Post CABG worsening chest pain! - 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 07-18-2012
tyagee's Avatar
USMLE Forums Master
 
Steps History: ---
Posts: 1,365
Threads: 648
Thanked 591 Times in 355 Posts
Reputation: 601
Heart Post CABG worsening chest pain!

A 72-year-old man underwent bypass grafting for severe coronary artery disease. On the 1st postoperative
day, his temperature is 36.6C (97.9F), blood pressure is 120/70 mm Hg, pulse is 80/min and respirations are
12/min. On postoperative day 10 he is complaining of worsening retrosternal pain despite continuing
analgesia with morphine. He also has dyspnea at rest. His temperature currently is 37 .9C ( 1 DO .1 F), blood
pressure is 11 0/70 mm Hg, pulse is 1 DO/min and respirations are 24/min. Examination shows clear heart
sounds without murmurs or rubs. EKG shows no acute changes compared to the EKG on the 1st
postoperative day. An x-ray film of the chest shows widening of the mediastinum. Echocardiography shows
a small amount of pericardial fluid. Laboratory studies show:
Hemoglobin 11 .0 g/L
Platelets 120,000/mm 3
Leukocy1e count 16,500/mm 3
Neutrophils 86%
Lymphocy1es 13%

W hich of the following will this patient most likely require?
A. Aspirin therapy
B. Thoracotomy for debridement and drainage; antibiotic therapy
C. Thoracotomy for hemostasis
D. Pericardia! puncture and aspirin therapy
E. Antibiotic therapy alone

guys, what is the diagnosis here ? i thought acute pericarditis but as per qbank its not acute pericarditis. may i know why it cant be acute pericarditis ?
Reply With Quote Quick reply to this message



  #2  
Old 07-18-2012
USMLE Forums Master
 
Steps History: 1+CK+CS
Posts: 646
Threads: 52
Thanked 762 Times in 256 Posts
Reputation: 773
Default

D. Pericardia! puncture and aspirin therapy
Reply With Quote Quick reply to this message
  #3  
Old 07-18-2012
Hitman's Avatar
USMLE Forums Master
 
Steps History: Not yet
Posts: 928
Threads: 17
Thanked 539 Times in 375 Posts
Reputation: 549
Default

Ans ..C...... appears to be Aortic dissection with small fluid collection ... thoracotomy to control bleed .... although BP normal ?? dont know what else .....
Reply With Quote Quick reply to this message
 
  #4  
Old 07-18-2012
USMLE Forums Master
 
Steps History: 1+CK+CS
Posts: 646
Threads: 52
Thanked 762 Times in 256 Posts
Reputation: 773
Default

Quote:
Originally Posted by Hitman View Post
Ans ..C...... appears to be Aortic dissection with small fluid collection ... thoracotomy to control bleed .... although BP normal ?? dont know what else .....
yup i thought aortic dissection too.. but was confused with the normal BP.
Reply With Quote Quick reply to this message
  #5  
Old 07-18-2012
Hitman's Avatar
USMLE Forums Master
 
Steps History: Not yet
Posts: 928
Threads: 17
Thanked 539 Times in 375 Posts
Reputation: 549
Default

Quote:
Originally Posted by mbbs2010 View Post
yup i thought aortic dissection too.. but was confused with the normal BP.

well this could make sense that Aortic dissection have high BP but the pt is bleeding into the mediastinum so low BP .... do thoracotomy and control bleeding ....
Reply With Quote Quick reply to this message
  #6  
Old 07-18-2012
tyagee's Avatar
USMLE Forums Master
 
Steps History: ---
Posts: 1,365
Threads: 648
Thanked 591 Times in 355 Posts
Reputation: 601
Default

nope, not aortic dissection
Reply With Quote Quick reply to this message
  #7  
Old 07-18-2012
USMLE Forums Master
 
Steps History: 1+CK+CS
Posts: 646
Threads: 52
Thanked 762 Times in 256 Posts
Reputation: 773
Default

anyway the answer i picked is for dresslers syndrome or something similar.
hence tap and nsaids.
Reply With Quote Quick reply to this message
  #8  
Old 07-18-2012
USMLE Forums Master
 
Steps History: 1+CK+CS
Posts: 1,867
Threads: 149
Thanked 2,106 Times in 1,049 Posts
Reputation: 2126
Default

B. Thoracotomy for debridement and drainage; antibiotic therapy

He had surgery and now has infection (10th PO day)---mediastinitis.
Reply With Quote Quick reply to this message
The above post was thanked by:
mbbs2010 (07-18-2012), tyagee (07-19-2012)
  #9  
Old 07-18-2012
USMLE Forums Master
 
Steps History: 1+CK+CS
Posts: 1,867
Threads: 149
Thanked 2,106 Times in 1,049 Posts
Reputation: 2126
Default

Quote:
EKG shows no acute changes compared to the EKG on the 1st
postoperative day
.
Quote:
Originally Posted by tyagee View Post
may i know why it cant be acute pericarditis ?
Because Acute pericarditis has very specific EKG changes like PR depression. concave ST elevation and does not have mediastinal widening which is the real clue here along with raised white cell counts with neutrophilia.
Reply With Quote Quick reply to this message
The above post was thanked by:
tyagee (07-19-2012)
  #10  
Old 07-19-2012
USMLE Forums Scout
 
Steps History: Not yet
Posts: 61
Threads: 7
Thanked 82 Times in 32 Posts
Reputation: 92
Default

oh yeah, this is acute mediastinitis.
Q. Id. 2337 in UWorld

Acute Mediastinitis is a Cx of cardiac surgery that presents usually 14 days after surgery. C/F- fever, chest pain, leukocytosis, wound drainage and widened mediastinum. Rx- drainage, surgical debridement and prolonged antibiotic therapy.
Reply With Quote Quick reply to this message
The above post was thanked by:
tyagee (07-19-2012)



Reply

Tags
Cardiology-, Internal-Medicine-, 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
Chest pain after MI Seetal USMLE Step 2 CK Forum 7 03-31-2013 08:44 PM
Chest Pain in a 21-year old sonu.agarwall USMLE Step 2 CK Forum 4 11-02-2011 09:30 AM
Neck and Arm Pain and this Chest X Ray! Evergreen USMLE Step 1 Forum 13 10-25-2011 04:57 PM
migraine with chest pain ricko335 USMLE Step 1 Forum 5 08-12-2011 04:34 AM
62 y oldwoman with worsening abdominal pain mosallam USMLE Step 2 CK Forum 6 04-01-2010 02:15 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)