#april2020mccqe1
A 54-year-old man is evaluated in the emergency department for a 1-hour history of chest pain and dyspnea. The patient had been hospitalized 1 week ago for a colectomy for colon cancer. His medical history also includes hypertension and nephrotic syndrome secondary to membranous glomerulonephritis. His medications are furosemide, ramipril, and pravastatin. On physical examination, the temperature is 37.5°C (99.5°F), the blood pressure is 110/60 mm Hg, the pulse rate is 120/min, the respiration rate is 24/min, and the BMI is 30. Oxygen saturation is 89% with the patient breathing ambient air and 97% on oxygen, 4 L/min. Cardiac examination shows tachycardia and an S4. Breath sounds are normal. Serum creatinine concentration is 2.1 mg/dL (185.6 μmol/L). Chest radiograph is normal. Empiric unfractionated heparin therapy is begun.
Which of the following tests should be done next?
(A) Assay for plasma D-dimer
(B) CT pulmonary angiography
(C) Lower extremity ultrasonography
(D) Measurement of antithrombin III
(E) Ventilation/perfusion scan
A 54-year-old man is evaluated in the emergency department for a 1-hour history of chest pain and dyspnea. The patient had been hospitalized 1 week ago for a colectomy for colon cancer. His medical history also includes hypertension and nephrotic syndrome secondary to membranous glomerulonephritis. His medications are furosemide, ramipril, and pravastatin. On physical examination, the temperature is 37.5°C (99.5°F), the blood pressure is 110/60 mm Hg, the pulse rate is 120/min, the respiration rate is 24/min, and the BMI is 30. Oxygen saturation is 89% with the patient breathing ambient air and 97% on oxygen, 4 L/min. Cardiac examination shows tachycardia and an S4. Breath sounds are normal. Serum creatinine concentration is 2.1 mg/dL (185.6 μmol/L). Chest radiograph is normal. Empiric unfractionated heparin therapy is begun.
Which of the following tests should be done next?
(A) Assay for plasma D-dimer
(B) CT pulmonary angiography
(C) Lower extremity ultrasonography
(D) Measurement of antithrombin III
(E) Ventilation/perfusion scan
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