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 Case #11 Loraine and the ticking time bomb
A 66 yr old female presents after passing
out in her doctors bathroom. She went there
for a routine visit, but while in the
waiting room, became ill and went to the
rest room. The nurse heard a thump, and when
the door was opened, the patient was on the
floor.
EMS was called, and by the time she was
moved from the bathroom to an exam room, she
was conscious, lethargic, and had blood
pressure of 98/ palp, heart rate of 78, and
RR of 18. She said she felt much better and
didn't want to go to the hospital. Her
doctor convinced her to go, and she arrives
by ambulance.
She currently denies any symptoms, feels
much better, and laughs about the event
stating: "I'm just getting old!" She denies
any chest pain or shortness of breath, now
or preceeding the syncope. She has no
obvious head injury, and has no headache. It
is unknown how long she was unconscious.
Review of symptoms: No headache, change in
vision, neck pain, nausea, vomiting, chest
pain, shortness of breath, abdominal pain,
diarrhea, or urinary complaints. No fevers,
chills, cough, rash, weakness or numbness
anywhere. She continually reiterates: "I
feel fine!"
PMH: Hypertension (treated with lopressor).
No hx of MI, stroke, CHF
PE: Well kept, thin female, smiling and in
no acute distress BP 100/40, pulse = 75,
RR=16, Temp=98.6F.
Exam:
HEENT: WNL
Heart RRR No Murmers or gallup
Lungs; clear
Abd; Non-tender. She does have a palpable
aorta (she is thin), but it feels enlarged.
Ext: No edema or rashes. Good pulses
throughout.
Neurological: Normal motor, sensorary,
cranial nerves, reflex, mental status, and
cerebellar exam.
EKG (already done before your evaluation)
reveals flipped T waves in Inferior leads.
New compared to old EKG.
1. What portion of the exam is omitted here?
2. What is the first thing to consider? What
is the most important blood test to order?
3. Who should you call, and what test can
you do to make the diagnosis?
4. Can she have a stent, or will she need an
open procedure?
Click here for answers and to respond
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Previous Articles
Cardiovascular (01/02/08)
Renal (12/26/07)
Cardiovascular (12/19/07)
Pediatric (12/12/07)
Neurologic (12/05/07)
Trauma (11/27/07)
Trauma (11/20/07)
Neurologic (11/13/07)
Pediatric (11/12/07)
Cardiovascular (10/29/07)
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