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  #1  
Old 03-24-2012
tyagee's Avatar
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Heart CHF ... Confusing!

A 55-year-old woman sees her internist with a complaint of difficulty breathing when she lies flat on her back. She also reports shortness of breath with exertion and swelling of her ankles. Her medical history is significant for type 1 diabetes mellitus diagnosed 40 years ago and hypertension diagnosed 20 years ago. Her conditions are treated with normal and NPH insulin and an ACE inhibitor. Which of the following findings on physical examination is most likely?

A. Absent abdominal jugular reflux
B. Jugular venous distension at rest
C. Pedal edema
D. Rales
E. Third heart sound (S3)

do mention reason for ur choice plz.
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Old 03-24-2012
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my ans wud be E. s3


A. Absent abdominal jugular reflux ----- this wud be a findind in sever chf
B. Jugular venous distension at rest------ this is seen in severe chf which involves right side.. or right sided failure.. rt hf can be ruled out considering the long hx of htn
C. Pedal edema ----- again rt sided chf
D. Rales ------ too non specific...
E. Third heart sound (S3) ----- most specific as u get remodelling of ur lv
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  #3  
Old 03-24-2012
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wud go for Rales... since she has breathing difficulty.. indicates Pul edema .. so rales must be present
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Old 03-25-2012
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Quote:
Originally Posted by dr.dhruvdesai View Post
wud go for Rales... since she has breathing difficulty.. indicates Pul edema .. so rales must be present

i agree ,it's rales
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Old 03-25-2012
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s3 i would think as i did a world q similar to this yesterday. s3 is a specific indicator for left ventricular failure. rales, pedal edema, are nonspecific and can indicate lung or heart failure or liver failure. how to rule out A and B though i dont know. the reason i think she's got heart failure on left side is the ankle swelling along with pulm cong.
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  #6  
Old 03-25-2012
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Quote:
Originally Posted by absolutjag9 View Post
s3 i would think as i did a world q similar to this yesterday. s3 is a specific indicator for left ventricular failure. rales, pedal edema, are nonspecific and can indicate lung or heart failure or liver failure. how to rule out A and B though i dont know. the reason i think she's got heart failure on left side is the ankle swelling along with pulm cong.
I agree with you. I think it should be S3 as it is specific for LVF and orthopnea and PND are signs of LVF.
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Old 03-26-2012
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Quote:
Originally Posted by tyagee View Post
A 55-year-old woman sees her internist with a complaint of difficulty breathing when she lies flat on her back. She also reports shortness of breath with exertion and swelling of her ankles. Her medical history is significant for type 1 diabetes mellitus diagnosed 40 years ago and hypertension diagnosed 20 years ago. Her conditions are treated with normal and NPH insulin and an ACE inhibitor. Which of the following findings on physical examination is most likely?

A. Absent abdominal jugular reflux
B. Jugular venous distension at rest
C. Pedal edema
D. Rales
E. Third heart sound (S3)

do mention reason for ur choice plz.
ans.E, this pt has systolic dysfunction due to chronic hypertension, rales are hear in acute heart failure, so ans is E
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Old 03-26-2012
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I think it is S3...more specific answers, given symptoms of CHF. Rales is too non specific, so is pedal edema.
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Old 03-26-2012
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A ,B , C represent right failure
E non seen in both right and left
D is seen only in left
so my ans is d...
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