Question 7

7. Your patient is a 75 year old male that presents with sharp chest pain radiating through to his back.  His vitals signs are BP 85/53, HR 110, RR 12, Temp 96.5.  His Chem 7 is as follows Na 130, K 4.1, Cl-112, HCO3 22, BUN-36, Creatinine-2.5, Glucose 96.  Which of the following is the best management option?

A. Order a Stat CTA of Chest with IV contrast to look for a dissection
B  Order a Stat Bedside ECHO
C. Order a Transesophageal ECHO (TEE)
D. Call the cardiothoracic surgeon and take the patient to the operating room immediately.

Answer 6

6.  Choice A is the correct answer.  Aortic Stenosis presents with systolic murmur.  Presenting symptoms are usually dizziness and sometimes chest pain.  They also can present with CHF.  Mitral Stenosis and Aortic Regurgitation are both diastolic murmurs so are incorrect.  Carotid artery stenosis is not likely because the patient does not have any carotid bruits.

Question 6

 6.  Your patient is a 84 year old female that presents with a new onset of systolic murmur bets heard at the sternal border.  She has been having near syncope getting progressively worse.  She has no carotid bruits.  Which of the following is the most likely diagnosis?

A. Aortic Stenosis
B. Aortic Regurgitation
C. Carotid Artery Stenosis
D. Mitral Stenosis