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 10-20-2011
drnrpatel's Avatar
Guest
 
Steps History: 1+CK+CS
Posts: 441
Threads: 153
Thanked 396 Times in 211 Posts
Reputation: 419
Default Cardiology

A 42-year-old man comes to the office complaining of two episodes of syncope. He denies any specific trigger for these episodes. He denies any chest pain, shortness of breath, or palpitations. His first episode occurred while driving, when he abruptly turned his head to the right. His second episode occurred the day prior to presentation, while shaving. He denies any other medical problems. He is not taking any medications. At baseline, he is otherwise healthy and is able to conduct all activities of daily living. He denies any family history of sudden cardiac death. His blood pressure is 120/70 mm Hg and pulse is 70/min. His cardiac examination reveals no murmur. Examination of his neck reveals no bruits. Chest radiograph is normal. Electrocardiogram shows sinus rhythm at 60/min. He has a slight left axis deviation. All intervals are normal. Which of the following is the most appropriate diagnostic maneuver at this time?
A. Carotid sinus massage with monitoring
B. Echocardiogram
C. Electroencephalography
D. Electrophysiologic study
E. Tilt-table testing
Reply With Quote Quick reply to this message



  #2  
Old 10-21-2011
USMLE Forums Master
 
Steps History: Step 1 Only
Posts: 537
Threads: 80
Thanked 345 Times in 138 Posts
Reputation: 377
Default

A. Carotid sinus massage with monitoring
Reply With Quote Quick reply to this message
  #3  
Old 10-21-2011
USMLE Forums Veteran
 
Steps History: Step 1 Only
Posts: 239
Threads: 3
Thanked 48 Times in 37 Posts
Reputation: 58
Default

E. Tilt-table testing
__________________
I'm Predictable In The Unpredictable Future !
Reply With Quote Quick reply to this message
 
  #4  
Old 10-21-2011
USMLE Forums Guru
 
Steps History: 1 + CS
Posts: 405
Threads: 55
Thanked 535 Times in 155 Posts
Reputation: 545
Default

A. Carotid sinus massage with monitoring
Reply With Quote Quick reply to this message
  #5  
Old 10-21-2011
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

B. Echocardiogram
Reply With Quote Quick reply to this message
  #6  
Old 10-21-2011
drnrpatel's Avatar
Guest
 
Steps History: 1+CK+CS
Posts: 441
Threads: 153
Thanked 396 Times in 211 Posts
Reputation: 419
Default Answer

The correct answer is A. This patient is presenting with symptoms that are consistent with vagally mediate carotid hypersensitivity that is leading to syncope. Thus, shaving and head turning are causing his episodes. A simple test wherein his carotid body is massaged during cardiac monitoring can clarify the diagnosis, making other studies unnecessary.

An echocardiogram (choice B) is very helpful when structural heart disease is suspected as the cause of the syncope. This patient most likely has carotid hypersensitivity and such a study is unlikely to be very helpful.

Electroencephalography (choice C) would be useful if a seizure disorder or another central nervous system source is suspected to be the cause of this patientís syncope.

An electrophysiologic study (choice D) is useful in patients presenting with syncope of no obvious source. In such patients, typically an arrhythmia is suspected, and the study is useful in inducing such arrhythmias and determining if the symptoms are reproducible.

Tilt-table tests (choice E) include carotid body massage, but this test is typically very prolonged and in this patient would be unnecessary. The yield of this testing is usually very low as well.
Reply With Quote Quick reply to this message
The above post was thanked by:
pass7 (10-21-2011), sonu.agarwall (10-22-2011)



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 5 10-21-2011 07:47 PM
Cardiology drnrpatel USMLE Step 2 CK Forum 4 10-20-2011 08:10 PM
Cardiology drnrpatel USMLE Step 2 CK Forum 3 10-20-2011 07:59 PM
Cardiology drnrpatel USMLE Step 2 CK Forum 5 10-20-2011 07:44 PM
Cardiology drnrpatel USMLE Step 2 CK Forum 7 10-20-2011 08:23 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)