1. A female patient 42 year old presented to the ER with dyspnea and frothy expectorations with a history of persistent headache of one day duration, not relieved by analgesics On examination the pulse was 120 bpm , afebrile, the blood pressure was 210 /140, bilateral mid-zonal inspiratory crepitations and audible abdominal bruit , hypoxic, hypocapnic and rapidly was kept on non invasive mechanical ventilation All laboratory investigations were within normal ranges Abdominal ultrasound revealed unequal kidney size and echocardiography showed mild concentric left ventricular hypertrophy in addition to normal contractility and other dimensions 1. What is most likely diagnosis? 2. What other investigations to be done? 3. Discuss other lines of management?
2. A 53 -year- old female presented with severe epigastric pain, vomiting, mild abdominal distension together with dark colored stools few hours ago. She is non smoker , was known to have atrial fibrillation, non compliant to anticoagulant therapy which was given for the last 4 years. On examination ,she had rapid irregular pulse 130 bpm , BP 120/60, low grade fever , normal blood glucose , mild abdominal distension and decrease intestinal sounds. Chest and neurological examinations were free On laboratory investigations normal hemoglobin and coagulation profile, mild leukocytosis, increase serum amylase. There was metabolic acidosis and high lactate level. Abdominal ultrasound showed jejunal distension. ECG showed atrial fibriilation with rapid ventricular response
1. What is most likely diagnosis? 2. What other investigations to be done? 3. Discuss lines of management?
