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A 42-year-old man presents with a chief complaint of severe, sharp chest pain that started suddenly while lifting heavy objects. The pain began in a midsternal location, then radiated to both shoulders as well as to his back. It has been constant for 18 hours but started to get worse during the past 2 hours. On physical examination, the patient is in severe distress, with a temperature of 36.9 C (98.5 F), blood pressure of 160/90 mm Hg, pulse of 92/ min, and respirations of 18/min. Heart sounds are normal without rubs or murmur. An ECG reveals a normal tracing. Which of the following is the most appropriate next step in diagnosis?
(A) Chest x-ray film
(B) CT scan of chest
(C) MRI
(D) Ventilation-perfusion (V/Q) scan
(E) Angiogram
A 42-year-old man presents with a chief complaint of severe, sharp chest pain that started suddenly while lifting heavy objects. The pain began in a midsternal location, then radiated to both shoulders as well as to his back. It has been constant for 18 hours but started to get worse during the past 2 hours. On physical examination, the patient is in severe distress, with a temperature of 36.9 C (98.5 F), blood pressure of 160/90 mm Hg, pulse of 92/ min, and respirations of 18/min. Heart sounds are normal without rubs or murmur. An ECG reveals a normal tracing. Which of the following is the most appropriate next step in diagnosis?
(A) Chest x-ray film
(B) CT scan of chest
(C) MRI
(D) Ventilation-perfusion (V/Q) scan
(E) Angiogram
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