QuestionSBA
QuestionChoice
This is unlikely to prove helpful in cases of pulmonary embolism whereby the priority is treating the clot.
10028468
c
Chest physiotherapy
QuestionChoice
This is not appropriate given her history and symptoms.
10028470
e
Discharge with reassurance
QuestionChoice
This is the treatment of choice in cases of tension pneumothorax, which the examination and chest x ray do not support.
10028467
b
Emergency needle decompression
QuestionChoice
This is correct. This woman likely has a pulmonary embolism with pro-thrombotic risk factors of SLE, pregnancy and immobilisation. Her chest x-ray is normal which is common in pulmonary embolism. She requires a CTPA or V/Q scan, but should be anticoagulated until this can be done.
10028466
a
Start on treatment dose low molecular weight heparin
QuestionChoice
There is nothing to suggest an infective pathology at present with the chest x-ray appearing normal.
10028469
d
Start on co-amoxiclav and clarithromyxin
QuestionComment
Didn't impact my answer but please, just say she's pregnant. Recent history of hyperemesis doesn't imply she's pregnant now. Unnecessarily confusing 
43570
QuestionComment
the 'gravidarum' means during pregnancy, if it said hyperemesis alone that would be different
44016
User
subscriber
Monoclonal Yeast
User
subscriber
Ale
QuestionComment
anyone else think the trachea is devsiated?
56888
QuestionComment
it's central, maybe you are looking at the right bronchus but this is normal
59230
User
subscriber
Acute Kinin
User
subscriber
Malignant Syndrome
QuestionComment
why did they do a CXR if shes pregnant? the distractors really got me...
62213
User
subscriber
Maya
Concept
Chapter
2693
6068
Pulmonary embolism
Topic
316
Imaging
18091
Patients with systemic lupus erythematosus are at increased risk of pulmonary embolism, especially during pregnancy and periods of immobilisation.
Picture
https://commons.wikimedia.org/wiki/File:Chest_Xray_PA_3-8-2010.png
2327
normal cxr.png
images/xg7k08mo1701431616622.jpg
images/xg7k08mo1701431616622_256.jpg
images/xg7k08mo1701431616622_512.jpg
HAgKBoB36EhweYiJc0RXeGh1AAAAAAA=
Topic
316
Imaging
A 26 year old woman presents to the emergency department short of breath since yesterday. She is tachycardic on examination. She has systemic lupus erythematosus and has recently been struggling with hyperemesis gravidarum, causing her to take time off work in the last week.

Her chest x-ray is shown below. Further imaging investigations are not available until tomorrow.

[lightgallery]

What is the most appropriate management?
a