Pulsus paradoxus puzzle - 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 09-24-2013
USMLE Forums Guru
 
Steps History: 1+CK+CS
Posts: 359
Threads: 39
Thanked 228 Times in 135 Posts
Reputation: 238
Heart Pulsus paradoxus puzzle

A 70 year old female with a history of coronary artery disease, hypertension, arthritis, and breast cancer presents with dyspnea on exertion and dizziness slowly progressing over the past 2 weeks. She denies any chest pains. Her blood pressure is 80/40, heart rate 120, respirations 24, and oxygen saturation 88% on room air. Physical exam revealed pulmonary rales at the left lung base, distant heart sounds, and elevated jugular venous pressures especially with inspiration. Her pulsus paradoxus is 20 mmHg. Laboratory studies are normal. Which of the following is the best initial management of this patient?

A. Intravenous fluids

B. Intravenous beta-blockers

C. Pericardiocentesis

D. Coronary angiography
Reply With Quote Quick reply to this message
The above post was thanked by:
dkdk (09-24-2013)



  #2  
Old 09-24-2013
USMLE Forums Addict
 
Steps History: 1+CK+CS
Posts: 118
Threads: 10
Thanked 94 Times in 44 Posts
Reputation: 104
Default

C- centesis, cardiac tamponade.
Reply With Quote Quick reply to this message
  #3  
Old 09-24-2013
USMLE Forums Scout
 
Steps History: 1+CK+CS
Posts: 83
Threads: 9
Thanked 23 Times in 19 Posts
Reputation: 33
Default

pericardiocentesis to relieve cardiac tamponade
Reply With Quote Quick reply to this message
  #4  
Old 09-24-2013
USMLE Forums Guru
 
Steps History: 1+CK+CS
Posts: 359
Threads: 39
Thanked 228 Times in 135 Posts
Reputation: 238
Default

yea even i went for pericardiocentesis...but thats not the answer.
Reply With Quote Quick reply to this message
  #5  
Old 09-25-2013
USMLE Forums Addict
 
Steps History: 1+CK+CS
Posts: 118
Threads: 10
Thanked 94 Times in 44 Posts
Reputation: 104
Default

Quote:
Originally Posted by drsrb View Post
yea even i went for pericardiocentesis...but thats not the answer.
So what is the answer???
Reply With Quote Quick reply to this message
  #6  
Old 09-25-2013
USMLE Forums Guru
 
Steps History: 1+CK+CS
Posts: 359
Threads: 39
Thanked 228 Times in 135 Posts
Reputation: 238
Default

This patient has cardiac tamponade. Remember that the right-sided heart chambers are the lowest pressure chambers, thus as intrapericardial pressure rises, these chambers will be first compressed.
Also recall that right sided heart pressures reflect "preload" which is determined by 2 things: 1. intravenous volume (hydration status)
2. venous tone (dilated vs constricted). Giving fluids will allow the right ventricle to fill better and increase preload will improve the blood pressure. Nitroglycerine decreases preload by venodilating. Eventually pericardiocentesis would be needed.
this is what was given as explanation!!!
Reply With Quote Quick reply to this message
  #7  
Old 09-25-2013
USMLE Forums Addict
 
Steps History: 1+CK+CS
Posts: 118
Threads: 10
Thanked 94 Times in 44 Posts
Reputation: 104
Default

Where from was this question? Uworld?
Reply With Quote Quick reply to this message
  #8  
Old 09-25-2013
USMLE Forums Addict
 
Steps History: 1+CK+CS
Posts: 118
Threads: 10
Thanked 94 Times in 44 Posts
Reputation: 104
Default

By the way drsrb did you start uworld? How is it going and what is your average?
Reply With Quote Quick reply to this message
  #9  
Old 09-25-2013
USMLE Forums Guru
 
Steps History: 1+CK+CS
Posts: 359
Threads: 39
Thanked 228 Times in 135 Posts
Reputation: 238
Default

nah this wasnt from uworld..its from some random site..
was looking to do ecgs when i found these..
yea i started uworld...done with 13 blocks only..
my cumulative right now is 74...was better before i started cardio...
Reply With Quote Quick reply to this message
  #10  
Old 09-25-2013
USMLE Forums Addict
 
Steps History: 1+CK+CS
Posts: 118
Threads: 10
Thanked 94 Times in 44 Posts
Reputation: 104
Default

Are you doing it in random or subject wise mode? I started uworld too, 18 blocks done, cummulative is 70 %. My exam is in december and my panic button is activated too(as you said in previous posts). By the way how did you manage abstracts and drug ad questoins? Is there any helpfull link or something like this?
Reply With Quote Quick reply to this message
  #11  
Old 09-25-2013
USMLE Forums Guru
 
Steps History: 1+CK+CS
Posts: 359
Threads: 39
Thanked 228 Times in 135 Posts
Reputation: 238
Default

i am doing it subject wise right now.....will start random once i cover all the topics once...so another 3-4 days..
haven't done biostats yet but there was this link i found on the fourm...
How to prepare for Drug Advertisements and Research Abstracts CK Questions
check it out...i havent used it yet!!
Reply With Quote Quick reply to this message
The above post was thanked by:
Gikson (09-25-2013)
  #12  
Old 09-25-2013
USMLE Forums Addict
 
Steps History: 1+CK+CS
Posts: 118
Threads: 10
Thanked 94 Times in 44 Posts
Reputation: 104
Default

Thanks. I have already read it but didn't find helpfull for drug ads... Looking for something else. Will send you link, if I find something more usefull.
Reply With Quote Quick reply to this message
The above post was thanked by:
drsrb (09-26-2013)
  #13  
Old 09-30-2013
USMLE Forums Newbie
 
Steps History: Not yet
Posts: 1
Threads: 0
Thanked 0 Times in 0 Posts
Reputation: 10
Default A

The answer is "intravenous fluids"......but it seems the question has a wrong part, because in Tamponade Kussmaul's sign is negative,I mean the JVP pressure doesn't elevate with inspiration.
Reply With Quote Quick reply to this message
  #14  
Old 09-30-2013
USMLE Forums Guru
 
Steps History: 1+CK+CS
Posts: 359
Threads: 39
Thanked 228 Times in 135 Posts
Reputation: 238
Default

no its not wrong...kussmaul sign even though rare can present in tamponade!!!
Reply With Quote Quick reply to this message
  #15  
Old 09-30-2013
USMLE Forums Addict
 
Steps History: Step 1 Only
Posts: 177
Threads: 8
Thanked 60 Times in 48 Posts
Reputation: 70
Default

ITS BAD QUESTION OVERALL, usmle never gIVES such QUESTION
Reply With Quote Quick reply to this message






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
Do we see pulsus paradoxus in pericarditis ?? Scombroid USMLE Step 2 CK Forum 3 02-08-2013 04:02 PM
Pulsus paradoxus in asthma?? sruthi USMLE Step 1 Forum 5 08-23-2012 11:56 AM
clarify point on pulsus paradoxus sfsheran USMLE Step 1 Forum 1 12-24-2011 07:42 PM
Pulsus Paradoxus StepTaker USMLE Step 1 Mnemonics 3 12-24-2011 07:09 PM
Pulsus paradoxus drzamzam USMLE Step 1 Forum 0 07-27-2011 05:59 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)