ok so someone msg me about part of a post I put in another thread and had some questions so I figured I start a new thread and talk some medicine
[57 y/o male w/ Hx of IDDM and DVT on Insulin and Warfarin c/o chest pn x 2 hrs radiates from sub-sternal "crushing" pn to "jumping" pn in umbilical region.
Report via telephone/radio consult. You may order one lab test now and then others in 15 min, at which time you will receive a telephonic objective report. What one lab test do you wish to order STAT?
A. CBC
B. CMP/CHEM20
C. 'Blood Panel' (PT, PTT, INR)
D. Cardiac ER Panel
E. 'D-Stick' Glucose Level
If this was on Step 3 what do you think the answer would be? At first guess I thought D.]
the point of the question was to flame multiple choice questions... but good retort question.... lets take a look at it
1. D. would make sense because of c/o CP
2. A. would make sense because thats what the say all the time on "ER"
Pretty much this is the nightmare patient... especially if tele-reported just chief complaint and basic history, plus I was mean and stipulated only one initial lab test just to point out that there is no ONE correct answer. All of the labs make sense so the question is invalid... but raises a good question, how do you deal with this? For now with the info provided I'd think:
1. 50+ male... poss. cardiac
2. Pn radiates to abd... Pt on coumadin... poss. triple AAA
3. Diabetic... Need to check sugar
Honestly I'd say (and this is just hypothetical... again I ment to make this an impossible multiple choice) that the best bet would be a D-stick... small, fast, very useful. There does exist a possibility that the patient is having a sugar problem, I've seen chest pn as the initial presentation of a 30-40 y/o male with a glucose at ~670 (HONC), and the pn is tied to either glucose level or even fear/stress. Then again Pt would probably die out of spite right after I got the D-stick
equal time... let's hear what y'all think
I'll come up with a full history and physical if I get some good response to this and go further into it.
[57 y/o male w/ Hx of IDDM and DVT on Insulin and Warfarin c/o chest pn x 2 hrs radiates from sub-sternal "crushing" pn to "jumping" pn in umbilical region.
Report via telephone/radio consult. You may order one lab test now and then others in 15 min, at which time you will receive a telephonic objective report. What one lab test do you wish to order STAT?
A. CBC
B. CMP/CHEM20
C. 'Blood Panel' (PT, PTT, INR)
D. Cardiac ER Panel
E. 'D-Stick' Glucose Level
If this was on Step 3 what do you think the answer would be? At first guess I thought D.]
the point of the question was to flame multiple choice questions... but good retort question.... lets take a look at it
1. D. would make sense because of c/o CP
2. A. would make sense because thats what the say all the time on "ER"
Pretty much this is the nightmare patient... especially if tele-reported just chief complaint and basic history, plus I was mean and stipulated only one initial lab test just to point out that there is no ONE correct answer. All of the labs make sense so the question is invalid... but raises a good question, how do you deal with this? For now with the info provided I'd think:
1. 50+ male... poss. cardiac
2. Pn radiates to abd... Pt on coumadin... poss. triple AAA
3. Diabetic... Need to check sugar
Honestly I'd say (and this is just hypothetical... again I ment to make this an impossible multiple choice) that the best bet would be a D-stick... small, fast, very useful. There does exist a possibility that the patient is having a sugar problem, I've seen chest pn as the initial presentation of a 30-40 y/o male with a glucose at ~670 (HONC), and the pn is tied to either glucose level or even fear/stress. Then again Pt would probably die out of spite right after I got the D-stick
equal time... let's hear what y'all think
I'll come up with a full history and physical if I get some good response to this and go further into it.
