Select a Community
Are you sure you want to trigger topic in your Anconeus AI algorithm?
You are done for today with this topic.
Would you like to start learning session with this topic items scheduled for future?
CT angiogram
6%
16/260
D-dimer
33%
86/260
Psychiatry consult for pseudocyesis
26%
67/260
Ultrasound
20%
53/260
Ventilation-perfusion scan
12%
32/260
Select Answer to see Preferred Response
This pregnant patient is presenting with pleuritic chest pain, tachycardia, and hypoxia suggesting a diagnosis of a pulmonary embolism (PE). Given the high suspicion for a PE, the best next step in management is a ventilation-perfusion (V/Q) scan. Pregnant women are more likely to develop venous thromboembolism (VTE) compared to non-pregnant women. The increased estrogen state and venous stasis can predispose them to DVTs. This subsequently also increases the risk of a PE. A PE presents with pleuritic chest pain, dyspnea, tachycardia, and hypoxia. In a pregnant patient for whom there is a high suspicion for a PE in the setting of a normal chest radiograph, the best next step in management is a V/Q scan. Treatment with heparin can subsequently follow. Incorrect Answers: Answer 1: CT angiogram is generally the diagnostic test of choice for a pulmonary embolism in a patient for whom there is a high pre-test probability of a PE. However, CT angiogram is avoided in pregnant patients if possible due to the higher radiation exposure to the maternal breasts and the difficulty with dosing and timing of the contrast load given the hemodynamic changes in pregnancy. Notably, CT angiogram does result in lower fetal radiation exposure. Answer 2: D-dimer is an appropriate test in a non-pregnant patient to rule out a PE if there is low clinical suspicion of a PE using Wells criteria. D-dimer has not been well validated in pregnant patients and its interpretation is unclear in pregnancy. Answer 3: Psychiatry consult for pseudocyesis is incorrect as it is false pregnancy by definition. Beta-hCG should not be positive. Answer 4: Ultrasound is the best diagnostic test for PE if the patient also has symptoms of a DVT. If it is positive, then no further workup is needed since the treatment will still involve heparin. However, this patient has no signs or symptoms of a DVT thus making this diagnostic test not indicated. Bullet Summary: V/Q scan is indicated for evaluation of venous thromboembolism in a pregnant woman.
4.3
(22)
Please Login to add comment