July/2006

ANSWER 14 =A

DISCUSSION:

These are key words in the presentation of this patient: 
a) 73-year-old woman; 
b) history of glaucoma
c) history of diabetes mellitus;
d) history of hypothyroidism;
e) complained of shortness of breath;
f) onset about 5 hours prior to entry implied suddenly;
g) Associated symptom is diaphoresis;
h) mild respiratory distress on exam;
h) respiratory rate at rest is 24 per minute; 
i) the pulse is 110 regular;
j) the blood pressure is 190/106;
k)rales in both bases and a systolic murmur at the apex in systole.
Pro BNP is elevated.  The history, physical examination and elevated pro-BNP all suggest congestive heart failure.