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Questions and Answers

What should you do if no pulse is present?

Immediately start chest compressions.

What is the recommended treatment for a 65 y/o with atrial fibrillation on warfarin and acute intracerebral hemorrhage after a fall?

  • Administer aspirin
  • Perform surgery
  • Start 4-factor Prothrombin Complex Concentrate (KCentra) + Vitamin K 10mg IV (correct)
  • Monitor and wait

    • What condition should the 31-year-old male with blood positive in dipstick but no blood seen under microscope be admitted for?

    Rhabdomyolysis

    Wound irrigation with tap water has higher rates of wound infection than sterile saline.

    <p>False</p> Signup and view all the answers

    In which scenario should child abuse be suspected?

    <p>12-month-old with a fracture after a fall</p> Signup and view all the answers

    What is the diagnosis for a 12-month-old with fever, cough, pulling on left ear, but does not allow pneumatic otoscopy?

    <p>URI, acute otitis media uncertain</p> Signup and view all the answers

    What is the best treatment option for a 22-month-old male with acute distress from right ear pain and fever of 103.6°F?

    <p>Start antibiotics immediately</p> Signup and view all the answers

    What is the most appropriate treatment for a 22-month-old male patient diagnosed with AOM and severe symptoms?

    <p>Amoxicillin 1800 mg/day</p> Signup and view all the answers

    What should be recommended for a child who is asymptomatic after AOM treatment but has a middle ear effusion?

    <p>Reassurance and reevaluate in 2 months</p> Signup and view all the answers

    What would be the next step for a patient with five days of nasal congestion and purulent rhinorrhea?

    <p>Treat with decongestants/mucolytics</p> Signup and view all the answers

    What is the most likely diagnosis for a 57-year-old with brief episodes of dizziness lasting a few seconds and no hearing symptoms?

    <p>Benign paroxysmal positional vertigo</p> Signup and view all the answers

    Which of the following bites has the highest risk of infection?

    <p>Cat bite to the hand</p> Signup and view all the answers

    What is the treatment for a 24-year-old male with a 3-day rash that is getting bigger with central clearing?

    <p>Doxycycline 100mg BID for 10 days</p> Signup and view all the answers

    What is the first medication an allergic reaction patient with a rash and facial swelling should receive?

    <p>Epinephrine</p> Signup and view all the answers

    What would be the best course of action for a 21-year-old college student who swallowed a large amount of Tylenol and drank alcohol?

    <p>Administer activated charcoal</p> Signup and view all the answers

    What initial diagnostic study would you choose for a 38-year-old female with bilateral pitting ankle edema?

    <p>D-dimer</p> Signup and view all the answers

    What initial diagnostic study should be chosen for a 63-year-old male with shortness of breath and pleuritic chest pain after returning from Japan?

    <p>CT angiography</p> Signup and view all the answers

    Bupropion is contraindicated in a patient with an eating disorder.

    <p>True</p> Signup and view all the answers

    The number 1 cause of preventable morbidity and mortality in the US today is:

    <p>Tobacco</p> Signup and view all the answers

    The USPSTF recommends screening and counseling adults about the risks of alcohol misuse.

    <p>True</p> Signup and view all the answers

    Which immunization would be considered safe to administer during pregnancy?

    <p>Tdap</p> Signup and view all the answers

    Self-help measures recommended for patients with NYHA class 2 HF on optimal medications include:

    <p>Avoiding NSAID use</p> Signup and view all the answers

    How much daily vitamin D supplementation do infants need during the first month of life?

    <p>400 IU</p> Signup and view all the answers

    Following a scheduled repeat C-section delivery, what is the most common cause of a term infant having a respiratory rate greater than 60?

    <p>Transient tachypnea of the newborn</p> Signup and view all the answers

    Breastfeeding jaundice is characterized by:

    <p>insufficient feeds</p> Signup and view all the answers

    What advice would you give parents to reduce the risk of death from sudden infant death syndrome (SIDS) in their infant?

    <p>Avoid exposure of the infant to second-hand smoke</p> Signup and view all the answers

    The majority of failure to thrive cases in infants is due to:

    <p>inadequate caloric intake</p> Signup and view all the answers

    Medicare will pay once a medical need for services is clearly documented.

    <p>False</p> Signup and view all the answers

    The largest portion of the Medicare budget is spent on:

    <p>the 20% of Medicare recipients with five or more chronic diseases</p> Signup and view all the answers

    What is the next step for a patient on medications including risperidone, metoclopramide, and valproate presenting with Parkinson's symptoms?

    <p>stop his risperidone, metoclopramide, and valproate</p> Signup and view all the answers

    What is a good choice to decrease long-term effects of dyskinesia in a patient with Parkinson's?

    <p>Dopamine agonist, such as ropinirole</p> Signup and view all the answers

    What should you do for an elderly patient who develops C.Diff?

    <p>begin PO vancomycin 125mg QID</p> Signup and view all the answers

    What causes peripheral vision loss?

    <p>glaucoma</p> Signup and view all the answers

    What type of hearing loss is presbycusis typically associated with?

    <p>hearing threshold at higher frequencies</p> Signup and view all the answers

    What condition associated with early morning shoulder and hip discomfort and ESR of 52 should an elderly woman be at risk for developing?

    <p>giant cell arteritis (polymyalgia rheumatica)</p> Signup and view all the answers

    What step should be taken for a 72-year-old obese Black woman with sudden onset mid-back pain and T4 vertebral compression fracture?

    <p>work up for secondary causes of osteoporosis</p> Signup and view all the answers

    Which of the following has been shown to have analgesic benefit in acute osteoporotic fractures?

    <p>calcitonin</p> Signup and view all the answers

    Who is typically next in line for decision making for a demented 70-year-old woman lacking capacity?

    <p>her sister</p> Signup and view all the answers

    What is the most appropriate step to take when a patient with dementia says no to a pacemaker but the DPOA says yes?

    <p>not proceed with the procedure (has capacity)</p> Signup and view all the answers

    What is the most common cause of lack of sexual activity in older heterosexual couples?

    <p>male's medical condition</p> Signup and view all the answers

    When should you prescribe antimicrobials for a 82-year-old woman with a urine culture that grew >100,000 e.coli?

    <p>if she has frequency, urgency, dysuria, or suprapubic pain</p> Signup and view all the answers

    Of the following recommendations, which has not been shown to be helpful for recovery of acute low back strain?

    <p>Corticosteroids</p> Signup and view all the answers

    Regarding the USPSTF's recommendation on daily supplementation of vitamin D and calcium for postmenopausal women to prevent fracture, which is true?

    <p>Supplementation of vitamin D3 and calcium is not recommended for primary prevention only.</p> Signup and view all the answers

    For a patient with Type 2 DM and acute low back pain, what recommendation is best supported by clinical evidence?

    <p>consider surgical intervention due to motor deficit</p> Signup and view all the answers

    Rehabilitation with eccentric contractions is recommended to resolve overuse tendinopathies such as lateral epicondylosis or patellar tendonosis.

    <p>True</p> Signup and view all the answers

    What is the most appropriate treatment for a new overweight runner with knee pain that started late in the run?

    <p>reduction in running distance and physical therapy</p> Signup and view all the answers

    Which of the following is the most sensitive finding in patients with carpal tunnel syndrome?

    <p>Flick sign</p> Signup and view all the answers

    What conclusion can you draw from a patient suffering medial left heel pain that worsens with weight bearing?

    <p>she has tarsal tunnel syndrome and you provide an orthotic</p> Signup and view all the answers

    What do you do after noticing developmental examination findings in a 6-month-old boy?

    <p>refer to specialist for further evaluation</p> Signup and view all the answers

    What should you address during a routine care visit for a 9-month-old girl?

    <p>stating table food</p> Signup and view all the answers

    What should parents be advised regarding occasional bedwetting in a 5-year-old boy?

    <p>this occurs in 20-25% of boys this age</p> Signup and view all the answers

    What is the most appropriate automobile seating for a 7-year-old who is 50 inches tall?

    <p>rear seat in belt-positioning booster seat with lap/shoulder belt</p> Signup and view all the answers

    Which Tanner stage is a young girl in who has small but developed breasts and a small amount of dark, straight pubic hair?

    <p>III</p> Signup and view all the answers

    Bulimia nervosa is more prevalent than anorexia nervosa in adolescent females.

    <p>True</p> Signup and view all the answers

    What is the appropriate next step for an 79-year-old woman with mild dementia and distress after surgery?

    <p>review her outpatient medications</p> Signup and view all the answers

    What diagnosis would you give to a 76-year-old female with failing memory and word-finding issues?

    <p>dementia</p> Signup and view all the answers

    What is the most common type of dementia?

    <p>Alzheimer's</p> Signup and view all the answers

    What is the greatest risk factor for developing dementia?

    <p>aging</p> Signup and view all the answers

    What is the diagnosis for a 76-year-old man with memory issues but still capable of daily activities?

    <p>mild neurocognitive disorder</p> Signup and view all the answers

    What type of dementia is most likely for an 80-year-old man with unsteady gait and other symptoms?

    <p>vascular</p> Signup and view all the answers

    Which of the following has been proven to be protective against dementia?

    <p>educational attainment</p> Signup and view all the answers

    What can you do to assist an 81-year-old woman with advanced dementia displaying certain behaviors?

    <p>offer to help the staff find ways to manage the behaviors non-pharmacologically</p> Signup and view all the answers

    What should you do for a 14-day-old infant with a fever of 100.8ºF?

    <p>admit and do inpatient sepsis workup</p> Signup and view all the answers

    What is the next step for a lethargic 3-year-old girl with fever but no other symptoms?

    <p>order urinalysis with cultures</p> Signup and view all the answers

    What is the next step for a 16-year-old female with a sore throat and nonproductive cough?

    <p>supportive care</p> Signup and view all the answers

    What treatment should be administered for a 2-year-old child with barking cough and stridor?

    <p>nebulized epinephrine and dexamethasone</p> Signup and view all the answers

    What is the indicated treatment for a 9-month-old child with cough and wheezing?

    <p>supplemental O2 and fluids</p> Signup and view all the answers

    When can a 2-year-old child with a fine rash and red cheeks return to daycare?

    <p>today</p> Signup and view all the answers

    In addition to rehydration, what are the next treatment steps for a 5-year-old male with high fevers and a red, cracked tongue?

    <p>inpatient immune globulin and high-dose aspirin</p> Signup and view all the answers

    What is the best treatment option for a 3-year-old male showing pain when elbow is moved?

    <p>hyperpronation of the forearm</p> Signup and view all the answers

    What is the most commonly injured nerve in an outstretched hand injury leading to a distal radial fracture?

    <p>median nerve</p> Signup and view all the answers

    What is the best treatment option for a scaphoid fracture after an outstretched hand injury?

    <p>thumb spica cast for 8 weeks</p> Signup and view all the answers

    What is the most appropriate management for a football player with finger injuries?

    <p>referral to hand surgeon</p> Signup and view all the answers

    What is the most appropriate treatment for a volleyball player with finger extension issues?

    <p>immobilization of the DIPJ in extension for 6-8 weeks</p> Signup and view all the answers

    A 74-year-old female with osteoporosis has an increased mortality rate compared to those without this condition.

    <p>True</p> Signup and view all the answers

    What is the likely diagnosis for a 72-year-old man with left hip pain after a fall?

    <p>left hip fracture</p> Signup and view all the answers

    Which of the following is NOT a factor in the Ottawa Ankle Rules?

    <p>Discrete bony tenderness at the anterior distal fibula</p> Signup and view all the answers

    What finding would you expect in a 17-year-old male athlete with suspicion for hypertrophic cardiomyopathy?

    <p>a crescendo-decrescendo systolic murmur at the left sternal border that increases with valsalva</p> Signup and view all the answers

    What characteristic distinguishes between heat exhaustion and heat stroke?

    <p>mental status changes</p> Signup and view all the answers

    Physical rest is recommended during the first 24-48 hours post-concussion.

    <p>True</p> Signup and view all the answers

    Which statement about sports-related injuries in high school athletes is true?

    <p>Football has the highest injury rate.</p> Signup and view all the answers

    Which physical exam test is the most sensitive maneuver for detecting a knee injury?

    <p>Thessaly test</p> Signup and view all the answers

    In high school sports, football has the highest rate of ACL injury.

    <p>True</p> Signup and view all the answers

    What is the recommended course of action for an inversion ankle injury?

    <p>recommendation for early range of motion for the ankle</p> Signup and view all the answers

    Which pharmacokinetic factor changes least with age?

    <p>Absorption</p> Signup and view all the answers

    What is the most likely cause for a bradycardic, confused, and despondent 80-year-old woman switched to propranolol?

    <p>lipophilia of propranolol</p> Signup and view all the answers

    What is the explanation for a less alert and deteriorating balance in an 84-year-old man on diazepam?

    <p>active drug metabolites</p> Signup and view all the answers

    Which pharmacokinetic factor changes the most with age?

    <p>Elimination</p> Signup and view all the answers

    What is the best explanation for increased bleeding risk in an 80-year-old on warfarin with an INR of 2.5?

    <p>pharmacodynamic differences</p> Signup and view all the answers

    Which long-term medicine most likely contributed to a 75-year-old female's osteoporosis?

    <p>pantoprazole</p> Signup and view all the answers

    What should a 92-year-old with T2DM counsel regarding his A1C?

    <p>he should discontinue his glimiperide</p> Signup and view all the answers

    Which medicine is best to stop to improve cognition and reduce falls?

    <p>amitriptyline 25mg PO qHS</p> Signup and view all the answers

    Duchenne's muscular dystrophy is more common in males.

    <p>True</p> Signup and view all the answers

    Non-ossifying fibromas resolve with skeletal maturity.

    <p>True</p> Signup and view all the answers

    What is the most likely diagnosis for a 6-year-old girl who is clumsy and falling more?

    <p>femoral anteversion</p> Signup and view all the answers

    What is the presumptive diagnosis for a 12-year-old boy with a limp and overweight status?

    <p>slipped capital femoral epiphysis</p> Signup and view all the answers

    Which tests are most useful in determining a treatment plan for a 7-year-old girl with sudden hip pain?

    <p>CBC, ESR, CRP</p> Signup and view all the answers

    What is the diagnosis for a 12-year-old male with right elbow pain aggravated by throwing?

    <p>this is an apophysitis</p> Signup and view all the answers

    Sever's disease is associated with bilateral posterior heel pain in children.

    <p>True</p> Signup and view all the answers

    Pediatric obesity is associated with a decreased risk of herniated lumbar disc.

    <p>False</p> Signup and view all the answers

    What should be done when a passenger suddenly becomes unresponsive on a plane?

    <p>Call for assistance and prepare to assist with CPR if needed.</p> Signup and view all the answers

    Study Notes

    Antidepressants and Smoking Cessation

    • Bupropion is contraindicated in patients with eating disorders.

    Tobacco Use

    • Leading cause of preventable morbidity and mortality in the US is tobacco usage.

    Alcohol Abuse Counseling

    • USPSTF recommends counseling and screening for alcohol misuse in adults.

    Immunizations During Pregnancy

    • Tdap vaccine is safe for administration in pregnant women.

    Heart Failure Self-Help

    • In NYHA class 2 heart failure, patients should avoid NSAID use while on optimal medications.

    Vitamin D Supplementation for Infants

    • Breastfed infants require 400 IU of Vitamin D/day during the first month of life.

    Newborn Respiratory Complications

    • Common cause of elevated respiratory rate in a term infant post-C-section is transient tachypnea of the newborn.

    Breastfeeding Jaundice

    • Characterized by insufficient feeds during breastfeeding.

    SIDS Prevention

    • To reduce SIDS risk, infants should be protected from second-hand smoke exposure.

    Failure to Thrive in Infants

    • Most cases are due to inadequate caloric intake.

    Medicare Coverage for Elderly

    • Medicare will only cover facility living costs with documented medical necessity.

    Medicare Budget Allocation

    • The majority of Medicare spending goes to the 20% of recipients with five or more chronic conditions.

    Parkinson's Symptoms Management

    • Address Parkinson's symptoms by discontinuing risperdone, metoclopramide, and valproate.

    Long-Term Parkinson's Therapy

    • To reduce dyskinesia risks in Parkinson's, consider a dopamine agonist like ropinirole.

    Treatment for C. difficile

    • Initiate treatment with oral vancomycin 125 mg QID for C. difficile infection.

    Peripheral Vision Loss

    • Glaucoma is a common cause of peripheral vision loss.

    Hearing Loss

    • Presbycusis is associated with increased hearing threshold at higher frequencies.

    Polymyalgia Rheumatica Complications

    • Patients are at risk for developing giant cell arteritis.

    Management of Osteoporosis

    • In the case of vertebral compression fracture, assess for secondary causes of osteoporosis.

    Analgesic Benefits of Calcitonin

    • Calcitonin has shown analgesic benefits in acute osteoporotic fractures.

    Decision-Making Capacity

    • In the absence of advance directives, a patient's sister is typically next in line for healthcare decision-making.

    Capacity and Medical Procedures

    • If a patient with dementia refuses a procedure but a DPOA agrees, do not proceed without the patient's consent.

    Sexual Activity in Older Couples

    • The most common reason for lack of sexual activity in older heterosexual couples is the medical condition of the male partner.

    Urinary Tract Infections in Elderly

    • Treat urinary tract infections in elderly women with signs of urgency, frequency or dysuria.

    Acute Low Back Strain Recovery

    • Corticosteroids have not been shown to aid recovery from acute low back strain.

    Vitamin D and Calcium in Postmenopausal Women

    • USPSTF does not recommend daily vitamin D3 and calcium supplementation for primary fracture prevention.

    Surgery for Motor Deficits

    • Evidence supports considering surgical intervention for patients with type 2 diabetes and motor deficits.

    Eccentric Contractions for Tendinopathy

    • Rehabilitation for overuse tendinopathies like lateral epicondylosis should include eccentric contractions.

    Running Injury Management

    • For non-acute patellar pain, reduce running distance and initiate physical therapy.

    Carpal Tunnel Syndrome

    • The flick sign is the most sensitive indicator in diagnosing carpal tunnel syndrome.

    Tarsal Tunnel Syndrome

    • Symptoms include burning medial heel pain and may benefit from orthotic support.

    Developmental Screening

    • Refer infants who do not follow developmental milestones for further evaluation.

    Early Infant Nutrition

    • Introduce table food at the 9-month well-child visit.

    Bedwetting in Children

    • Occurs in 20-25% of boys aged 5, and reassurance is key.

    Child Car Safety

    • A 7-year-old should be seated in a booster seat using a lap/shoulder belt.

    Tanner Stage Assessment

    • Tanner stage III indicates small but developed breasts and minimal pubic hair.

    Bulimia Nervosa Prevalence

    • More prevalent among adolescent females than anorexia nervosa.

    Elderly Patient Behavioral Changes

    • Review outpatient medications for sudden behavioral changes in elderly patients.

    Dementia Diagnosis

    • Clinical signs of memory failure and word-finding difficulty indicate dementia.

    Most Common Dementia Type

    • Alzheimer’s disease is the most prevalent type of dementia.

    Risk Factors for Dementia

    • Aging is the primary risk factor for developing dementia.

    Mild Neurocognitive Disorder

    • Patients may exhibit memory issues but retain ability to manage daily activities.

    Vascular Dementia Indicators

    • Symptoms may include impaired gait and diminished speech volume, often with a medical history of hypertension and diabetes.

    Protective Factors Against Dementia

    • Higher educational attainment is protective against dementia.

    Non-Pharmacological Management of Advanced Dementia

    • Non-pharmacological strategies should be explored for managing inappropriate behaviors.

    Sepsis Evaluation in Infants

    • Newborns with fever should undergo inpatient sepsis evaluations, regardless of the appearance of well-being.

    Lethargy in Young Children

    • In a lethargic child with fever, a urinalysis with cultures is essential for diagnosis.

    Supportive Care for Viral Symptoms

    • For sore throat and cough without complications, supportive care is often sufficient.

    Croup Treatment

    • Nebulized epinephrine and dexamethasone are key in treating croup.

    RSV Management in Children

    • Supplemental oxygen and fluids are indicated for managing RSV with mild peribronchial cuffing on CXR.

    Day Care Return Post-Infection

    • A child with a mild rash post-fever can return to daycare immediately.

    Kawasaki Disease Management

    • Treatment involves rehydration, inpatient immune globulin, and high-dose aspirin.

    Elbow Pain Treatment in Children

    • Use hyperpronation as an effective treatment for potential elbow injuries due to trauma.

    Median Nerve Injury from FOOSH

    • Distal radial fractures commonly injure the median nerve.

    Scaphoid Fracture Treatment

    • Best treatment for scaphoid fracture is a thumb spica cast for 8 weeks.

    Management of Mallet Finger

    • Referral to a hand surgeon is warranted for significant distal phalanx injuries.

    Injury Management for Head-Impacted Fingers

    • Immobilization of the distal interphalangeal joint in extension is critical after injury.

    Osteoporosis Consequences

    • Vertebral compression fractures significantly increase the risk of 15% mortality.

    Hip Fracture Diagnosis

    • Diagnosis is confirmed with a history of pain and ambulation difficulties after a fall.

    Ottawa Ankle Rules Exclusions

    • Discrete bony tenderness at the anterior distal fibula is not included in the Ottawa Ankle Rules.

    Hypertrophic Cardiomyopathy Indicators

    • Crescendo-decrescendo systolic murmur intensifying with Valsalva is a finding in suspected hypertrophic cardiomyopathy.

    Heat Illness Diagnosis

    • Mental status changes differentiate between heat exhaustion and heat stroke.

    Concussion Management

    • Physical rest is advised during the first 24-48 hours after a concussion.

    Sports Injury Statistics

    • Football has the highest overall injury rate among high school sports.

    Sensitive Knee Injury Test

    • The Thessaly test is the most sensitive for detecting meniscal tears.

    ACL Injuries in High School Sports

    • Football holds the highest rate of ACL injuries in high school athletes.

    Early Range of Motion for Ankle Sprains

    • Early range of motion exercises should be recommended post ankle injury.

    Aging and Pharmacokinetics

    • Absorption of drugs changes least with age.

    Lipophilia of Propranolol

    • Lipophilia explains worsened bradycardia and confusion when switched from atenolol to propranolol in the elderly.

    Active Drug Metabolites

    • Prolonged effects of medications in elderly patients are often due to active metabolites.

    Pharmacokinetics and Aging

    • Drug elimination is significantly altered with age.

    Increased Bleeding Risk with Warfarin

    • Aging alters pharmacodynamic responses, increasing bleeding risk on warfarin.

    Long-term Osteoporosis Medication Impact

    • Pantoprazole can contribute to osteoporosis in long-term use.

    Diabetes Management in Older Adults

    • Discontinuing glimiperide may be advisable in older adults with managed A1c.

    Cognitive Functions and Medication Impacts

    • Reducing amitriptyline can improve cognitive function and reduce fall risk in the elderly.

    Musculoskeletal Conditions in Children

    • Duchenne's muscular dystrophy is more commonly diagnosed in males.

    Pediatric Bone Tumor Characteristics

    • Non-ossifying fibromas typically resolve as the child matures.

    Femoral Anteversion Diagnosis

    • Inwardly pointed toes and patellae in a clumsy child suggests femoral anteversion.

    Slipped Capital Femoral Epiphysis

    • Common in overweight children presenting with hip pain; often requires radiographic investigation.

    Diagnosis for Abrupt Limps

    • Conduct CBC, ESR, and CRP to assess a child presenting with sudden hip pain and fever.

    Pitcher’s Elbow Pain

    • Tenderness over the medial epicondyle likely indicates an apophysitis due to overuse.

    Sever's Disease

    • Common in children experiencing heel pain related to activity, signifying stress at the calcaneal growth plate.

    Pediatric Obesity Associations

    • Pediatric obesity does not decrease the risk of herniated### Case Studies and Definitions

    • A patient with a temperature of 100.8°F, purulent rhinorrhea, and minimal tenderness over the frontal and maxillary sinuses should be treated with decongestants and mucolytics.

    • A 57-year-old with brief episodes of spinning sensation and dizziness due to quick movements likely has benign paroxysmal positional vertigo (BPPV), with no associated hearing symptoms.

    • Among bite wounds, a cat bite to the hand carries the highest risk of infection.

    • A 24-year-old male develops a rash over three days with central clearing, likely indicating Lyme disease after a visit to Martha's Vineyard; treatment is doxycycline 100 mg bid for 10 days.

    • In cases of allergic reactions presenting with rash, diffuse pruritus, erythema, and facial/oral swelling, the first-line medication is epinephrine.

    • A 21-year-old college student who ingested Tylenol and alcohol should be given activated charcoal as immediate treatment.

    • A 38-year-old female with a history of laparoscopic cholecystectomy presents with bilateral pitting ankle edema; the initial diagnostic study of choice is a D-dimer test to assess for possible thrombosis.

    • A 63-year-old male experiences shortness of breath (SOB) with exertion and pleuritic chest pain, presenting with low SpO2, tachycardia, and tachypnea after returning from Japan; the best initial diagnostic study is CT angiography to evaluate for a pulmonary embolism.

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