Cases from class Flashcards
A 54-year-old male with a history of DM presents to your clinic complaining of abdominal pain for one week. His pain is left lower quadrant, 7/10, constant, sharp, worse with movement, with associated fever to 101, dysuria, and the sensation of air coming out when he urinates. Labs and urine are obtained. The decision is made to pursue CT scan of the abdomen. What is the best test to order?
Labs: WBC 17k Hemoglobin 13 Hematocrit 37 Sodium 134 Potassium 3.9 Creatinine 1.7 GFR 40 Lactate 2.2
Abdominal CT without contrast Abdominal CT with IV and oral contrast Abdominal CT with IV contrast only Abdominal CT With oral contrast only Abdominal CT with rectal contrast
Abdominal CT with IV and oral contrast
Which has the greatest amount of ionizing radiation?
Chest x-ray Chest CTA V/Q scan MR Angiography An airplane flight across country
Chest CTA
A 55-year-old female with a history of a hysterectomy and appendectomy presents to the emergency department complaining of diffuse abdominal pain, nausea, and vomiting. She is not passing gas. Vitals are notable for tachycardia to 115. Physical examination reveals a distended, diffusely tender abdomen. Labs return with a Cr of 1.1 and GFR >60. She has no allergies. KUB is non-diagnostic. What is the best imaging modality to order?
A. CT scan with oral and IV contrast B. CT scan with IV contrast only B. CT without contrast C. CT scan with oral contrast only D. CTA of the abdomen
A. CT scan with oral and IV contrast
The patient informs you that she has an IV contrast allergy of rash but has tolerated oral contrast. How would you modify your CT order? (CT order = CT scan with oral and IV contrast)
A. IV contrast only with 12 hours of steroid pre-medication B. Oral contrast only with gastrografin C. Oral contrast only with barium D. Non-contrast E. Order MRI of abdomen
B. Oral contrast only with gastrografin
A 24-year-old female with a history of kidney stones present to urgent care complaining of left flank pain. The pain radiates into her left groin. She has associated nausea and vomiting.
Vitals: Temp 98.9 HR 105 BP 112/68 RR 14 Oxygen 99RA
Physical exam: Left CVAT. Benign abdomen.
What is the first test you would order?
UA
Your PA colleague who works in oncology calls you while you are in cardiology clinic for your advice. She has a patient with a history of breast cancer on her floor having shortness of breath. On examination, she has a temperature of 98.8, her heart rate is 114, her blood pressure is 88/56 and her respiratory rate is 18. She has muffled heart sounds. Portable chest x-ray is unremarkable. STAT d-dimer is negative. You recommend she orders a STAT transthoracic echo to assess for:
A. Infective endocarditis B. Pericardial effusion C. Cardiomyopathy D. Pulmonary embolism E. Cardiac tamponade
E. Cardiac tamponade
