clear this trouble - vanco

[ArchivalUser]

yes this is what Kaplan says...."spiral CT scan makes sense as the first diagnostic study" and also "most frequently performed initial test"

and also you should go for spiral CT scan when you have other pulmonary pathology which can interfere with V/Q scan...like COPD

of note: we had one of the best cardiac catheterization team and we used to directly go for "pulmonary angiogram"...so I always tempt to answer this when available in the options...but you are right, USMLE wants academic steps......

[ArchivalUser]

IF U SUSPECT PE :

*********************1ST : CHEST X-RAY**************************************

IF NO CHANGE : V/Q SCAN***********IF ANY CHANGE OR CP DISEASE : HELICAL CTSCAN

1)IF V/Q SCAN IS EQUIVOCAL*********1)HIGH CLINICAL SUSPICION BUT -VE :
BUT LOW CLINICAL SUSPICION********PUL.ANGIO
: VENOUS STUDIES***************** 2)LOW CLINICAL SUSPICION BUT +:
2)IF V/Q SCAN IS EQUIVOCAL********** TREAT FOR PE
BUT HIGH CLINICAL SUSPICION
: PUL.ANGIOGRAPHY
3)IF V/Q SCAN IS -VE
: NO PE
4)IF +VE
: TREAT FOR PE

[ArchivalUser]

thank you for the question and the explanation! It really helps, dr. vanco.