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+--- Thread: You should have an answer in 60 seconds. - paganini (/showthread.php?tid=150117)
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You should have an answer in 60 seconds. - paganini - ArchivalUser - 01-05-2007
A 40 year old healthy Caucasian man is brought to the emergency department because of sudden onset of shortness of breath and diaphoresis. He denies fever, chills, cough or abdominal pan. He has no other medical problems. He had surgery for bilateral inguinal hernia when he was 16. He does not use tobacco, alcohol or illicit drugs. He takes no medication and has no known drug allergies. His blood pressure is 110/60 mm Hg, pulse is 116/min and respirations are 28/min. He is in marked respiratory distress. Pallor and diaphoresis are noted. His skin is velvety and has multiple scars. On auscultation of the heart, an early, decrescendo, systolic murmur at the cardiac apex is heard; the murmur decreases with Valsalva maneuver, and increases with the grip maneuver, radiating to the axilla. The first sound is barely audible; the second heart sound is normal. A fourth sound is also present. There are bilateral crackles in both lungs. Jugular venous distention and hepatojugular reflux are present. The abdomen is soft, non-tender and non-distended. The neurologic examination reveals no abnormalities. The initial EKG shows sinus tachycardia with occasional premature ventricular complexes. The ches x-ray reveals no cardiomegaly, but bilateral alveolar infiltrates and hilar prominence are preset.
Which of the following is the most likely cause of his condition?
A. Acute myocardial infarction
B. Rupture of chordate tendineae
C. Pulmonary embolism
D. Infective endocarditis
E. Papillary muscle rupture
0 - ArchivalUser - 01-05-2007
B.....Tricuspid Regurgitation..it me 65 secs
0 - ArchivalUser - 01-05-2007
B. But Mitral regurgitation... Does he have marfan, ED or something (scars)? (mitral valve prolapse). Bbeautiful question... it really tests you. That's what I mean when I am proposing real time challenge, the ultimate forum using messenger... what do you think?
A
0 - ArchivalUser - 01-05-2007
well, I thought it thru (cheated with time) and figured out that if the guy has RHF. It can either be a
TR due to ruptured chordae or maybe a ruptured Papillary muscle causing CHF at such a sudden onset.
Isnt ruptured papillary more common than ruptured chordae? what do u say andy?
0 - ArchivalUser - 01-05-2007
I believe this shoud be related to a collagen problem. Could be ED or marfan sd. For papillary muscle rupture, there is no history of MI (chest pain). But I am not 100% sure.
A
0 - ArchivalUser - 01-05-2007
What's up paganini, where's your answer. I do not wanna go w/0 seeing your comments especially.
Thanx,
A
0 - ArchivalUser - 01-05-2007
I will give the answer latter, meanwhile things are getting complicated for you Dr.andyneurosurgery2008, here is more about this patient:
The patient is feeling better after receiving the appropriate therapy. A more detailed physical examination reveals the presence of scoliosis and pes planus. The cardiac enzymes were negative. Blood gas analysis reveals respiratory alkalosis. Complete blood cell count and serum chemistry results are unremarkable. The patient is scheduled for echocardiography. Which of the following is the most probable diagnosis?
A. Coronary artery disease
B. Rheumatic fever
C. Marfan syndrome
D. Ehlers-Danlos syndrome
E. Thyrotoxicosis
0 - ArchivalUser - 01-05-2007
Marfans Syndrome - C . Hey this looks like step 3 q's
0 - ArchivalUser - 01-05-2007
I answered to it before, but I would stick with ED. I do not kown what type?
Thanks,
A
0 - ArchivalUser - 01-05-2007
Andyneurosurgery2008 you got both Qs right.
Rupture of chordate tendinae should be suspected in healthy individuals who develop flash pulmonary edema(heart failure) associated with an acute mitral regurgitation. His pathologic murmur is characteristic of MR, which may lead to acute heart failure. Letters D and E are differential diagnoses, the patient does not have fever or risk factor for bacterial endocarditis and spontaneous papillary muscle rupture usually presents in elderly people who have acute chest pain or as a complication of MI, none of these are present here.
Pes planus and scoliosis are frequent, though not specific findings of ED. The skin can be velvety or thin, and is usually covered with multiple characteristic scars, due to its frailty and easy bruisability.