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 11/10/2009
A 30 year old male presents to the ED after injuring his left knee when playing basketball. He says that he went up for a rebound and came down on his knee. He heard a pop, felt severe pain and was not able to walk since. On exam you notice significant effusion of the knee, he is unable to flex his hip and hold his leg up in the air. Even with assistance he has difficulty raising his leg and his lower leg falls to the bed. There is also a step-off along the pattelar tendon. The knee is stable and he has no tenderness over the bone. Below is his xray. What is your diagnosis and management?
