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 Best of Five 102

 

   

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BOF: 102

A 60-year-old female is admitted with a history of syncopal episodes and breathlessness of one-week duration.  No history of immobilisation or recent travel.

On examination she looks distressed her conjunctiva and tongue are pale. Her pulse rate is 120 beats per minute, blood pressure 90/60, JVP elevated 5 cms. Respiratory rate 26 per minute, apex 5 LICS MCL heart sounds triple rhythm, soft systolic murmur at the left sternal edge. Lungs clear.

HB 13.5 g/dL

Blood gases pH 7.46 Pa CO2 3.2   kPa, Pa O2 7.7 kPa

The next step in management of this patient is:

a)      Immediate thrombolysis followed by an ECHO to confirm the diagnosis

b)      Immediate thrombolysis followed by computerised tomographic pulmonary angiography (CTPA) to confirm the diagnosis

c)      Immediate thrombolysis followed by ventilation perfusion scan to confirm the diagnosis

d)      Urgent CT pulmonary angiography followed by thrombolysis

e)      Full dose fragmin followed by ventilation perfusion scan

 

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