His physical exam is remarkable for fever, a generalized petechial rash and petechiae of the mucous membranes, dark red linear lesions of the nailbeds, tender subcutaneous nodules of the digital pads, and nontender maculae on the palms and soles. He denies chills, a history of travel, sick or confined contacts, exposure to animals, bites, stings, cigarette smoking, otalgia, sore throat, swollen glands, drug use, dysuria, preceding GI or GU infections, previous surgeries, or sexual contact in the past year. He has come to see you because he has experienced acute left upper and lower extremity weakness and painless hematuria since this morning. He has an associated cough, dyspnea, anorexia, arthralgias, abdominal pain, diarrhea, a widespread rash throughout his body, and back pain. There is no JVD noted however, 2+ pitting edema of the lower extremities to the level of the mid-calf is evident.Ī 42-year-old man with a past medical history of hypertension and hypertension presents with intermittent fever of 6 weeks duration. The exam reveals a diminished first heart sound, S3 gallop, laterally displaced PMI, bibasilar rales, dullness to percussion, and expiratory wheezing. She is afebrile but tachycardic, diaphoretic, and her extremities are cool. Upon physical examination, the patient is short of breath she requires numerous pauses during conversation. The patient denies cough, fever, chills, diaphoresis, anxiety, chest pain, pleurisy, cough, nausea, abdominal pain, vomiting, diarrhea, rashes, lightheadedness, and syncope. Her past medical history is significant for hypertension, hyperlipidemia, and myocardial infarction. Additionally she is experiencing orthopnea and nocturnal dyspnea. She has been finding it difficult to walk short distances due to shortness of breath. What is the most appropriate treatment of the pain, hypertension, and suspected pulmonary edema in this patient?Ī 70-year-old woman presents with a 3-day history of shortness of breath at rest. Bedside electrocardiogram demonstrates sinus tachycardia, ST-segment elevations, and occasional premature ventricular contractions. His lung exam is noteworthy for diffuse crackles.
His physical exam reveals tachycardia, hypertension, cyanosis, cool and moist skin, diaphoresis, an S3 gallop, and evidence of painful respiratory distress. He denies chills, abdominal pain, diarrhea, cough, and pleurisy. He notes that he has had a 1-week history of similar, recurrent chest pain of about 10 minutes duration that has been occurring following exposure to the cold weather and following consumption of a meal. Additionally, he admits to shortness of breath, nausea, productive cough with a frothy sputum, and profound diaphoresis. Which of the following is the most accurate diagnostic modality for diagnosing this patient's condition?Ī 68-year-old man with a past medical history of diabetes mellitus type II, hypothyroidism, and hypderlipidemia presents with a constant moderate to severe "squeezing, pressure, and tight" left-sided chest pain for 1 hour.
Chest radiograph: borderline cardiomegaly and a prominent aorta scattered patchy infiltrates bilaterally, small left pleural effusion. Extremities: right calf is 0.5 cm larger than left with some deep tenderness and a trace of ankle edema. Chest: dullness to percussion left base with scattered crackles and wheezes throughout. Systemic examination reveals: Heart: tachycardia, soft systolic murmur, questionable ventricular gallop. For the last week, he had experienced swelling and discomfort in his right calf.Įxamination shows: BP- 90/55 mm Hg, P- 122/min, RR -40/min, Temp- 37.6° C.
#Beats x which is right and left driver
He works as a truck driver and has a history of heavy cigarette smoking, hypertension, and obesity. His pain is substernal and left anterolateral, with some exacerbation on inspiration, and has been increasing in severity over the last 36 hours. A 56-year-old man enters your hospital urgent care center complaining of moderately severe chest pain.
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