Answer: Diffuse T-wave inversion with ST-segment elevation.
Many of you probably went for the "no rub" answer. However, remember that a rub is actually not that common. So if we read the question as, "Which of the following findings can occur in acute pericarditis?" then the finding of "no rub" is certainly a possibility. Now, if the rub is there, it is diagnostic; if not, then it really doesn't help you rule out the diagnosis. With a pericarditis, you would expect to see frequent atrial premature beats. Also, PR-segment depression, especially in Lead II, would help you here. CPKs frequently will rise with pericarditis and in fact can be 2-3 times normal; but they are transiently elevated. The finding of diffuse T-wave inversion with ST-segment elevation more likely means the poor guy had an MI, not pericarditis. These ECG findings would least support the diagnosis of acute pericarditis.
A 30-year-old woman presents with complaints of bleeding gums and easy bruisability for the past 7 months. She notes that her menses have been heavier than usual during the past few months.
Which of the following is appropriate in the initial workup?
A. To be cost effective, start with a coagulation factor deficiency workup.
B. CBC with platelet count, PT, PTT, and bleeding time.
C. CBC with platelet count, PT, PTT, bleeding time, and Factors VIII and IX level.
D. CBC with platelet count, PT, PTT, antiplatelet antibody, and Factor VIII level.
Answer: CBC with platelet count, PT, PTT, and bleeding time.
Note that coagulation factor deficiencies are more likely to present with complications such as hemarthrosis.
Platelet disorders usually present with mucosal bleeding and a history of bleeding with light trauma.
Knowing what the PTT, PT, and platelet counts are will help guide the direction in which you need to proceed.
If the PT alone is elevated, then you know you are dealing with a deficiency/inhibitor of Factor VII, vitamin K deficiency, or liver disease.
If the PTT alone is elevated, then you could be dealing with deficiency/inhibitors of Factors VIII, IX, or XI, or inhibitor of XII (deficiency of Factor XII does not cause a bleeding diathesis), von Willebrand disease, or lupus anticoagulant.
Abnormal bleeding time would indicate von Willebrand disease or a platelet abnormality.