23 yo female p/w one week h/o dyspnea with exertion and increasing lower extremity edema. Pt c/o intermittent episodes of atypical chest tightness and pressure that does not occur necessarily during rest or with exertion. Non-radiating. Does not occur with palpation, shortness of breath, nausea/vomtting or diaphoresis. Dyspnea not present at rest. Pt denies PND, fevers, cough or syncopal episodes. No recent long plane flights or car rides. Denies tobacco, alcohol or drugs. No recent changes in medication. Symptoms have been getting progressively worse over past one week. Pt now unable to climb stairs in apartment without resting mulitple times. Leg swelling is equal bilateral. No redness, warmth or pain. LMP one week ago. Her PE is significant for the following She is in NAD with normal vitals, well appearing, resting comfortably with mild b/l basilar crackles, no wheeze; has an audible murmer III/VI ASB and has b/l +1 pitting edema up to mid calf, no redness, warmth, negative homan’s sign. Below is her ECG. What is your diagnosis?
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Posted on 10/11/2009
A 56 year old female presents to the emergency department after a fall backwards on a stretched hand. The patient presents with tremendous pain in the right arm. She is unable to fully extend the elbow and has much discomfort when asked to actively flex the elbow. She cannot supinate or pronate. Upon palpation you notice a visible deformity and effusion of the elbow. The patient has a radial and ulnar pulse. The extremity is warm. The patient has normal sensation along the ulnar nerve distribution. Describe the patient's elbow x-ray.
