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 22-year-old man is brought to the emergency department after a motor vehicle accident. He is complaining of back and neck pain, as well as diffuse chest pain and shortness of breath. The man was driving and, while talking on his mobile phone, lost control of the vehicle and drove into a tree. On examination, he is a young man who appears to be in moderate distress. His blood pressure is 100/50 mm Hg, which drops to 82/45 mm Hg on inspiration; pulse is 122/min; and respirations are 32/min. Cardiac examination reveals jugular venous distension and faint but audible heart sounds. While the patientís vital signs are being taken, leads are placed and a 12-lead electrocardiogram is obtained. Which of the following electrocardiogram findings is most consistent with this patientís condition?
A. Deep, symmetric T-wave inversions; bradycardia
B. Large S wave in lead I, Q wave in lead III, and an inverted T wave in lead III
C. Low voltage, T-wave flattening, and beat-to-beat variation in amplitude
D. 2-mm ST segment elevations in leads I, aVL, V5, and V6
Reply With Quote Quick reply to this message



  #2  
Old 10-19-2011
pass7's Avatar
USMLE Forums Guru
 
Steps History: 1+CK+CS+3
Posts: 406
Threads: 30
Thanked 141 Times in 109 Posts
Reputation: 151
Default

Quote:
Originally Posted by drnrpatel View Post
A 22-year-old man is brought to the emergency department after a motor vehicle accident. He is complaining of back and neck pain, as well as diffuse chest pain and shortness of breath. The man was driving and, while talking on his mobile phone, lost control of the vehicle and drove into a tree. On examination, he is a young man who appears to be in moderate distress. His blood pressure is 100/50 mm Hg, which drops to 82/45 mm Hg on inspiration; pulse is 122/min; and respirations are 32/min. Cardiac examination reveals jugular venous distension and faint but audible heart sounds. While the patientís vital signs are being taken, leads are placed and a 12-lead electrocardiogram is obtained. Which of the following electrocardiogram findings is most consistent with this patientís condition?
A. Deep, symmetric T-wave inversions; bradycardia
B. Large S wave in lead I, Q wave in lead III, and an inverted T wave in lead III
C. Low voltage, T-wave flattening, and beat-to-beat variation in amplitude
D. 2-mm ST segment elevations in leads I, aVL, V5, and V6
Cardiac temponade, so C. Low voltage, T-wave flattening, and beat-to-beat variation in amplitude?
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 344 Times in 138 Posts
Reputation: 376
Default

i guess...C...low voltage
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
Correct Answer

The correct answer is C. This patient has cardiac tamponade. The Beck triad of hypotension, jugular venous distension, and diminished heart sounds, along with the findings of pulsus paradoxus, strongly point toward the diagnosis. Tamponade is caused by an intrapericardial bleed. One of the effects of this effusion is to blunt the electrical signals recorded on an EKG, thus dampening the voltage. The heart also moves within this new pericardial fluid with each beat, altering the electrical axis and creating a beat-to-beat variation in amplitude.

Symmetric T-wave inversions and bradycardia (choice A) can be ďcerebral T waves,Ē a rare but striking example of an extracardiac condition that can be picked up on EKG. These findings are sometimes found with intracerebral bleeds and are thought to be related to increased vagal tone. This patient, however, is tachycardic.

The pattern of large S wave in lead I, Q wave in lead III, and an inverted T wave in lead III (choice B) is classic for pulmonary embolus. While it is highly specific, it is rarely seen. The most common EKG findings associated with pulmonary embolus are nonspecific ST segment and T-wave abnormalities, tachycardia, and right axis deviation.

Two-millimeter ST segment elevations in leads I, aVL, V5, and V6 (choice D) are consistent with an acute MI in a lateral distribution, likely from an occlusion of the left circumflex artery.
Reply With Quote Quick reply to this message
The above post was thanked by:
pass7 (10-20-2011), 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- MCQ meduploader USMLE Step 3 Forum 3 07-08-2012 04:24 PM
Cardiology drnrpatel USMLE Step 2 CK Forum 7 10-20-2011 09:32 AM
Cardiology drnrpatel USMLE Step 2 CK Forum 3 10-20-2011 07:42 AM
Cardiology drnrpatel USMLE Step 2 CK Forum 5 10-20-2011 07:11 AM
Cardiology drnrpatel USMLE Step 2 CK Forum 4 10-19-2011 04:32 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)