Gyrus Daily Questions; Internal Medicine #37 - 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 09-28-2012
USMLE Forums Master
 
Steps History: 1+CK+CS
Posts: 720
Threads: 217
Thanked 552 Times in 309 Posts
Reputation: 562
Arrow Gyrus Daily Questions; Internal Medicine #37

A 61-year-old male is admitted to your service for swelling of the abdomen. You detect ascites on clinical examination and perform a paracentesis. The results show a white blood cell count of 300 leukocytes/µL with 35% polymorphonuclear cells. The peritoneal albumin level is 1.2 g/dL, protein is 2.0 g/dL, and triglycerides are 320 mg/dL. Peritoneal cultures are pending. Serum albumin is 2.6 g/dL. Which of the following is the most likely diagnosis?

A. Congestive heart failure
B. Peritoneal tuberculosis
C. Peritoneal carcinomatosis
D. Chylous ascites
E. Bacterial peritonitis
Reply With Quote Quick reply to this message



  #2  
Old 09-28-2012
K06100's Avatar
USMLE Forums Master
 
Steps History: 1+CK+CS+3
Posts: 730
Threads: 90
Thanked 460 Times in 289 Posts
Reputation: 470
Default

A. Congestive heart failure ??????
__________________
Try Not To Become A Man Of Success But A Man Of Value.
Reply With Quote Quick reply to this message
The above post was thanked by:
cingulate.gyrus (09-28-2012)
  #3  
Old 09-29-2012
USMLE Forums Guru
 
Steps History: 1+CK+CS
Posts: 387
Threads: 82
Thanked 618 Times in 234 Posts
Reputation: 628
Default

SAAG= 2.6/1.2= 2.1 which is > 1.1
So will pick answer A
Reply With Quote Quick reply to this message
 
  #4  
Old 09-29-2012
USMLE Forums Master
 
Steps History: 1+CK+CS
Posts: 720
Threads: 217
Thanked 552 Times in 309 Posts
Reputation: 562
Default

Absolutly correct../

The answer is A.
The serum-ascites albumin gradient (SAG) offers the best correlation with portal pressure.

A high gradient (>1.1 g/dL) is characteristic of uncomplicated cirrhotic ascites and differentiates ascites caused by portal hypertension from ascites not caused by portal hypertension in more than 95% of cases.

Conditions that cause a low gradient include more “exudative” processes such as infection, malignancy, and inflammatory processes. Similarly, congestive heart failure and nephrotic syndrome cause high gradients.

In this patient the SAG is 1.5 g/dL, indicating a high gradient. The low number of leukocytes and polymorphonuclear cells makes bacterial or tubercular infection unlikely.

Chylous ascites often is characterized by an opaque milky fluid with a triglyceride level greater than 1000 mg/dL in addition to a low SAG.



Reply With Quote Quick reply to this message
The above post was thanked by:
chriledi (04-17-2013), heartbeat (09-30-2012)
  #5  
Old 09-29-2012
USMLE Forums Master
 
Steps History: 1+CK+CS
Posts: 1,867
Threads: 149
Thanked 2,107 Times in 1,049 Posts
Reputation: 2127
Default

SAAG = (albumin concentration of serum) - (albumin concentration of ascitic fluid).

Quote:
High gradient

A high gradient (> 1.1 g/dL) indicates the ascites is due to portal hypertension with 97% accuracy.[2] This is due to increased hydrostatic pressure within the blood vessels of the hepatic portal system, which in turn forces water into the peritoneal cavity but leaves proteins such as albumin within the vasculature.
Important causes of high SAAG ascites (> 1.1 g/dL) include:
Low gradient

A low gradient (< 1.1 g/dL ) indicates causes of ascites not associated with increased portal pressure, tuberculosis, and various types of cancer.
__________________
A man doesn't know what he knows until he knows what he doesn't know.
“What is man? He's just a collection of chemicals with delusions of grandeur.”
Reply With Quote Quick reply to this message
The above post was thanked by:
cingulate.gyrus (09-29-2012)
  #6  
Old 06-08-2016
USMLE Forums Scout
 
Steps History: 1 + CK
Posts: 56
Threads: 0
Thanked 5 Times in 5 Posts
Reputation: 15
Default

Glad I was correct. I pack A. everyone agree
Reply With Quote Quick reply to this message
  #7  
Old 06-10-2016
USMLE Forums Newbie
 
Steps History: 1 + CS
Posts: 4
Threads: 2
Thanked 1 Time in 1 Post
Reputation: 11
Default Correction

SAAG gradient in Nephrotic syndrome is LOW . Not high
Reply With Quote Quick reply to this message
The above post was thanked by:
datson (06-16-2016)



Reply

Tags
Gastroenterology-, Internal-Medicine-, Step-2-Questions, Tables-

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
Gyrus Daily Questions; Internal Medicine #20 cingulate.gyrus USMLE Step 2 CK Forum 9 01-10-2013 09:21 AM
Gyrus Daily Questions; Internal Medicine #27 cingulate.gyrus USMLE Step 2 CK Forum 4 09-23-2012 02:19 PM
Gyrus Daily Questions; Internal Medicine #24 cingulate.gyrus USMLE Step 2 CK Forum 2 09-23-2012 09:54 AM
Gyrus Daily Questions; Internal Medicine #17 cingulate.gyrus USMLE Step 2 CK Forum 5 09-22-2012 09:42 AM
Gyrus Daily Questions; Internal Medicine #8 cingulate.gyrus USMLE Step 2 CK Forum 4 09-20-2012 08:08 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)