28.Which of the following patients has the lowestclinical probability for
the diagnosis of pulmonary embolism?
a. A 21-year-old woman 2 days after a cesarean delivery
b. A 55-year-old woman on estrogen replacement therapy who underwent a total
hip replacement procedure 3 days ago
c. A 39-year-old man who smokes cigarettes occasionally and underwent an uncom-
plicated appendectomy 2 months ago
d. A 62-year-old man with pancreatic cancer
e. A 45-year-old man with factor V Leiden deficiency
29.A 75-year-old man goes out to shovel snow from his driveway. After
5 minutes of shoveling, he feels short of breath, chest pain, and then
passes out. He awakens minutes later to his wife shaking him. In the ED,
he denies chest pain or dyspnea. His BP is 160/85 mm Hg, HR is 71 beats
per minute, and oxygen saturation is 97% on room air. On examination,
you hear a harsh systolic ejection murmur. An ECG reveals a sinus rhythm
with left ventricular hypertrophy. Which of the following is the most likely
diagnosis?
a. Asystolic cardiac arrest
b. Brugada syndrome
c. Subclavian steal syndrome
d. PE
e. Aortic stenosis
30.While playing a match of tennis, a 56-year-old man with a medical
history significant only for acid reflux disease starts to feel substernal chest
pain that radiates into his left arm and shortness of breath. His pain feels
better after drinking antacid, but since it is not completely resolved, his
partner calls 911. Upon arrival, EMS administers aspirin and sublingual
nitroglycerin. After 20 minutes, the man’s symptoms resolve. He is brought
to the ED for further evaluation where his ECG shows sinus rhythm with-
out any ischemic abnormalities. You order a chest radiograph and send his
blood work to the laboratory for analysis. Which of the following state-
ments regarding the diagnosis of acute MI is most accurate?
a. A normal ECG rules out the diagnosis of acute MI.
b. One set of negative cardiac enzymes is sufficient to exclude the diagnosis of MI
in this patient.
c. Troponin may not reach peak levels for at least 12 hours.
d. Relief of symptoms by antacids essentially rules out a cardiac cause of his chest
pain.
e. Epigastric discomfort and indigestion is a rare presentation of ACS.
16 Emergency Medicine