15 Yr Old Immigrant with murmur? - 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 04-03-2012
USMLE Forums Scout
 
Steps History: Not yet
Posts: 43
Threads: 11
Thanked 7 Times in 6 Posts
Reputation: 17
Heart 15 Yr Old Immigrant with murmur?

A 15-year-old white female, has recently immigrated from Asia, is found to have a heart murmur during his routine physical examination, otherwise she is completely asymptomatic. Her vitals are stable. Her apex beat is tapping. Cardiac
auscultation shows a loud first heart sound, opening snap and mid-diastolic rumble at the apex. Her lungs are clear to auscultation. Chest x-ray and EKG are unremarkable. What is the next most appropriate step in the management of this patient?
a- penicillin
b- metoprolol
c- enalapril
d- digoxin
e- warfarin
Reply With Quote Quick reply to this message



  #2  
Old 04-03-2012
USMLE Forums Scout
 
Steps History: Step 1 Only
Posts: 10
Threads: 1
Thanked 3 Times in 3 Posts
Reputation: 13
Default

it should be pencillin prophylaxis for MITRAL STENOSIS
Reply With Quote Quick reply to this message
The above post was thanked by:
Ayman Qasrawi (04-05-2012)
  #3  
Old 04-04-2012
USMLE Forums Scout
 
Steps History: Step 1 Only
Posts: 76
Threads: 10
Thanked 31 Times in 27 Posts
Reputation: 41
Default

ans. B .
Reply With Quote Quick reply to this message
 
  #4  
Old 04-04-2012
USMLE Forums Scout
 
Steps History: Not yet
Posts: 43
Threads: 11
Thanked 7 Times in 6 Posts
Reputation: 17
Default

Quote:
Originally Posted by usmlepak View Post
ans. B .
???????????????????????????????????????
can you explain pl.
Reply With Quote Quick reply to this message
  #5  
Old 04-04-2012
USMLE Forums Newbie
 
Steps History: Not yet
Posts: 1
Threads: 0
Thanked 0 Times in 0 Posts
Reputation: 10
Default

Ans- B, Metoprolol and other beta blockers are indicated for use as antiarrhythmic agents and are preferable over Digoxin to Digoxins adverse side effects.

Reply With Quote Quick reply to this message
  #6  
Old 04-04-2012
USMLE Forums Scout
 
Steps History: Not yet
Posts: 43
Threads: 11
Thanked 7 Times in 6 Posts
Reputation: 17
Default

Quote:
Originally Posted by nwoyshner View Post
Ans- B, Metoprolol and other beta blockers are indicated for use as antiarrhythmic agents and are preferable over Digoxin to Digoxins adverse side effects.
but the patient does not have any arrhythmia!!!!!!!!!!!!!!!!!!!!!
so??????
Reply With Quote Quick reply to this message
  #7  
Old 04-05-2012
USMLE Forums Veteran
 
Steps History: 1+CK+CS
Posts: 225
Threads: 13
Thanked 326 Times in 105 Posts
Reputation: 336
Default

Read this from Harrison 18th

RF is the most commom cause of MS

Penicillin prophylaxis of group A -hemolytic streptococcal infections (Chap. 322) for secondary prevention of rheumatic fever is important for at-risk patients with rheumatic MS (Table 237-2). Recommendations for infective endocarditis prophylaxis have recently changed. In symptomatic patients, some improvement usually occurs with restriction of sodium intake and small doses of oral diuretics. Beta blockers, nondihydropyridine calcium channel blockers (e.g., verapamil or diltiazem), and digitalis glycosides are useful in slowing the ventricular rate of patients with AF. Warfarin to an international normalized ratio (INR) of 23 should be administered indefinitely to patients with MS, who have AF or a history of thromboembolism. The routine use of warfarin in patients in sinus rhythm with LA enlargement (maximal dimension >5.5 cm) with or without spontaneous echo contrast is more controversial.
Reply With Quote Quick reply to this message
  #8  
Old 04-05-2012
USMLE Forums Addict
 
Steps History: Not yet
Posts: 137
Threads: 2
Thanked 65 Times in 40 Posts
Reputation: 75
Default

pt has rhomatic heart disease(IMEGRANT,AGE,MS),recomendation is proflaxes pencillin untill age 18(for most physician) some physician say till age 25.
Reply With Quote Quick reply to this message
The above post was thanked by:
tyagee (04-05-2012)
  #9  
Old 04-05-2012
muntasha's Avatar
USMLE Forums Scout
 
Steps History: 1 + CS
Posts: 33
Threads: 15
Thanked 1 Time in 1 Post
Reputation: 11
Default

I don't understand this. He already has mitral stenosis and the better approach would be to give metoprolol rather than pencillin prophylaxis..???
Reply With Quote Quick reply to this message
  #10  
Old 04-05-2012
USMLE Forums Scout
 
Steps History: Not yet
Posts: 43
Threads: 11
Thanked 7 Times in 6 Posts
Reputation: 17
Default

Quote:
Originally Posted by um aala View Post
pt has rhomatic heart disease(IMEGRANT,AGE,MS),recomendation is proflaxes pencillin untill age 18(for most physician) some physician say till age 25.
the right answer is penicillin until age 18 years old.
Reply With Quote Quick reply to this message
The above post was thanked by:
um aala (04-05-2012)
  #11  
Old 04-06-2012
USMLE Forums Addict
 
Steps History: Not yet
Posts: 105
Threads: 2
Thanked 42 Times in 37 Posts
Reputation: 52
Default a- penicillin

a- penicillin
Reply With Quote Quick reply to this message
  #12  
Old 04-06-2012
shyangel18's Avatar
USMLE Forums Guru
 
Steps History: 1 + CS
Posts: 388
Threads: 48
Thanked 237 Times in 128 Posts
Reputation: 247
Send a message via MSN to shyangel18
Default

i jus strted ck prep. dont kno much but heres why answer is A. PENICILLIN

pt has MVP.. the murmurs tells it. plus the age and sex gives it away. and MVP is either surgically repaired. or damaged valves hav tendency to develop bacterial endocarditis. so put pt on prophylactic antibiotics!
__________________
Ppl come here to study n ponder
I am here to Excell like Thunder!
To view links or images in signatures your post count must be 10 or greater. You currently have 0 posts.
Reply With Quote Quick reply to this message
  #13  
Old 04-06-2012
USMLE Forums Scout
 
Steps History: Step 1 Only
Posts: 82
Threads: 8
Thanked 114 Times in 49 Posts
Default

@shyangel18

Welcome to the forum & best of luck for your prep.

This is a case of Rheumatic Fever. The correct answer is A.
Refer to the nice explanations given by Ayman Qasrawi &um aala.

MVP does not need antibiotic prophylaxis.
__________________
Will you look back on life and say, "I wish I had," or "I'm glad I did
Reply With Quote Quick reply to this message
The above post was thanked by:
aiminghigh (04-15-2012), Ayman Qasrawi (04-07-2012)
  #14  
Old 04-06-2012
shyangel18's Avatar
USMLE Forums Guru
 
Steps History: 1 + CS
Posts: 388
Threads: 48
Thanked 237 Times in 128 Posts
Reputation: 247
Send a message via MSN to shyangel18
Default

Quote:
Originally Posted by doc_study View Post
@shyangel18

Welcome to the forum & best of luck for your prep.

This is a case of Rheumatic Fever. The correct answer is A.
Refer to the nice explanations given by Ayman Qasrawi &um aala.

MVP does not need antibiotic prophylaxis.
oh ya ya its MS !! i need to refresh my step1 memory . i was think OS is the mid systolic clock of MVP. nvm

thanx for the correction
__________________
Ppl come here to study n ponder
I am here to Excell like Thunder!
To view links or images in signatures your post count must be 10 or greater. You currently have 0 posts.
Reply With Quote Quick reply to this message
  #15  
Old 04-15-2012
USMLE Forums Scout
 
Steps History: 1 + CS
Posts: 99
Threads: 27
Thanked 71 Times in 31 Posts
Reputation: 81
Default

Quote:
Originally Posted by doc_study View Post
@shyangel18

Welcome to the forum & best of luck for your prep.

This is a case of Rheumatic Fever. The correct answer is A.
Refer to the nice explanations given by Ayman Qasrawi &um aala.

MVP does not need antibiotic prophylaxis.

Right!! One addition I want to do is..::
MVP with click doesn't need antibiotic prophylaxis.
MVP with murmur needs ANTIBIOTIC PROPHYLAXIS.
Reply With Quote Quick reply to this message



  #16  
Old 04-15-2012
Ace3's Avatar
USMLE Forums Master
 
Steps History: 1+CK+CS
Posts: 735
Threads: 89
Thanked 289 Times in 191 Posts
Reputation: 301
Default

a- penicillin is the answer
Reply With Quote Quick reply to this message
  #17  
Old 04-15-2012
Ace3's Avatar
USMLE Forums Master
 
Steps History: 1+CK+CS
Posts: 735
Threads: 89
Thanked 289 Times in 191 Posts
Reputation: 301
Default

Quote:
Originally Posted by nwoyshner View Post
Ans- B, Metoprolol and other beta blockers are indicated for use as antiarrhythmic agents and are preferable over Digoxin to Digoxins adverse side effects.

Above q do not show any rhythm disorder..so why beta blocker??
Reply With Quote Quick reply to this message
  #18  
Old 04-16-2012
USMLE Forums Scout
 
Steps History: 1+CK+CS
Posts: 99
Threads: 27
Thanked 10 Times in 9 Posts
Reputation: 20
Default

Quote:
Originally Posted by confident View Post
Above q do not show any rhythm disorder..so why beta blocker??
The correct answer should be A, hence beta blocker isn't needed.
Penicillin should be given because the patient has mitral stenosis
Reply With Quote Quick reply to this message



Reply

Tags
Cardiology-, 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
Is USMLE Step 1 Live Preparation Kaplan good for a immigrant GP? hamjaf60 USMLE Step 1 Forum 10 11-27-2016 08:30 PM
Heart condition in the immigrant question. DocSikorski USMLE Step 1 Forum 7 02-23-2012 01:26 AM
A PPD Positive Immigrant with Abdominal Pain Dr.NickRiviera USMLE Step 1 Forum 9 01-23-2012 09:27 PM
35 yr old man,illegal immigrant indigo USMLE Step 1 Forum 4 12-27-2011 06:32 AM
New Immigrant, No longer a fresh graduate! laarnijoy General Topics Forum 1 03-24-2011 10:24 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)