Pulmonary Hypertension Case 3
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Question 1 of 3
1. Question
A 42-year-old man is brought to the emergency department by ambulance after being found unresponsive in bed 1 hour ago. He had last been seen well the previous night by his daughter just before he went to bed. His daughter says he had just returned from a 3 week holiday in France 2 days previously. While on holiday he had some low back pain and was prescribed 'a painkiller'. He is known to have primary pulmonary hypertension and chronic low back pain. His medications include: warfarin and bosentan (an endothelin receptor antagonist used for primary PH).
On examination he withdraws to painful stimuli, opens his eyes to painful stimuli and has no verbal response (GCS = 7/15); Temperature is 37.1oC; Pulse is 92 per minute; BP is 160/90; RR is 16 per minute and SaO2 is 96% on air. He has a left hemiparesis. Heart sounds are normal and his chest is clear.
His ECG is normal.
What is the most likely diagnosis?
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Question 2 of 3
2. Question
Chose the most urgent initial laboratory investigations from the following list.
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Question 3 of 3
3. Question
The patient's INR comes back as 8.8. After endotracheal intubation and intermittent positive pressure ventilation, he is taken for a CT brain which shows a right intracerebral haemorrhage. Which of the following statements represents the most likely cause of the intracerebral haemorrhage?
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