Vignettes

Question 1

64 year old man presents with 5 hours of SS chest pressure associated with SOB, nausea and diaphoresis. Gradual onset while shoveling the snow. Improved with rest.
PMH: HTN, DM
Gen: Nontoxic appearing, apprehensive, mildly diaphoretic
Vitals: 37.5ºC, RR16, HR 100, BP 160/95
CVS: RRR, Normal S1, S2, no M/R/G
Resp: CTAB, easy respirations
Abd: Soft, NTND
Ext: No calf tenderness or swelling, no edema, strong distal pulses

Answer 1

ST-elevation MI

Question 2

51 year old woman brought in by EMS with acute onset of right sided weakness and aphasia.
PMH: HTN
Gen: Somnolent, diaphoretic
Vitals: 37.5ºC, RR16, HR 110, BP 180/110
CVS: Tachy, Normal S1, S2, no M/R/G
Resp: CTAB, easy respirations
Abd: Soft, NTND
Ext: No calf tenderness or swelling, no edema, weak distal pulses
Neuro: Right leg/arm 4/5 strength, +expressive aphasia

Answer 2

Aortic Dissection

Question 3

40 year old woman brought in by EMS with acute onset pleuritic right sided chest sharpness associated with SOB.
PMH: HTN
Gen: Well appearing, mildly uncomfortable
Vitals: 38ºC, RR 22, HR 120, BP 150/85
CVS: RRR, Normal S1, S2, no M/R/G
Resp: CTAB, easy respirations
Abd: Soft, NTND
Ext: No calf tenderness but mild left-sided swelling, no edema, strong distal pulses

Answer 3

Pulmonary Embolism

Question 4

40 year old man presents with acute onset of SOB and pleuritic right sided chest sharpness.
PMH: none
Gen: Mildly uncomfortable
Vitals: 37ºC, RR 22, HR 120, BP 145/95
CVS: Tacky, Normal S1, S2, no M/R/G
Resp: Decreased bs on the right, tachypeic
Abd: Soft, NTND
Ext: No calf tenderness or swelling, no edema, strong distal pulses

Answer 4

Pneumothorax