SAQ 1003 – Respiratory – sudden severe dyspnoea with shock

A 29-year-old woman is brought to ED by ambulance with sudden severe shortness of breath that began 1 hour earlier.

She is previously well, takes the oral contraceptive pill and has no allergies.

Observations are T 36.5 C, pulse 130, BP 80/60, oxygen saturation 82% on room air and RR 55. She is cyanosed and speaks only in short sentences.

List three differential diagnoses in order of probability.

(Marked out of 3.0)

/ 3

List four possible indications for thrombolysis in pulmonary embolism and identify the indication most clearly shown to reduce mortality.

(Marked out of 5.0)

/ 5

List three diagnostic tests for pulmonary embolism and describe a positive result for each.

(Marked out of 6.0)
</p> <table class="saq-prop-table" style="width: 100%; max-width: 100%; table-layout: fixed; border-collapse: collapse;"> <thead> <tr> <th style="overflow-wrap: anywhere; word-break: normal; white-space: normal; vertical-align: top; box-sizing: border-box;">Test</th> <th style="overflow-wrap: anywhere; word-break: normal; white-space: normal; vertical-align: top; box-sizing: border-box;">Positive result</th> </tr> </thead> <tbody> <tr> <td style="overflow-wrap: anywhere; word-break: normal; white-space: normal; vertical-align: top; box-sizing: border-box;">Bedside echo</td> <td style="overflow-wrap: anywhere; word-break: normal; white-space: normal; vertical-align: top; box-sizing: border-box;"></td> </tr> <tr> <td style="overflow-wrap: anywhere; word-break: normal; white-space: normal; vertical-align: top; box-sizing: border-box;">CTPA</td> <td style="overflow-wrap: anywhere; word-break: normal; white-space: normal; vertical-align: top; box-sizing: border-box;"></td> </tr> <tr> <td style="overflow-wrap: anywhere; word-break: normal; white-space: normal; vertical-align: top; box-sizing: border-box;">V/Q</td> <td style="overflow-wrap: anywhere; word-break: normal; white-space: normal; vertical-align: top; box-sizing: border-box;"></td> </tr> <tr> <td style="overflow-wrap: anywhere; word-break: normal; white-space: normal; vertical-align: top; box-sizing: border-box;">D-dimer</td> <td style="overflow-wrap: anywhere; word-break: normal; white-space: normal; vertical-align: top; box-sizing: border-box;"></td> </tr> <tr> <td style="overflow-wrap: anywhere; word-break: normal; white-space: normal; vertical-align: top; box-sizing: border-box;">Pulmonary angiogram</td> <td style="overflow-wrap: anywhere; word-break: normal; white-space: normal; vertical-align: top; box-sizing: border-box;"></td> </tr> <tr> <td style="overflow-wrap: anywhere; word-break: normal; white-space: normal; vertical-align: top; box-sizing: border-box;">MRI pulmonary angiogram</td> <td style="overflow-wrap: anywhere; word-break: normal; white-space: normal; vertical-align: top; box-sizing: border-box;"></td> </tr> <tr> <td style="overflow-wrap: anywhere; word-break: normal; white-space: normal; vertical-align: top; box-sizing: border-box;">ECG</td> <td style="overflow-wrap: anywhere; word-break: normal; white-space: normal; vertical-align: top; box-sizing: border-box;"></td> </tr> </tbody> </table> <p>

/ 6

Which test would you use to decide whether to thrombolyse in this case, and why?

(Marked out of 2.0)

/ 2

List two contraindications to thrombolysis for pulmonary embolism and indicate whether they are absolute or relative.

(Marked out of 2.0)

/ 2

Total Score: 0 / 18

Percentage: 0%