nbme bl1 q 22 - dream4mle - Printable Version +- USMLE Forum - Largest USMLE Community (https://www.usmleforum.com) +-- Forum: USMLE Forum (https://www.usmleforum.com/forumdisplay.php?fid=1) +--- Forum: Step 2 CK (https://www.usmleforum.com/forumdisplay.php?fid=3) +--- Thread: nbme bl1 q 22 - dream4mle (/showthread.php?tid=309080) |
nbme bl1 q 22 - dream4mle - ArchivalUser - 06-07-2008 22.) A 42-year-old man with alcoholism is brought to the emergency department by a friend because of fever and progressive shortness of breath for 12 hours. His friend reports that they were eating leftover chicken and drinking beer earlier in the day when the patient suddenly choked and vomited. Six hours later, he developed sweating, chills, and shortness of breath. He has not had any subsequent nausea, vomiting, hematemesis, or abdominal pain. He has smoked Two packs of cigarettes daily for 22 years and drinks 12 to 18 beers daily. He is in moderate respiratory distress. His temperature is 39.3 C (102.8 F), blood pressure is 90/60 mm Hg, pulse is 120/min, and respirations are 24/min. Examination shows no jugular venous distention. Breath sounds are decreased halfway up the left lung with increased dullness. Cardiac examination shows a normal S1 and S2; no murmurs are heard. There is no abdominal tenderness. Bowel sounds are hypoactive. X-ray films of the chest show a left pleural effusion and air in the mediastinum. Thoracentesis is performed. Laboratory studies show: Leukocyte count 18,000/mm3 Segmented neutrophils 85% Bands 10% Lymphocytes 5% Serum Protein 6 g/dL Lactate dehydrogenase 200 U/L Pleural fluid Leukocyte count 8000/mm3 Segmented neutrophils 98% Monocytes 2% Protein 4.2 g/dL Amylase 140 U/L Lactate dehydrogenase 180 U/L Gram's stain WBC present Organisms none Which of the following is the most likely diagnosis? A) Congestive heart failure B) Esophageal rupture C) Pancreatitis D) Pericarditis E) Tuberculosis 0 - ArchivalUser - 06-07-2008 why is the answwr c and not b??? 0 - ArchivalUser - 06-07-2008 B? 0 - ArchivalUser - 06-07-2008 DREAM4MLE WHO TOLD U ANSWER IS C.I MEAN RU SURE 0 - ArchivalUser - 06-07-2008 it is esophageal rupture pnemomediatium indicates esophageal rupture 0 - ArchivalUser - 06-07-2008 it might be CHF. it is a transudative efffusion 0 - ArchivalUser - 06-07-2008 even in esophageal rupture there is pleural effusion this fluid is rich in amylase |