A 66-Year-Old Man Comes to the Emergency Department with Acute

question 950

Multiple Choice

A 66-year-old man comes to the emergency department with acute onset of severe chest pain and shortness of breath.  The pain is in the right upper chest and is aggravated by deep breathing and coughing.  Medical history is significant for hypertension and obstructive sleep apnea.  The patient quit smoking 10 years ago and drinks beer on weekends.  Blood pressure is 110/70 mm Hg, pulse is 116/min and regular, and respirations are 22/min.  BMI is 30 kg/m².  Normal vesicular breath sounds are heard on auscultation of the chest.  Cardiac auscultation reveals tachycardia and an accentuated S2.  Chest x-ray is unremarkable.  ECG shows sinus tachycardia.  CT angiogram of the chest reveals an embolus in the right pulmonary artery.  Which of the following is the most likely origin of this embolus?

• A)Calf vein
• B)Femoral vein
• C)Renal vein
• D)Right atrium
• E)Upper extremity vein

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