A 55-year-old woman with a long-standing history of atrial fibrillation secondary to mitral regurgitation presents to the emergency department with a painful right foot. The patient reports that, over the past few hours, her foot has become more painful and now is nearly insensate. She describes the pain as burning and states that it is not relieved by any intervention. She takes coumadin, atenolol, digoxin, and aspirin. On physical examination, her pulse is irregularly irregular. Her lungs are clear, and she has a loud holosystolic murmur heard best at the apex. Her right foot is gray and cool to the touch and has poor capillary refill. Dorsalis pedis and posterior tibial pulses are absent on the right. Her prothrombin time is 14.4 seconds (INR 1.4). Which of the following is the most appropriate course of action?
- A. Arrange for her to be seen by a vascular surgeon in the emergency department now
- B. Arrange for her to be seen by a neurologist within the next few days
- C. Arrange for her to undergo an MRI of the head that day
- D. Ask her to make an appointment to be in seen in your office within 1 week
- E. Instruct her to soak her leg in warm water and to place a fitted stocking on her affected leg
A case of suspecting acute coronary syndrome with BP 160/90. What will you give?
- A. Clopidogrel
- B. Enoxaparin
- C. Aspirin
- D. Oxygen via nasal cannula
- E. Metoprolol
An old smoker man with H/O cough with sputum. Fatigue, lethargy, no fever. Green coloured sputum. Axillary lymph nodes enlarged. Labs were given. All cell lines depressed. •Lymphocytosis
•Blast cells increased markedly.
Bilateral crackles in lungs.
What is your probably diagnosis ?
Shahriar’s amc guideline
- A. Chronic Lymphocytic leukemia
- B. CML
- C. Acute leukemia
- D. Infection related depressed marrow
- E. Something regarding CA Lung