Question

A 38-year-old lady has been immobilized in bed for several days after motor vehicle accident. She has been improving, but this morning she complains of sudden onset of chest pain and Dyspnea. She is a regular smoker and takes birth controll pills. ECG normal, BP 125/85mmHg and heart rate 120.

Option 1

1) What is the most likely diagnosis in her case?

2 points

a) Angina pectoris

b) Acute pneumonia

c) Miocardial Infarction

d) Pulmonary embolism

2) Among the following statements which one is true concerning the diagnosed disease?

2 points

a) Rupture of young atheroma in the left coronary

Presence of mucus plug in the bronchioles

c) Interstitial granulomatous inflammation of the lungs

d) Formation of a thrombus in the lower extremities with embolization to a branch of the pulmonary artery

3) What is the most important risk factor for her disease?

1 point

a) Pulmonary Hypertension

b) Smoking

c) Immobilizzazione for several days

d) Tachycardia

4) Which among the following could be a severe complication of the diagnosed disease?

1 point

a) Heart attack

b) Saddle embolus

c) Acute pneumonia

d) Ischemic heart diseases

Answer 1

1) (d) Pulmonary embolism : The patient has difficulty in breathing and faster heart rate. Correlating this with the history of accident she had, it is highly probable that she has pulmonary embolism. Of note, blood clots that travel from legs are the main cause of pulmonary embolism

2) (d) Pulmonary embolism results from blood clots that block the arteries in lungs, causing limited blood supply to the lungs.

3) (c) immobilization for several days. This is an important risk factor, as being bedridden for long increases the possibility of blood clot formation.

Smoking is also a risk factor, but it is not the major cause here. Her previous condition is the major cause here. Though, this aggravates her present condition as smoking is known to cause blood clots, and reduction in respiratory capacity.

Tachycardia is a symptom, and is thus not a risk factor.

4) (b) Saddle embolus. This is an extreme case of pulmonary embolism, in this condition in which the pulmonary trunk is straddled. This increases pressure exerted by the heart, and eventually weakens the heart. It is life threatening.