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 BOF 87

 

   

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BOF: 87

A 36 year old female presents with progressive breathlessness. There is a history of cough and breathlessness in childhood but no other significant past illnesses. Apart from the contraceptive pill the patient is not on any drugs. She is married and has 3 children and is a housewife.

On examination she looked thin. Her pulse rate is 100 beats per minute; the pulse volume is low and decreases with inspiration. BP 100/60 JVP elevated 6 cms above the manubriosternal angle and the height of the JVP increases with inspiration. There is no abnormality detected on inspection of the praecordium. The apex is difficult to palpate. The heart sounds are soft and there is an additional sound heard in mid diastole. Lungs are clear. The liver is enlarged 4 fingerbreadths below the costal margin, it is non-pulsatile. The patient has ascites.

In this patient which one of the following investigations is likely to lead to a diagnosis?

a)      Ventilation perfusion scan

b)      CT pulmonary angiogram

c)      ECG

d)     Paracentesis abdominis

e)      ECHO cardiogram

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