A 57-year-old woman is brought into the emergency department because of the sudden onset of severe left-sided chest pain and shortness of breath. She had flown back to the United States yesterday following a tour of Southeast Asia. Other than feeling tired after her long trip, she was in her usual state of good health, but this afternoon she had the sudden onset of stabbing left chest pain and noted severe shortness of breath. She denies any previous history of peripheral vascular, cardiac, or respiratory disease. Past medical history is unremarkable, and she is not currently taking any medications. On examination, the patient is in severe discomfort. Temperature is 100.5°F (38°C) orally, pulse 130, respirations 26, and BP 130/90. Pulse oximetry reveals an O2 saturation of 88% while the patient is breathing room air. Physical examination is otherwise unremarkable. Stat labs show normal kidney function. A chest radiograph and ECG are obtained.  What is the most appropriate action at this time?

Female, 20 years old, presents with acute onset of severe right-sided chest pain and shortness of breath following a long flight. Which radiological examination should be performed first?Question 17Select one:a.CT Pulmonary Angiogramb.Chest X-rayc.Ventilation-perfusion (V/Q) scan

A 24-year-old woman comes to the office due to pressure-like, substernal chest pain that occurs when she exercises.  The patient began noticing the pain approximately 6 months ago when she started to exercise to lose weight.  Prior to that, her lifestyle was largely sedentary.  She has no associated nausea, vomiting, diaphoresis, dyspnea, palpitations, or syncope.  The patient has no significant past medical history but was told as a child that she has a "murmur."  She has no significant family history of heart disease.  Blood pressure is 130/70 mm Hg on the right and 105/55 mm Hg on the left, and pulse is 72/min and regular.  BMI is 29 kg/m2.  A palpable thrill is present in the suprasternal notch.  There is a loud midsystolic murmur best heard at the first right intercostal space.  The lungs are clear to auscultation.  What is the most likely cause of this patient's chest pain?

A 45-year-old man comes to the emergency department due to a 1-day history of constant upper abdominal pain, nausea, and several episodes of vomiting.  The pain is partially relieved by sitting up or bending forward.  He has also had mild shortness of breath.  The patient's other medical history includes hyperlipidemia and hypertension.  He uses tobacco and alcohol.  There is a family history of coronary artery disease and hypertension.  Temperature is 38.1 C (100.6 F), blood pressure is 110/70 mm Hg, pulse is 114/min, and respirations are 22/min.  There is dullness to percussion and decreased breath sounds at the left lung base.  Abdominal examination shows epigastric tenderness.  Laboratory results are as follows:Hematocrit 44%Leukocytes 16,000/mm3Calcium 7.8 mg/dLGlucose 250 mg/dLWhich of the following plays a principal role in initial management of this patient's current condition? A.Antiplatelet agents B.Broad-spectrum antibiotics C.Calcium gluconate D.Exploratory laparotomy E.Insulin infusion F.Isotonic crystalloids G.Proton pump inhibitors

A 48-year-old man presents to the hospital with swelling of the abdomen and legs. He first noticed shortness of breath with exertion several months ago, and has had a few episodes where he momentarily became lightheaded and lost consciousness. Now the symptoms have been progressing with increased dyspnea and edema. He reports that he has always lived a healthy lifestyle and has no past medical history. There is no family history of any cardiac or pulmonary disease, or any cancer. He was born in Brazil and moved to the United States at the age of 43. He does not smoke or drink alcohol. On cardiac examination, the apex is displaced laterally with an S3 on auscultation. Estimated central venous pressure is 15 mmHg, and there are faint crackles at the base of his lungs. He has hepatomegaly with shifting dullness and bilateral pitting edema of the lower extremities. An ECG is normal, with no visible Q waves. Which infectious etiology is most likely responsible for this patient's disease?

A 32-year-old man comes to the physician complaining of fever, shortness of breath, and a productive cough that has developed slowly over the past week. He has no other medical history and does not take any medications. His temperature is 38.5°C, blood pressure is 122/78 mmHg, heart rate is 68 beats per minute, respiratory rate is 18 breaths per minute, and oxygen saturation is 98% on room air. There are decreased breath sounds and dullness to percussion over the right lung base. The rest of the physical examination, including cardiac auscultation, is normal. A chest x-ray confirms consolidation of the right lower lobe. What is the most appropriate course of action for this patient?