CLINICAL MEDICINE

MEDICINE

CARDIOLOGY

Question [CLICK ON ANY CHOICE TO KNOW THE RIGHT ANSWER]
yo F, lacrosse player. 2 months of chest pain during activity. Episodes of pain last 3-5 minutes and have been associated with palpitations and pre-syncope. MURMUR:Soft 2/6 systolic ejection murmur at lower left sternal border. Normal EKG. Of the following, the MOST appropriate next step in evaluation of this teenager is to:
A
Order magnetic resonance imaging of the brain with contrast
B
Order serum C-reactive protein and white blood cell count with differential
C
Order tilt-table testing
D
Reassure her and her family that are no further testing is needed
E
Restrict her from exercise pending evaluation by a cardiologist
Explanation: 

Detailed explanation-1: -Cardiac syncope causes These conditions can include: Abnormal heart rhythm (arrhythmia). Obstructed blood flow in your heart because of your heart’s structure (hypertrophic cardiomyopathy). Blockage in your heart’s blood vessels (myocardial ischemia).

Detailed explanation-2: -See a doctor if chest pain keeps coming back, gets worse, or accompanies other symptoms. Pain that lasts for weeks or months is unlikely to be caused by a life-threatening emergency. The issue is more likely related to the muscles or skeletal structure.

Detailed explanation-3: -Angina. Angina is a condition where the blood supply to the muscles of the heart is restricted. Chest pain caused by angina is usually triggered by physical activity (exertion). It usually gets better with rest after a few minutes.

Detailed explanation-4: -Stable angina is the most common form of angina. It usually happens during activity (exertion) and goes away with rest or angina medication. For example, pain that comes on when you’re walking uphill or in the cold weather may be angina.

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