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MEDICAL CASE No. 4

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MEDICAL CASE No. 4




A man with acute shortness of breath - 10 Point

A 57-year-old man develops acute shortness of breath shortly after a 12-hour automobile ride. The patient consults his internist, and findings on physical examination are normal except for tachypnea and tachycardia.
An electrocardiogram reveals sinus tachycardia but is otherwise normal.


Which of the following is correct?

a. A definitive diagnosis can be made by history alone
b. The patient should be admitted to the hospital, and, if there is no contraindication to anticoagulation, intravenous heparin should be started pending further testing
c. Normal findings on examination of the lower extremities are extremely unusual in this clinical setting
d. Early treatment has little effect on overall mortality


The most important next step in the diagnosis of this patient is

a. Pulmonary angiogram
b. Ventilation-perfusion scan
c. D-dimer assay
d. Venous ultrasound

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