Cardiology - 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 10-19-2011
drnrpatel's Avatar
Guest
 
Steps History: 1+CK+CS
Posts: 441
Threads: 153
Thanked 396 Times in 211 Posts
Reputation: 419
Default Cardiology

A 41-year-old man is admitted to the hospital for workup of suspected endocarditis after complaining of persistent fevers and being found to have a new murmur. A transesophageal echocardiogram confirms the diagnosis of aortic valve endocarditis, and the patient is started on nafcillin after blood cultures reveal methicillin-sensitive Staphylococcus aureus. He receives approximately 1 week of parenteral therapy, during which his fever drops from 39.5 C (103.1 F) to 37.9 (100.2 F) and he improves symptomatically. However, at the end of 1 week of therapy he is found to have a bradycardic and irregular rhythm on cardiac auscultation. An electrocardiogram reveals new conduction abnormalities, including what appear to be grouped ventricular beats with a progressively shorter R-R interval, a slightly widened QRS interval, and occasional premature ventricular contractions. A repeat transthoracic echocardiogram fails to visualize the vegetation. This patient is most likely to benefit from which of the following?
A. Amiodarone, intravenous bolus and drip
B. Anticoagulation to reduce the risk of septic emboli
C. No additional intervention but close cardiac monitoring
D. Surgical consultation for valve resection
E. Trial of empiric intravenous vancomycin
Reply With Quote Quick reply to this message
The above post was thanked by:
dryogi (10-20-2011)



  #2  
Old 10-19-2011
USMLE Forums Veteran
 
Steps History: Step 1 Only
Posts: 239
Threads: 3
Thanked 48 Times in 37 Posts
Reputation: 58
Default

E. Trial of empiric intravenous vancomycin
__________________
I'm Predictable In The Unpredictable Future !
Reply With Quote Quick reply to this message
  #3  
Old 10-20-2011
USMLE Forums Master
 
Steps History: Step 1 Only
Posts: 537
Threads: 80
Thanked 345 Times in 138 Posts
Reputation: 377
Default

wats the answer?
Reply With Quote Quick reply to this message
 
  #4  
Old 10-20-2011
drnrpatel's Avatar
Guest
 
Steps History: 1+CK+CS
Posts: 441
Threads: 153
Thanked 396 Times in 211 Posts
Reputation: 419
Show Teeth Answer

The correct answer is D. This patient likely has a perivalvular abscess, which is one of the indications for surgical treatment of endocarditis. In general, congestive heart failure, embolic phenomena, persistent bacteremia while on appropriate therapy, and extravalvular infection are indications for surgical treatment of infective endocarditis. Perivalvular abscess should be suspected if the patientís fever never fully resolves and new conduction abnormalities, particularly heart block, occur.

Amiodarone (choice A) is not indicated for this patientís heart block, which is due to a structural problem created by an extending abscess.

Septic emboli should not be anticoagulated (choice B) because there is a significant risk of hemorrhage. There is no indication that this patient is suffering from septic emboli.

Close cardiac monitoring (choice C) is appropriate. However, an abscess is extremely difficult to treat with antibiotics, which already have poor penetration, and surgical intervention is appropriate.

Vancomycin (choice E) is an appropriate empiric treatment before sensitivities are known. However, given the culture results, little is likely to be gained by adding vancomycin.
Reply With Quote Quick reply to this message
The above post was thanked by:
sonu.agarwall (10-20-2011)



Reply

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
Cardiology drnrpatel USMLE Step 2 CK Forum 6 10-20-2011 07:31 AM
Lipid Profile and risk of future coronary events drnrpatel USMLE Step 2 CK Forum 8 10-20-2011 07:23 AM
Cardiology drnrpatel USMLE Step 2 CK Forum 4 10-20-2011 07:22 AM
Cardiology drnrpatel USMLE Step 2 CK Forum 4 10-20-2011 07:13 AM
Cardiology drnrpatel USMLE Step 2 CK Forum 5 10-20-2011 07:11 AM

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)