Duchene Muscular Dystrophy with Fever - 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 07-09-2012
tyagee's Avatar
USMLE Forums Master
 
Steps History: ---
Posts: 1,365
Threads: 648
Thanked 591 Times in 355 Posts
Reputation: 601
Question Duchene Muscular Dystrophy with Fever

A 14-year old boy with Duchenne muscular dystrophy (DMD) is brought to the hospital by his mother, who states that her son seems to be developing a cold. He has been running a low-grade fever for the past 2 days and has had copious secretions of thick, white to yellow sputum, which she suctions from his oropharynx. On physical examination, you note a very thin, pale adolescent boy with extensive muscle wasting and joint contractures. He is wearing a diaper and reclining in the hospital bed. He appears to be in no distress and is alert and oriented. His voice is hypophonic. Vital signs are: temperature 37.6°C (99.7°F), blood pressure 104/68 mm Hg, heart rate 78 beats/minute, and respiratory rate 12 breaths/minute. Spo2 is 93% on 2 L/min O2 via nasal cannula. The chest examination is remarkable for a laterally displaced PMI. On auscultation, he has an S3 and an occasional ectopic beat. Pulmonary auscultation reveals diminished breath sounds bilaterally with shallow respiratory effort. There are no wheezes, rales, or crackles. A chest radiograph reveals cardiomegaly and bilateral basilar pulmonary infiltrates without pleural effusion. Which of the following is the most appropriate next step in the care of this patient?

A. Intubate and place on mechanical ventilation
B. Obtain a computed tomography scan of the chest
C. Obtain an echocardiogram
D. Obtain arterial blood gases
E. Obtain sputum for bacterial analysis
Reply With Quote Quick reply to this message
The above post was thanked by:
mayursn39 (07-11-2012)



  #2  
Old 07-10-2012
USMLE Forums Scout
 
Steps History: Step 1 Only
Posts: 25
Threads: 1
Thanked 3 Times in 2 Posts
Reputation: 13
Default

Answer is C ... correct me if im wrong ...
Reply With Quote Quick reply to this message
  #3  
Old 07-10-2012
USMLE Forums Master
 
Steps History: 1+CK+CS
Posts: 646
Threads: 52
Thanked 762 Times in 256 Posts
Reputation: 773
Default

C. Obtain an echocardiogram

hints towards cardiac involvement... so do echo?
Reply With Quote Quick reply to this message
 
  #4  
Old 07-10-2012
tyagee's Avatar
USMLE Forums Master
 
Steps History: ---
Posts: 1,365
Threads: 648
Thanked 591 Times in 355 Posts
Reputation: 601
Default

Ans is d


Sent from my iPhone using Tapatalk
Reply With Quote Quick reply to this message
  #5  
Old 07-10-2012
USMLE Forums Scout
 
Steps History: Step 1 Only
Posts: 25
Threads: 1
Thanked 3 Times in 2 Posts
Reputation: 13
Default

Quote:
Originally Posted by tyagee View Post
Ans is d


Sent from my iPhone using Tapatalk
hi can u explain ....
Reply With Quote Quick reply to this message
  #6  
Old 07-10-2012
tyagee's Avatar
USMLE Forums Master
 
Steps History: ---
Posts: 1,365
Threads: 648
Thanked 591 Times in 355 Posts
Reputation: 601
Default

Quote:
Originally Posted by mle.com View Post
hi can u explain ....
from qbank...

Option D (Obtain arterial blood gases) is correct. This patient has an acute pulmonary infection, a common problem in patients with DMD. Their muscles of respiration are weakened by the disease and the stasis of secretions in their pulmonary tree puts them at high risk for frequent and serious infection. Blood gases should be obtained to check for degree of hypoxemia (expected to be present in patients with late-stage DMD, who have ventilation-perfusion mismatch) and hypercarbia (found intermittently in acute infection and a late sign in respiratory failure in the absence of infection) and to help determine when or if mechanical ventilation should be started. Impaired cardiac function could also contribute to pulmonary symptoms and should also be evaluated and resulting symptoms treated.

Option A (Intubate and place on mechanical ventilation) is incorrect. Intubation may well be likely at some point, because the patient’s ability to breathe will be further damaged by his increased secretions, and fatigue increases. However, intubating a patient who is still able to breathe fairly well on his own may harm him, because it increases the risk of additional infection. Such intervention should be made only when necessary, because it is very difficult to wean such a compromised patient from ventilation once it is started. Determination of the need for intubation would best be done using arterial blood gas to assess the adequacy of ventilation; this patient could have underlying chronic respiratory insufficiency and a blunted respiratory response.

Option B (Obtain a computed tomography scan of the chest) is incorrect. A computed tomography scan of the chest would be unnecessary at this point and delay other therapy.

Option C (Obtain an echocardiogram) is incorrect. The patient’s cardiac findings and cardiomegaly on chest radiography are concerning for cardiomyopathy and early congestive heart failure. This is a common finding in patients with advanced DMD, who can develop a dilated cardiomyopathy. Although an echocardiogram would be in order at some point to assess cardiac function, it is unlikely to change the acute management of the problem, which is a pulmonary infection. An infection could result in worsening of acute failure, and diuretic therapy may be indicated.

Option E (Obtain sputum for bacterial analysis) is incorrect. Although sputum cultures are frequently obtained, they rarely result in the identification of the organism causing a pulmonary infection. Cultures of bronchial washings or mucus obtained from deep suctioning would be more valuable.
Reply With Quote Quick reply to this message
The above post was thanked by:
mle.com (07-10-2012), venky2600 (03-30-2013)
  #7  
Old 07-10-2012
XpaezX's Avatar
USMLE Forums Master
 
Steps History: 1+CK+CS+3
Posts: 1,216
Threads: 41
Thanked 1,328 Times in 711 Posts
Reputation: 1343
Default

C , sadly these patients either die from resp failure or dilated cardiomyopathy, we have to document that

EDIT lo, ididnt see the slight fever he had.. f.....K
Haha yeah D makes sense
Reply With Quote Quick reply to this message



Reply

Tags
Pediatrics-, 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
About Q Fever m82_ghasemi USMLE Step 1 Forum 7 10-18-2011 01:30 PM
recurrent fever versus undulent fever chienpolska USMLE Step 1 Forum 0 09-05-2011 06:33 AM
Gene Frequency of Duchenne Muscular Dystrophy INCOGNITO USMLE Step 1 Forum 7 05-16-2011 07:19 PM
Duchene Muscular Dystrophy Genetics Question? doctorF USMLE Step 1 Forum 5 02-14-2011 07:33 PM
Physiology of Disuse Muscular Atrophy Seetal USMLE Step 1 Forum 6 04-24-2010 07:38 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)