An 18-year-old male comes to your primary care clinic complaining of pain near the breastbone for the last three days. It is a sharp pain that gets worse when he presses on the bone, moves sideways, and when he takes a deep breath, coughs, or sneezes. He can’t even laugh comfortably. The pain has no relationship with meals. His grandmother gave him a nitroglycerin tablet, but it did not relieve the pain. He also took some over-the-counter antacids without any relief. On further questioning, he reveals that he has been doing lots of exercises as part of his athletic training, including lifting heavy weights in the gym to develop a “six-pack” physique. Vital signs: Temperature: 98.8 °F Heart rate: 67 beats/min Blood pressure: 110/78 mm Hg Respirations: 15 breaths/min Oxygen saturation: 98% on room air Physical examination: Significant for tenderness over the sternum and right-sided ribs. ECG: Normal. Laboratory tests: Normal troponin levels. What is the next step in the management of this patient?
An 18-year-old male comes to your primary care clinic complaining of pain near the breastbone for the last three days. It is a sharp pain that gets worse when he presses on the bone, moves sideways, and when he takes a deep breath, coughs, or sneezes. He can’t even laugh comfortably. The pain has no relationship with meals. His grandmother gave him a nitroglycerin tablet, but it did not relieve the pain. He also took some over-the-counter antacids without any relief. On further questioning, he reveals that he has been doing lots of exercises as part of his athletic training, including lifting heavy weights in the gym to develop a “six-pack” physique. Vital signs: Temperature: 98.8 °F Heart rate: 67 beats/min Blood pressure: 110/78 mm Hg Respirations: 15 breaths/min Oxygen saturation: 98% on room air Physical examination: Significant for tenderness over the sternum and right-sided ribs. ECG: Normal. Laboratory tests: Normal troponin levels. What is the most likely diagnosis in this patient?
A 28-year-old woman presents to your pulmonary clinic with worsening shortness of breath. She has been taking sildenafil, iloprost, and diuretics, but they did not improve her condition. She would like to try a new medication that acts by blocking endothelin receptors in the pulmonary bed. After going through her options, she expresses interest in trying Bosentan. Which of the following is the most worrisome side effect of bosentan?
A 28-year-old woman presents to your pulmonary clinic with worsening shortness of breath. She has been taking sildenafil, iloprost, and diuretics, but they did not improve her condition. She would like to try a new medication that acts by blocking endothelin receptors in the pulmonary bed. After going through her options, she expresses interest in trying Bosentan. What is the mechanism of action of this medication?
A 28-year-old woman presents to your pulmonary clinic with worsening shortness of breath. She has been taking sildenafil, iloprost, and diuretics but they did not improve her condition. She would like to try a new medication that acts by blocking endothelin receptors in the pulmonary bed. As part of patient education, which of the following is the right information to give to this patient about endothelin receptor antagonists?
A 46-year-old woman presents to the clinic with a 6-month history of progressive shortness of breath, especially with exertion. She also reports occasional fatigue and lightheadedness during physical activity but denies chest pain or syncope. She is being evaluated for possible pulmonary hypertension.Of the following, which is the gold standard for the diagnosis of pulmonary hypertension?
A 43-year-old woman presents to the clinic with a 6-month history of progressive shortness of breath, especially with exertion. She also reports occasional fatigue and lightheadedness during physical activity but denies chest pain or syncope. She is being evaluated for possible pulmonary hypertension.Of the following, which is the most sensitive examination finding characteristic of pulmonary hypertension?
A 43-year-old woman presents to the clinic with a 6-month history of progressive shortness of breath, especially with exertion. She also reports occasional fatigue and lightheadedness during physical activity but denies chest pain or syncope. Physical examination reveals mild jugular venous distention, a loud pulmonary component of the second heart sound (P2), and peripheral edema. She is being evaluated for possible pulmonary hypertension. Of the following, which is the most common symptom of pulmonary hypertension?
A 38-year-old woman presents to the primary care clinic with progressive shortness of breath on exertion over the past several weeks. She reports episodes of chest pain, nonproductive cough, fatigue, and lightheadedness. She works as a teacher in a middle school. Physical examination reveals: Oxygen saturation: 92% on room air Loud P2 and right ventricular heave Jugular venous distention and lower extremity edema An ECG shows: Right axis deviation Tall R waves in the right precordial leads R-to-S wave ratio >1 in lead V1 Atrial fibrillation Right heart catheterization demonstrates a pulmonary artery pressure of 32 mm Hg. Which of the following is the most likely cause of this patient’s symptoms?
A 42-year-old woman presents for a follow-up visit after being initiated on bosentan for her pulmonary hypertension. During the interview, a medical student asks how bosentan works to improve pulmonary hypertension. Which of the following best explains the mechanism of action of bosentan?
