V/Q scan principlesDownloads

A 50-year-old man presents to the urgent care clinic for 3 hours of worsening cough, shortness of breath, and dyspnea. He works as a long-haul truck driver, and he informs you that he recently returned to the west coast from a trip to Arkansas. His medical history is significant for gout, hypertension, hypercholesterolemia, diabetes mellitus type 2, chronic obstructive pulmonary disease (COPD), and mild intellectual disability. He currently smokes 1 pack of cigarettes/day, drinks a 6-pack of beer/day, and he endorses a past history of injection drug use but currently denies any illicit drug use. The vital signs include: temperature 36.7°C (98.0°F), blood pressure 126/74 mm Hg, heart rate 87/min, and respiratory rate 23/min. His physical examination shows mild, bilateral, coarse rhonchi, but otherwise clear lungs on auscultation, grade 2/6 holosystolic murmur, and a benign abdominal physical examination. He states that he ran out of his albuterol inhaler 6 days ago and has been meaning to follow-up with his primary care physician (PCP) for a refill. Complete blood count (CBC) and complete metabolic panel are within normal limits. He also has a D-dimer result within normal limits. Which of the following is the most appropriate next step in evaluation?

A 60-year-old male is admitted to the ICU for severe hypertension complicated by a headache. The patient has a past medical history of insulin-controlled diabetes, hypertension, and hyperlipidemia. He smokes 2 packs of cigarettes per day. He states that he forgot to take his medications yesterday and started getting a headache about one hour ago. His vitals on admission are the following: blood pressure of 160/110 mmHg, pulse 95/min, temperature 98.6 deg F (37.2 deg C), and respirations 20/min. On exam, the patient has an audible abdominal bruit. After administration of antihypertensive medications, the patient has a blood pressure of 178/120 mmHg. The patient reports his headache has increased to a 10/10 pain level, that he has trouble seeing, and he can't move his extremities. After stabilizing the patient, what is the best next step to diagnose the patient's condition?