 128. What is the best next step?
سؤال مجاني 1 من 10 اليوم · اشترك وكمّل بدون حد
اعرض الإجابة
الإجابة والشرح
ادخل لحسابك عشان نحفظ إجاباتك ونوريك أخطاءك.
الإجابة: B. CT pulmonary angiogram
Modified Wells: PE most likely diagnosis (3) + HR > 100 (1.5) + surgery within 4 weeks (1.5) = 6 → PE likely (>4). With high pretest probability a D-dimer should not be used (and it is elevated anyway after surgery); proceed straight to CT pulmonary angiography. Leg Doppler is mainly for when CTPA/V/Q is contraindicated or indeterminate, and ABG does not confirm PE.
ليش كل خيار صح أو غلط
-
A
ليش غلط
D-dimer is only useful when pretest probability is low; here the pretest probability is high, so it is not helpful.
✓ Step Up To Medicine 6th Edition 2024( PE).pdf · p. 8 -
B
ليش صح
With a high pretest probability of PE, skip D-dimer and do CTPA, which has high sensitivity and specificity.
✓ Step Up To Medicine 6th Edition 2024( PE).pdf · p. 8 -
C
ليش غلط
Leg duplex ultrasound is used mostly when definitive imaging is contraindicated or indeterminate; a normal result does not rule PE out.
✓ Step Up To Medicine 6th Edition 2024( PE).pdf · p. 8 -
D
ليش غلط
ABG levels are not diagnostic for PE; they usually show low PaO2 and PaCO2 with a high pH.
✓ Step Up To Medicine 6th Edition 2024( PE).pdf · p. 6
- المصدر
- Step Up To Medicine 6th Edition 2024( PE).pdf · p. 8
Step Up To Medicine 6th Edition 2024( PE).pdf · p. 9 - المحاضرة
- Venous Thromboembolism · Pulmonology · Module B
- ظهر في
- MED42 ♂ EOM B