A 54 year old patient 7 days after a total hip replacement presents with acute onset
breathlessness and raised JVP. Which of the following investigation will be most helpful in
leading to a diagnosis?
- a. CXR
- b. CTPA
- c. V/Q scan
- d. D-Dimer
- e. Doppler US of legs
0 voters
Ans. The key is B. CTPA. [The patient has a +ve two level PE Wells score (if it was negative we should do
D-Dimer) and there is no renal impairment or history suggestive of allergy to contrast media (if these
were present we should have gone for VQ scan) the investigation of choice is PTCA. NICE guideline].
A 61 year old man has been referred to the OPD with frequent episodes of breathlessness and
chest pain along with palpitations. He has a regular pulse rate 60bpm. ECG sinus rhythm. What
is the most appropriate investigation to be done?
- a. Cardiac enzymes
- b. CXR
- c. ECG
- d. Echo
- e. 24h ECG
0 voters
Ans. The key is E. 24h ECG. [Episodic breathlessness, chest pain and palpitations are suggestive of
paroxysmal arrhythmia. As paroxysmal arrhythmia it will only be evident during attack and in between
attacks ECG will be normal (as in given case). So to confirm the diagnosis 24h ECG should be done].