MCQ 48 - painless vaginal bleeding in pregnancy. What is the most likely diagnosis? What is the pathophysiology behind this condition? What are the risk factors and how is it managed? #physicianassociate #medicine #exampreparation #physicianassociatestudent #physicianassistantstudent #physicianassistant #medicalstudent #premed #prepa #doctor #obstetrics
Answer - A. This patient is experiencing sudden onset shortness of breath, associated with cough and pleuritic chest pain. With these symptoms in mind the top differentials would be pulmonary embolism and pneumothorax, with less likely differentials including pneumonia, ACS, pulmonary oedema, tamponade, foreign body ingestion and MSK chest pain. Although the calves are soft and non-tender, this is not enough to exclude PE with confidence, as a DVT could have developed elsewhere. Applying the Well’s score to this scenario the patient would score 3 points for PE being the top differential, or as likely as the top differential - therefore this patient should be investigated with D-dimer testing. The patient appears well from the history/examination/vital signs and so answers C-E are needlessly exposing the patient to radiation at this stage, equally the patient should be investigated somehow due to the acute onset of SOB.
If D-dimer is raised then an immediate CTPA should be requested. If this is not available immediately then a LMHW should be used to bridge the gap. If d-diner is negative then an alternative diagnosis should be sought.
This history was not the most detailed and other information such as any history of trauma, chest percussion/palpation and ECG findings would have been useful to exclude other differentials. #physicianassociate #medicine #exampreparation #physicianassociatestudent #physicianassistantstudent #physicianassistant #medicalstudent #premed #prepa #doctor #generalpractice #respiratory