Question

Name Date Patient's Chief Complaints: "I have really bad chest pain and I can't seem to catch my breath. I think that I may be having a heart attack." History of Present illness: Mrs.W.A. is a 30-year-old woman who presents to the hospital emergency department following 90 minutes of chest pain. She describes the severity of her pain as "8" on a scale from 1 to 10. An hour and half ago, she developed sharp and constant right-sided chest pain and right-sided mid-back pain. The pain became worse when she attempted to lie down or take a deep breath and she sat down. She also had had difficulty breathing. She denies any fever, chills, or coughing up blood. She reports that she just returned home 36 hours ago following a 13-hour flight from Tokyo, Japan. Past Medical History: * Migraines with aura since age 23 *Mild endometriosis for 5 years *Positive for Protein S deficiency • Episode of deep vein thrombosis 2 years ago; treated with warfarin for 1 year * Acute sinusitis 1 year ago Past Surgical History: *Orthopedic surgery for leg trauma at age 7 *Ovarian cyst removed 10 months ago Family History: *Father has HTN *Mother died from metastatic cervical cancer at age 49 * Brother is alive and well No family history of venous thromboembolic disease Social History: Patient lives with her husband and 8-year-old daughter

Answer 1

Ans1. Clinical manifestation suggesting pulmonary embolism in patient:

• A sharp ,stabbing chest pain that might worsen when breathing in.
• Difficulty in breathing, which may develop suddenly or over time.

Ans2. 5 major risk factors of patient with pulmonary thomboenbolism.

• Been immobile for long periods of time, eg travelling.
• Having certain inherited conditions, such as blood clotting disorders.
• Having surgery or have fractured a bone.
• Having cancer or a history of cancer.
• Smoking cigarettes.

An3. The clinical finding which provide strongest evidence for pulmonary embolism in patient is sharp, constant chest pain which worsens on deep breathing.

Ans4. The appropriate duration of warfarin treatment in this patient is for 3 months as it takes about 3months to complete active treatment of thombolisim with further treatment to prevent new episodes of thrombosis.

Thromboembolism associated with active cancer or unprovoked  thrombosis is usually treated indefinitely.