Question

Meera is a 24 year old woman who has been studying at a local university. She recently returned from a 14 hour flight to Delhi, where she had been visiting family. She came to your emergency room worried that she is having a heart attack; she describes 2 hours of a sharp pain in her chest and back, which is worse when she takes a deep breath. She states she is having a hard time breathing.

Her vital signs are as follows: Blood pressure is normal at 120/72, pulse elevated at 112, normal body temperature of 98.1℉, and an increased respiratory rate of 40. Meera’s past medical history is unremarkable. She has never been pregnant, and is currently taking an oral contraceptive to prevent pregnancy. In addition to her oral contraceptive, she takes a multivitamin daily and sometimes uses ibuprofen for menstrual cramps. She occasionally drinks alcohol, is a ½ pack per day smoker, and denies any illicit drug use.

You believe she has a pulmonary embolism and begin her workup.

• What risk factors in Meera’s history suggest pulmonary embolism? Name at least two.
• What clinical manifestations does she have that suggest pulmonary embolism? Name at least two manifestations.
• Based on Meera’s clinical manifestations, what other diagnoses should you be considering? Briefly explain which clinical manifestations you have chosen for each other diagnosis to be considered. Include at least two.
• What tests do you suspect will be ordered to confirm Meera’s diagnosis, and what value do they add to confirming or excluding pulmonary embolism as her diagnosis? Include at least three tests.

Answer 1