young woman on OCPs presents with RUQ pain, hepatomegaly, and bilateral edema... - 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 2 CK Forum

USMLE Step 2 CK Forum USMLE Step 2 CK Discussion Forum: Let's talk about anything related to USMLE Step 2 CK exam


Reply
 
Thread Tools Search this Thread Display Modes
  #1  
Old 06-24-2011
USMLE-Syndrome's Avatar
USMLE Forums Master
 
Steps History: ---
Posts: 1,203
Threads: 180
Thanked 1,254 Times in 441 Posts
Reputation: 1268
Liver young woman on OCPs presents with RUQ pain, hepatomegaly, and bilateral edema...

While doing a student health elective in California in your fourth year of medical school, you encounter a 21-year-old Korean American college sophomore who has previously been healthy but has had right upper quadrant pains for the past week. She has been taking oral contraceptive pills for 2 years. Vital signs are: temperature 37.1° C (98.7° F), blood pressure 100/78 mm Hg, heart rate 88 beats/minute, respiratory rate 20 breaths/minute. On examination, she has a normal physiologic split in S2 and no appreciated increase in P2 intensity. You estimate her central venous pressure as 2 cm when measuring at 30 degrees with a and v waves visible. She has no crackles or adventitious sounds on lung auscultation. Her liver span is 14 cm in the midclavicular line to percussion, and there is a tender, firm, but smooth liver edge palpable 3 cm below the right costal margin. Her abdomen does not appear distended, but you believe you detect shifting dullness when you move her to the left lateral decubitus position. Her sclera show no icterus, and skin examination reveals no color changes. Her legs have 2/4 pitting edema from her feet to knees bilaterally. Homans’ sign is negative and there is no erythema, warmth, or palpable cords on either leg. Which of the following is the most likely diagnosis?

Answer Choices
A. Aldosteronism
B. Bilateral deep venous thrombosis with pulmonary embolism
C. Budd-Chiari syndrome
D. Constrictive pericarditis
E. Nephrotic syndrome
Reply With Quote Quick reply to this message



  #2  
Old 06-24-2011
USMLE Forums Addict
 
Steps History: CK+CS
Posts: 145
Threads: 34
Thanked 82 Times in 37 Posts
Reputation: 92
Default

tender hepatomegaly + Ascitis + bilat L.L.edema with a history of OCPs
v.suggestive of Buddchiari $.......
__________________
“Learn from yesterday, live for today, hope for tomorrow. The important thing is not to stop questioning. ”
Albert Einstein
Reply With Quote Quick reply to this message
The above post was thanked by:
Amit07144 (12-22-2011)
  #3  
Old 06-24-2011
USMLE Forums Addict
 
Steps History: Not yet
Posts: 192
Threads: 0
Thanked 47 Times in 40 Posts
Reputation: 57
Default

I m with c
Reply With Quote Quick reply to this message
 
  #4  
Old 06-24-2011
aksyonez's Avatar
USMLE Forums Veteran
 
Steps History: 1+CK+CS
Posts: 218
Threads: 74
Thanked 116 Times in 64 Posts
Reputation: 128
Default

Yeah answer C. Budd Chiari
Reply With Quote Quick reply to this message
  #5  
Old 06-25-2011
USMLE-Syndrome's Avatar
USMLE Forums Master
 
Steps History: ---
Posts: 1,203
Threads: 180
Thanked 1,254 Times in 441 Posts
Reputation: 1268
Default

Option C (Budd-Chiari syndrome) is correct. The findings described in this patient are a classic presentation of Budd-Chiari in a patient taking oral contraceptive pills.

Option A (Aldosteronism) is incorrect. The patient does not have aldosteronism because she is normotensive.

Option B (Bilateral deep venous thrombosis with pulmonary embolism) is incorrect. Bilateral deep venous thrombosis would not normally cause the ascites described in this patient.

Option D (Constrictive pericarditis) is incorrect. The jugular venous pressure is normal without chronic distention as seen in constrictive pericarditis.

Option E (Nephrotic syndrome) is incorrect. Hepatomegaly is not usually seen with nephrotic syndrome.

High-yield Hit 1
Budd-Chiari Syndrome
BASIC INFORMATION
DEFINITION
Budd-Chiari syndrome (BCS) is a rare disease defined by the obstruction of hepatic venous outflow anywhere from the small hepatic veins to the junction of the inferior vena cava and the right atrium. Primary BCS is defined by endoluminal obstruction as seen in thromboses or webs. Secondary BCS is when the obstruction is due to nonvascular invasion (malignancy or parasitic masses) or extrinsic compression (tumor, abscess, cysts).
SYNONYMS
Hepatic vein thrombosis
Obliterative hepatocavopathy
Hepatic venous outflow obstruction
ICD-9CM CODES
453.0 Budd-Chiari syndrome

EPIDEMIOLOGY & DEMOGRAPHICS
BCS is a rare disorder. Clinical presentation and characteristics vary with geography. IVC thrombosis of an indolent course is more common in the Far East and more often complicated by hepatocellular carcinoma. Women are more commonly affected. Average age is 35, although the young and elderly can also be affected. In the U.S., BCS is more commonly associated with primary myeloproliferative disorders, underlying hypercoagulable states, IVC membranes, and tumors. Underlying factors contributing to BCS can be identified in approximately 75% of cases, and the finding of multiple causes in the same patient is quite common.
PHYSICAL FINDINGS & CLINICAL PRESENTATION
Variable according to the degree, location, acuity of obstruction, and presence of collateral circulation
Fulminant/Acute: (uncommon) severe RUQ abdominal pain, fever, nausea, vomiting, jaundice, hepatomegaly, ascites, marked elevation in serum aminotransferases and drop in coagulation factors, and encephalopathy. Early recognition and treatment are essential to survival.
Subacute/Chronic: (more common) vague abdominal discomfort, gradual progression to hepatomegaly, portal hypertension with or without cirrhosis; late-onset ascites, lower extremity edema, esophageal varices, splenomegaly, coagulopathy, hepatorenal syndrome, and rarely, encephalopathy.
Asymptomatic: usually discovered incidentally.
Reply With Quote Quick reply to this message
The above post was thanked by:
Gulara (06-27-2011)



Reply

Tags
Gastroenterology-, Step-2-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
Unexpected Hypertension + Resistant to treatment + Young woman + Increased Renin rasheed USMLE Step 1 Classic Clues 10 09-13-2015 08:04 AM
OCPs and weight gain ? kemoo USMLE Step 2 CK Forum 0 06-20-2011 12:07 AM
obese woman with abdominal pain? sam01 USMLE Step 1 Forum 4 04-22-2010 07:05 AM
A 30-year-old woman presents to a physician mudpiles USMLE Step 1 Forum 7 04-12-2010 04:22 AM
Young Women with dull chest pain? Hohepa USMLE Step 2 CK Forum 5 04-10-2010 02:09 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)