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....arterial blood gases and chest x-ray OR V/Q Lung scan?...usmle world says the former, kaplan says the latter.....thanks !
divinemsm said:....arterial blood gases and chest x-ray OR V/Q Lung scan?...usmle world says the former, kaplan says the latter.....thanks !
divinemsm said:....arterial blood gases and chest x-ray OR V/Q Lung scan?...usmle world says the former, kaplan says the latter.....thanks !
sophiejane said:I think it depends on your level of clinical suspicion. If it is high (all the typical signs, risk factors) then I think you start with V/Q. If that is neg, you can pretty much rule out a PE. If the sx are more vague, I think you can start with CXR and ABGs.
Does that sound right?
You might ask this in the EM forum. I asked a Q there the other day and got some great responses from actual docs and residents...unlike our lowly student forum.
ucbdancn00 said:damn sophie...
all done with the test and still at it....now that's a trooper
ucb
sophiejane said:no, not done just yet...I have the COMLEX tomorrow. this is called trying to keep my sanity until I can pass out in bed. better than studying.
ucbdancn00 said:word...
my brain is starting to melt inside my head..
ucb
rads0518 said:I had a question on Step 2 where all signs pointed to PE, but the question asked next step? ECG and V/Q were both on the list of next options, the others were obviously wrong. It would seem that V/Q is the obvious answer for PE. However, as we never want to miss an MI, might ECG be the correct answer. It seems that anytime a pt. had chest pain during my rotations, ECG was the first test run. This was one that I mulled for a while on the exam, ended up choosing ECG. Any thoughts on this?
DOapplicant said:it think if you're suspecting PE:
1) cxr (to r/o other eti in your ddx) and abg (to confirm PE findings of hypox and hypocarbia/inc pH)
2) if cxr neg and abg pos - start hep and then do confirmatory test (eg v/q).
if your suspecting massive PE (reg sx + new RBBB, JVD, MS change) s/p surgery- i think straight to hep.
4424 said:here's a ? from qbook.
sudden onset of palpitations and SOB 5days post op knee replacement surgery. PR 100/mon and regular. O2 sat 90%. ECG shows sinus tachy. CXR normal. what is next?
1- ABG
2- Doppler duplex of LE
3- VQ scan
4- give oxygen
5- start IV heparin
the answer was 1- ABG. i thought it was fairly safe to proceed with the VQ at that point but i guess not
lsu1000 said:UW is very contradictive on this. One explanation says V/Q is "usually" the first test to workup suspected PE.
However, in another more in depth explanation they say that the differential is very broad including pneumonia, CHF, pneumothorax, etc...so you should start with CXR abd ABG.
If the baseline CXR is abnormal(ie emphysema, fibrosis), you should perform spiral CT to check for larger clots.
If the baseline CXR is normal(the classic case) choose V/Q scan.
If V/Q is inconclusive(not negative but inconclusive), choose venous ultrasound of of lower extremities.
So recapping....the classic case that we will see on Step II....
1. CXR/ABG(most likely will be normal or noncontributory)
2. V/Q!!!
also..
D-dimers are non specific for PE, so they are not the "next best"