(Solved): History A 25 year old white female reports to the Emergency Room because of sharp left sided chest ...

History A 25 year old white female reports to the Emergency Room because of sharp left sided chest pain and shortness of breath of one day duration. The patient was in excellent health until yesterday. She was awakened from her sleep by sharp left sided chest pain. The pain worsened with motion and deep breathing. The pain has been progressively increasing in severity and she now has severe left shoulder pain. She complains of shortness of breath and is very apprehensive about dying. She denies any cough, fever, sputum production or hemoptysis. She is married and had one normal delivery three years ago. She is currently on birth control pills. She has never been hospitalized except for labor and delivery. Review of systems are negative. She denies any past history of venous problems. She reveals having a similar transitory minor episode of chest pain approximately one year ago while she was vacationing in Michigan. She works as a computer programmer. She smokes one pack of cigarettes a day for the past eight years. She considers herself a social drinker. Physical Examination Blood pressure 114/80; pulse 118; temperature $$37.0$$ (oral) She appears to be in moderate respiratory distress. She is well developed and nourished. Pertinent findings include a respiratory rate of 30 and shallow breathing. There is dullness, decreased chest expansion and decreased breath sounds in the left base. There were no rales or rubs. Heart reveals PMI in the 5 th intercostal space in $$\mathrm{MCL}$$. The pulmonic component of the second sound is accentuated. Abdomen pelvic and rectal exams are normal The extremities reveal no evidence of edema, cyanosis or clubbing Joint exam revealed shoulder movements complete in range. No warmth or tenderness noted The rest of the patient's joints are normal 3. Does the patient have hypertension? What specifically in the report helped you answer this? 4. The patient is in respiratory distress. Is she turning blue? What specifically in the report helped you answer this? 5. Does the patient have swelling in her arms and legs? What specifically in the report helped you answer this? The Emergency Room physician orders the following tests: CBC: Hgb 15 0; Hct 43; WBC 11,500; 83 polys, 1 band and 14 lymphs SMA-12: Normal Arterial blood gasses: F102. 21; pH 7.39; $$\mathrm{PCO}2$$ 30; $$\mathrm{HCO}2$$ 20; $$\mathrm{PO}280$$ and $$\mathrm{SO}2$$ $$95\%$$ EKG reveals sinus tachycardia and non-specific S-T-T wave changes axis $$+80$$. Decubitus chest $$x$$-ray reveals a small pleural effusion in the left base. The left diaphragm is elevated. Shoulder $$\mathbf{X}$$-ray is normal. 6. What type of arrhythmia does the patient have? a. Fast heart rate b. Ventricular fibrillation c. Atrial fibrillation d. Slow heart rate 7. What position is the patient in for the chest $$\mathrm{x}$$-ray? a. Sitting down with her back toward the $$x$$-ray machine b. Standing up with her front toward the $$x$$-ray machine c. Standing up with her back toward the $$x$$-ray machine d. Lying down Additional Studies Lung scan revealed a defect corresponding to the area of pleural effusion Pleural tap revealed yellow fluid, protein $$3.5$$ grams; glucose 64 and $$\mathrm{pH}7.4$$. Doppler exam revealed deep vein thrombosis of the left lung. The Patient was admitted to the hospital. Repeat lung scan revealed multiple defects 8. What is the patient's diagnosis? a. Myocardial infarction b. Pulmonary embolism c. Mitral valve prolapse d. Dislocated shoulder 9. What class of medication will probably be prescribed for her to immediately treat the problem? a. Thrombolytic b. Nitroglycerin c. Antitussive d. bronchodilator 8. What is the patient's diagnosis? a. Myocardial infarction b. Pulmonary embolism c. Mitral valve prolapse d. Dislocated shoulder 9. What class of medication will probably be prescribed for her to immediately treat the problem? a. Thrombolytic b. Nitroglycerin c. Antitussive d. bronchodilator 10. What class of medication will probably be prescribed for her to prevent this from happening again? a. Antitussive b. Anticoagulant c. Antihypertensive d. thrombolytic