62 Year Old Man with: Dyspnea/Tachypnea/Fever - USMLE Forums
USMLE Forums Logo
USMLE Forums         Your Reliable USMLE Online Community     Members     Posts
Home
USMLE Articles
USMLE News
USMLE Polls
USMLE Books
USMLE Apps
Go Back   USMLE Forums > USMLE Step 1 Forum

USMLE Step 1 Forum USMLE Step 1 Discussion Forum: Let's talk about anything related to USMLE Step 1 exam


Reply
 
Thread Tools Search this Thread Display Modes
  #1  
Old 05-31-2011
USMLE Forums Master
 
Steps History: 1+CK+CS+3
Posts: 1,175
Threads: 38
Thanked 852 Times in 478 Posts
Reputation: 862
Lungs 62 Year Old Man with: Dyspnea/Tachypnea/Fever

62 year old man comes into the ER with symptoms of Dyspnea, Tachypnea. History reveals he suffers from COPD. Physical Examination reveals absent tactile fremetius, and expiratory wheezing. Vitals include: RR 25 / min, Temp 103, and HR 99. Blood gases reveals PaO2 72 mm Hg, PaCO2 30 mm Hg.

What lab investigations should be done to confirm the diagnosis:

A) D-Dimer Assay
B) Gram Stain of Sputum Sample
C) Chest X Ray
D) Cardiac Troponin Assay
E) LDH Assay

Reply With Quote Quick reply to this message
The above post was thanked by:
Amenah (06-05-2011), doc_study (06-06-2011), heman466s (06-01-2011), prataptetali (06-01-2011), prepink (06-30-2011), singapur_md (06-28-2011)



  #2  
Old 06-01-2011
USMLE Forums Guru
 
Steps History: Not yet
Posts: 404
Threads: 108
Thanked 71 Times in 48 Posts
Reputation: 80
Default

Quote:
Originally Posted by patelmd View Post
62 year old man comes into the er with symptoms of dyspnea, tachypnea. History reveals he suffers from copd. Physical examination reveals absent tactile fremetius, and expiratory wheezing. Vitals include: Rr 25 / min, temp 103, and hr 99. Blood gases reveals pao2 72 mm hg, paco2 30 mm hg.

What lab investigations should be done to confirm the diagnosis:

A) d-dimer assay
b) gram stain of sputum sample
c) chest x ray
d) cardiac troponin assay
e) ldh assay

cxr..pneumonia?effusion?
Reply With Quote Quick reply to this message
The above post was thanked by:
patelMD (06-01-2011)
  #3  
Old 06-01-2011
mayursn39's Avatar
USMLE Forums Addict
 
Steps History: 1+CK+CS
Posts: 189
Threads: 20
Thanked 506 Times in 99 Posts
Reputation: 516
Default

a) d-dimer assay ?
Reply With Quote Quick reply to this message
The above post was thanked by:
patelMD (06-01-2011)
  #4  
Old 06-01-2011
USMLE Forums Guru
 
Steps History: Not yet
Posts: 324
Threads: 70
Thanked 236 Times in 143 Posts
Reputation: 246
Default

chest x ray?
Reply With Quote Quick reply to this message
The above post was thanked by:
patelMD (06-01-2011)
  #5  
Old 06-01-2011
Hope2Pass's Avatar
USMLE Forums Master
 
Steps History: 1+CK+CS+3
Posts: 1,684
Threads: 213
Thanked 1,590 Times in 660 Posts
Reputation: 1600
Default

It is probably a pneumothorax or pleural effusion because of diminished tactile fremitus. I think the best way to proceed would be to do a Chest X Ray.
Reply With Quote Quick reply to this message
The above post was thanked by:
patelMD (06-01-2011)
  #6  
Old 06-01-2011
USMLE Forums Master
 
Steps History: 1+CK+CS+3
Posts: 1,175
Threads: 38
Thanked 852 Times in 478 Posts
Reputation: 862
Correct Answer Correct Answer is A) D-Dimer Assay

Case of: Pulmonary Embolism

D-Dimer Assay is a Fibrin Degredation Product (FDP), that is released during fibrinolysis of thrombi. Assay of this product will lead us to this diagnosis.
Reply With Quote Quick reply to this message
The above post was thanked by:
oti nogonno (06-06-2011), prepink (06-30-2011), singapur_md (06-28-2011), struggle (06-01-2011)
  #7  
Old 06-01-2011
USMLE Forums Master
 
Steps History: 1+CK+CS+3
Posts: 1,175
Threads: 38
Thanked 852 Times in 478 Posts
Reputation: 862
Default

Quote:
Originally Posted by Hope2Pass View Post
It is probably a pneumothorax or pleural effusion because of diminished tactile fremitus. I think the best way to proceed would be to do a Chest X Ray.
Tactile Fremitus:

Increased in: Asthma, and Emphysema

Decreased in: Atelectasis, Pleural Effusion, Pneumothorax

Absent in: Alveolar Collapse (EX. Pneumonia)

In the above case, the tactile fremitus was Absent!
Reply With Quote Quick reply to this message
The above post was thanked by:
INCOGNITO (06-28-2011), struggle (06-01-2011)
  #8  
Old 06-01-2011
USMLE Forums Guru
 
Steps History: Not yet
Posts: 404
Threads: 108
Thanked 71 Times in 48 Posts
Reputation: 80
Default

Quote:
Originally Posted by patelmd View Post
tactile fremitus:

Increased in: Asthma, and emphysema

decreased in: Atelectasis, pleural effusion, pneumothorax

absent in: Alveolar collapse (ex. Pneumonia)

in the above case, the tactile fremitus was absent!

ok why not pneumonia?
Reply With Quote Quick reply to this message
The above post was thanked by:
patelMD (06-01-2011)
  #9  
Old 06-01-2011
USMLE Forums Master
 
Steps History: 1+CK+CS+3
Posts: 1,175
Threads: 38
Thanked 852 Times in 478 Posts
Reputation: 862
Default

Quote:
Originally Posted by heman466s View Post
ok why not pneumonia?
In Pneumonia, there is typically Respiratory Alkalosis:

Blood gases reveals PaO2 72 mm Hg, PaCO2 30 mm Hg.

Reply With Quote Quick reply to this message
  #10  
Old 06-02-2011
USMLE Forums Guru
 
Steps History: Not yet
Posts: 404
Threads: 108
Thanked 71 Times in 48 Posts
Reputation: 80
Default

Quote:
Originally Posted by patelMD View Post
In Pneumonia, there is typically Respiratory Alkalosis:

Blood gases reveals PaO2 72 mm Hg, PaCO2 30 mm Hg.

ok and what bout fever?
Reply With Quote Quick reply to this message
  #11  
Old 06-02-2011
Claus_CU's Avatar
USMLE Forums Addict
 
Steps History: 1 + CS
Posts: 113
Threads: 8
Thanked 88 Times in 61 Posts
Reputation: 98
Default

Quote:
Originally Posted by heman466s View Post
ok and what bout fever?
About 14 to 22% of patients with acute pulmonary embolism present with low grade fever, usually below 38.5C.
Reply With Quote Quick reply to this message
  #12  
Old 06-05-2011
USMLE Forums Addict
 
Steps History: 1+CK+CS+3
Posts: 109
Threads: 29
Thanked 20 Times in 13 Posts
Reputation: 30
Default

well mr patel, i think there should b other option on place of d-dimer assay, because from qtn it appears that patient is high risk and symptomatic, so i think there should b other option like ct spiral scan or angiogram (usualy do in high risk patient), and we do d-dimer assay in low risk patient....
Reply With Quote Quick reply to this message
  #13  
Old 06-06-2011
USMLE Forums Master
 
Steps History: 1+CK+CS+3
Posts: 1,175
Threads: 38
Thanked 852 Times in 478 Posts
Reputation: 862
Default

Quote:
Originally Posted by amresh kumar View Post
well mr patel, i think there should b other option on place of d-dimer assay, because from qtn it appears that patient is high risk and symptomatic, so i think there should b other option like ct spiral scan or angiogram (usualy do in high risk patient), and we do d-dimer assay in low risk patient....
Actually, Mr. Amresh, of the options listed above, the best choice is D Dimer Assay. You are right that you could perform a Spiral CT or Angiogram, but of the options listed, that is the best one.
Reply With Quote Quick reply to this message
The above post was thanked by:
bebix (06-06-2011), doc_study (06-06-2011), prepink (06-30-2011)
  #14  
Old 06-06-2011
USMLE Forums Scout
 
Steps History: Not yet
Posts: 45
Threads: 0
Thanked 31 Times in 21 Posts
Reputation: 41
Question Acute Exacerbation of COPD

B ==> Gram stain of sputum sample?
Reply With Quote Quick reply to this message
  #15  
Old 06-06-2011
bebix's Avatar
USMLE Forums Master
 
Steps History: 1+CK+CS+3
Posts: 1,357
Threads: 194
Thanked 3,259 Times in 881 Posts
Reputation: 3269
Default

@nevillenic the correct answer is A) d-dimer assay

Quote:
Originally Posted by patelMD View Post
Case of: Pulmonary Embolism

D-Dimer Assay is a Fibrin Degredation Product (FDP), that is released during fibrinolysis of thrombi. Assay of this product will lead us to this diagnosis.
Reply With Quote Quick reply to this message
The above post was thanked by:
nevillenic (06-06-2011)



  #16  
Old 06-06-2011
USMLE Forums Guru
 
Steps History: Not yet
Posts: 298
Threads: 45
Thanked 713 Times in 210 Posts
Reputation: 723
Default

Quote:
Originally Posted by patelMD View Post
In Pneumonia, there is typically Respiratory Alkalosis:

Blood gases reveals PaO2 72 mm Hg, PaCO2 30 mm Hg.

Correct me if I'm wrong but isnt a PaCO2 of 30 mm Hg a mild Respiratory Alkalosis? Normal value is 40 mm Hg so 30 mm Hg would indicate increased respirations and thus loss of CO2 and a mild respiratory alkalosis

Did you mean respiratory alkalosis or acidosis in pneumonia?
Reply With Quote Quick reply to this message
  #17  
Old 06-06-2011
USMLE Forums Master
 
Steps History: 1+CK+CS+3
Posts: 1,175
Threads: 38
Thanked 852 Times in 478 Posts
Reputation: 862
Default

Quote:
Originally Posted by apx85 View Post
Correct me if I'm wrong but isnt a PaCO2 of 30 mm Hg a mild Respiratory Alkalosis? Normal value is 40 mm Hg so 30 mm Hg would indicate increased respirations and thus loss of CO2 and a mild respiratory alkalosis

Did you mean respiratory alkalosis or acidosis in pneumonia?
Read what I posted in previously in my post, that you qouted

Its alkalosis:

If normal PaCO2 is around 40 than a reading of 30 would indicate hyperventilation, therefore you are getting rid of more CO2, so this would cause Alkalosis
Reply With Quote Quick reply to this message
  #18  
Old 06-06-2011
USMLE Forums Guru
 
Steps History: Not yet
Posts: 298
Threads: 45
Thanked 713 Times in 210 Posts
Reputation: 723
Default

Quote:
Originally Posted by patelMD View Post
Read what I posted in previously in my post, that you qouted

Its alkalosis:

If normal PaCO2 is around 40 than a reading of 30 would indicate hyperventilation, therefore you are getting rid of more CO2, so this would cause Alkalosis
I'm still a bit confused here. In that post you were giving a reason why it was not pneumonia and you said the reason was that because in pneumonia there is generally a respiratory alkalosis, which is present in this patient.
Reply With Quote Quick reply to this message



Reply

Tags
Cardiovascular-, Pathology-, Respiratory-, Step-1-Questions

Quick Reply
Message:
Options

Register Now

In order to be able to post messages on the USMLE Forums forums, you must first register.
Please enter your desired user name, your email address and other required details in the form below.
User Name:
Password
Please enter a password for your user account. Note that passwords are case-sensitive.
Password:
Confirm Password:
Email Address
Please enter a valid email address for yourself.
Email Address:
Medical School
Choose "---" if you don't want to tell. AMG for US & Canadian medical schools. IMG for all other medical schools.
USMLE Steps History
What steps finished! Example: 1+CK+CS+3 = Passed Step 1, Step 2 CK, Step 2 CS, and Step 3.

Choose "---" if you don't want to tell.

Favorite USMLE Books
What USMLE books you really think are useful. Leave blank if you don't want to tell.
Location
Where you live. Leave blank if you don't want to tell.

Log-in

Human Verification

In order to verify that you are a human and not a spam bot, please enter the answer into the following box below based on the instructions contained in the graphic.



Thread Tools Search this Thread
Search this Thread:

Advanced Search
Display Modes


Similar Threads
Thread Thread Starter Forum Replies Last Post
What the cause of dyspnea in this patient? DrNada USMLE Step 2 CK Forum 14 06-24-2015 01:19 PM
68 Year Old with Progressive Dyspnea ... mosallam USMLE Step 2 CK Forum 8 09-16-2012 11:40 PM
Tachypnea after severe trauma good_boy_1234 USMLE Step 2 CK Forum 4 06-12-2010 11:02 AM
A 54-year-old man is admitted to the hospital with cough and dyspnea, mudpiles USMLE Step 1 Forum 1 04-18-2010 10:21 PM
Dyspnea and Edema and Cardiomegaly Hohepa USMLE Step 2 CK Forum 3 04-10-2010 03:04 PM

RSS Feed
Find Us on Facebook
vBulletin Security provided by vBSecurity v2.2.2 (Pro) - vBulletin Mods & Addons Copyright © 2017 DragonByte Technologies Ltd.

USMLE® & other trade marks belong to their respective owners, read full disclaimer
USMLE Forums created under Creative Commons 3.0 License. (2009-2014)