A complicated case of a smoker, carpenter, and alcoholic man! - 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 05-31-2011
USMLE Forums Veteran
 
Steps History: Not yet
Posts: 200
Threads: 101
Thanked 195 Times in 65 Posts
Reputation: 218
Question A complicated case of a smoker, carpenter, and alcoholic man!

A 66-year-old retired carpenter presents with chronic shortness of breath upon exertion. He has smoked a pack of cigarettes per day for the past 5 years and drinks alcohol regularly. On physical examination, a displaced oint of maximal impulse and hepatosplenomegaly are noted. His medications include pantoprazole for gastroesophageal reflux and sertraline for depression. Echocardiogram reveals an ejection fraction of 30% and dilated left and right ventricles. Laboratory test results are:

Na- 129 mEq/L
K- 5.2 mEq/L
Cl- 101 mEq/L
Blood urea nitrogen 45 mg/dL
Creatinine 1.3 mg/dL
Glucose 134 mg/dL
Aspartate aminotransferase 220 U/L
Alanine aminotransferase 140 U/L
Alkaline phosphatase 280 U/L

Which of the following is the most likely etiology of his cardiac findings?

(A) Borrelia burgdorferi
(B) Cigarette smoking
(C) Coxsackie B virus
(D) Ethanol
(E) Pantoprazole toxicity
(F) Trypanosoma cruzi
Reply With Quote Quick reply to this message
The above post was thanked by:
mle guy (05-31-2011), Taiwan_Guy (06-03-2011)



  #2  
Old 05-31-2011
USMLE Forums Scout
 
Steps History: 1 + CK
Posts: 26
Threads: 7
Thanked 32 Times in 10 Posts
Reputation: 42
Cool

Well to me it ethanol because ethanol can lead to electrolyte abnormality mention in the qs and congestive heart failure can be because of thiamine deficiency the other relevant ans is smoking but there are not enough in the question to support that answer like description of hypertention.
Reply With Quote Quick reply to this message
  #3  
Old 05-31-2011
USMLE Forums Scout
 
Steps History: 1+CK+CS
Posts: 20
Threads: 10
Thanked 23 Times in 5 Posts
Reputation: 33
Default

Answer is D.
# dilated cardiomyopathy manifested as ( e.g. shortness of breath, displaced apical impulse, hepatomegaly) with decreased ejection fraction < 35% (wet beri beri) which is due deficiency in thiamine.
# elevated AST more than ALT which goes along with Alcohol-induced hepatitis.
and that's it.
Reply With Quote Quick reply to this message
The above post was thanked by:
mle guy (05-31-2011), Taiwan_Guy (06-03-2011)
 
  #4  
Old 05-31-2011
USMLE-Syndrome's Avatar
USMLE Forums Master
 
Steps History: ---
Posts: 1,203
Threads: 180
Thanked 1,251 Times in 441 Posts
Reputation: 1265
Default

D : ethanol alcohol cause ratio AST:ALT 2:1 alcholic hepatitis
Reply With Quote Quick reply to this message
  #5  
Old 05-31-2011
1TA2B's Avatar
USMLE Forums Guru
 
Steps History: CK Only
Posts: 475
Threads: 39
Thanked 353 Times in 169 Posts
Reputation: 376
Default

Yes. Alcoholic cardiomyopathy.

During the first half of the 20th century, the concept of beriberi heart disease (ie, thiamine deficiency) was present throughout the medical literature, and the idea that alcohol had any direct effect on the myocardium was doubted.

In the 1950s, evidence began to emerge that supported the idea of a direct toxic myocardial effect of alcohol, and research during the last 25 years has been particularly productive in characterizing the disease entity of alcoholic cardiomyopathy.

Alcohol use has also been shown to have numerous effects on the cardiovascular system other than heart failure. It has been associated with arrhythmia (eg, atrial fibrillation, atrial flutter, other supraventricular arrhythmia, premature ventricular contractions), sudden death, hypertension, and stroke.
http://emedicine.medscape.com/article/152379-overview
__________________
Skill+Hardwork+Preparation=Success
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
The above post was thanked by:
dr-ahmed (05-31-2011), healer2b (05-31-2011), Taiwan_Guy (06-03-2011)



Reply

Tags
Cardiology-, Infectious-Diseases, 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
55 Yr Old Smoker Sabio USMLE Step 1 Classic Clues 4 08-04-2011 11:35 PM
The most likely lung cancer in a smoker! heights USMLE Step 1 Forum 15 06-06-2011 07:34 AM
Alcoholic patient question INCOGNITO USMLE Step 1 Forum 2 05-01-2011 06:20 AM
Complicated unlicensed abortion RRMadukha USMLE Step 2 CK Forum 1 05-26-2010 02:49 PM
Alcoholic Patient; Next Step? mosallam USMLE Step 2 CK Forum 7 04-06-2010 07:39 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)