12CC - Case of the Month

Clinical Case: Mature Female, Hemiparesis

Mature Female 1
Mature Female 2
Mature Female 3
Mature Female 4
Mature Female 5
Mature Female 6

History of Present Illness:

A 79-year-old female presented to the emergency department withaltered mental status and left-side hemiparesis 30 minutes prior toarrival. She had no history of hypertension.

Examination: Vital signs were pulse 55beats/min, blood pressure 155/87 mm Hg (left arm) and 100/77(rightarm), respirations 19 breaths/min, oxygen saturation 98% (ambientair), and temperature 36.4°C (97.5°F). Grade III diastolic murmurover right sternal border was heard by auscultation. Right radialpulse was weaker as compared with contralateral side. LeftBabinski's sign was present. D-dimer was 5791 ng/ml. A computertomography(CT) of brain revealed gyrus effacement in right middlecerebral artery territory (Figure1). A magnetic resonanceimage(MRI) of brain revealed multiple cerebral infarction(figure2).A transthoracic echocardiography showed massive pericardialeffusion. A contrast CT of chest (figure3) was arranged


1)     What is the pretest probability foran abnormal Chest CTA finding.

2)     If you were managing this patient,which study would you have ordered first. 

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