WBR0431: Difference between revisions
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{{WBRQuestion | {{WBRQuestion | ||
|QuestionAuthor={{Rim}} | |QuestionAuthor={{Rim}} {{Alison}} | ||
|ExamType=USMLE Step 1 | |ExamType=USMLE Step 1 | ||
|MainCategory=Pathology | |MainCategory=Pathology | ||
Line 20: | Line 20: | ||
|MainCategory=Pathology | |MainCategory=Pathology | ||
|SubCategory=Cardiology | |SubCategory=Cardiology | ||
|Prompt=A 63-year-old male presents to the emergency room with complaints of severe chest pain and shortness of breath. Upon work-up, | |Prompt=A 63-year-old male presents to the emergency room with complaints of severe chest pain and shortness of breath. Upon work-up, you diagnose him with myocardial infarction (MI) following appropriate management he is discharged. The patient returns 5 weeks later with complaints of a new-onset low grade fever and chest pain that radiates to the back and is relieved when he leans forward. Cardiac auscultation demonstrates a friction rub. Which of the following pathologic processes is most likely responsible for this patient’s condition? | ||
|Explanation=[[ | |Explanation=[[Dressler syndrome]], an [[autoimmune]] process that occurs 4-6 weeks proceeding [[MI]], results in [[fibrinous pericarditis]] and causes symptoms of low-grade fever and characteristic pericarditis-induced chest pain that is frequently described as radiating to the back and relieved by leaning forward. Patients typically demonstrate signs of [[pericarditis]], such as pericardial [[friction rub]]. | ||
|EducationalObjectives= | |||
Dressler’s syndrome is an autoimmune fibrinous pericarditis that typically | [[Dressler’s syndrome]] is an autoimmune [[fibrinous pericarditis]] that typically manifests 4-6 weeks following MI. | ||
|AnswerA=Increased left ventricular (LV) preload due to left ventricular failure post-MI | |AnswerA=Increased left ventricular (LV) preload due to left ventricular failure post-MI | ||
|AnswerAExp=LV failure is a complication of MI, but the symptoms and | |AnswerAExp=LV failure is a complication of MI, but the patient's symptoms and manifestations do not suggest LV failure. | ||
|AnswerB=Ventricular free wall rupture with subsequent fluid accumulation in the pericardial sac | |AnswerB=Ventricular free wall rupture with subsequent fluid accumulation in the pericardial sac | ||
|AnswerBExp=Ventricular free wall rupture and subsequent cardiac tamponade are life-threatening emergencies. | |AnswerBExp=[[Ventricular free wall rupture]] and subsequent [[cardiac tamponade]] are life-threatening emergencies. Frequent manifestations of [[cardiac tamponade]] are chest pain, hypotension, [[jugular venous distension]], and [[pulsus paradoxus]]. | ||
|AnswerC=New onset cardiac arrhythmia that abolishes the atrial kick | |AnswerC=New onset cardiac arrhythmia that abolishes the atrial kick | ||
|AnswerCExp=Cardiac arrhythmias could result post-MI but their | |AnswerCExp=Cardiac arrhythmias could result post-MI but their manifestation would likely not resemble what is described in the vignette. | ||
|AnswerD=Autoimmune process that causes fibrinous disease | |AnswerD=Autoimmune process that causes fibrinous disease | ||
|AnswerDExp= | |AnswerDExp=[[Dressler syndrome]] is an autoimmune process that frequently results in [[fibrinous pericarditis]]. | ||
|AnswerE=Post-procedural stent thrombosis | |AnswerE=Post-procedural stent thrombosis | ||
|AnswerEExp=Post-procedural stent thrombosis is a complication of percutaneous interventions (PCI). | |AnswerEExp=Post-procedural stent thrombosis is frequently a complication of [[percutaneous interventions]] (PCI). The manifestations in the patient in the vignette are suggestive of a pericardial disease rather than a coronary disease. | ||
|RightAnswer=D | |RightAnswer=D | ||
|WBRKeyword=Dressler | |WBRKeyword=Dressler syndrome, myocardial infarction, MI, pericarditis fibrinous, chest pain, autoimmune | ||
|Approved= | |Approved=Yes | ||
}} | }} |
Revision as of 13:43, 22 July 2014
Author | [[PageAuthor::Rim Halaby, M.D. [1] (Reviewed by Alison Leibowitz)]] |
---|---|
Exam Type | ExamType::USMLE Step 1 |
Main Category | MainCategory::Pathology |
Sub Category | SubCategory::Cardiology |
Prompt | [[Prompt::A 63-year-old male presents to the emergency room with complaints of severe chest pain and shortness of breath. Upon work-up, you diagnose him with myocardial infarction (MI) following appropriate management he is discharged. The patient returns 5 weeks later with complaints of a new-onset low grade fever and chest pain that radiates to the back and is relieved when he leans forward. Cardiac auscultation demonstrates a friction rub. Which of the following pathologic processes is most likely responsible for this patient’s condition?]] |
Answer A | AnswerA::Increased left ventricular (LV) preload due to left ventricular failure post-MI |
Answer A Explanation | AnswerAExp::LV failure is a complication of MI, but the patient's symptoms and manifestations do not suggest LV failure. |
Answer B | AnswerB::Ventricular free wall rupture with subsequent fluid accumulation in the pericardial sac |
Answer B Explanation | [[AnswerBExp::Ventricular free wall rupture and subsequent cardiac tamponade are life-threatening emergencies. Frequent manifestations of cardiac tamponade are chest pain, hypotension, jugular venous distension, and pulsus paradoxus.]] |
Answer C | AnswerC::New onset cardiac arrhythmia that abolishes the atrial kick |
Answer C Explanation | AnswerCExp::Cardiac arrhythmias could result post-MI but their manifestation would likely not resemble what is described in the vignette. |
Answer D | AnswerD::Autoimmune process that causes fibrinous disease |
Answer D Explanation | [[AnswerDExp::Dressler syndrome is an autoimmune process that frequently results in fibrinous pericarditis.]] |
Answer E | AnswerE::Post-procedural stent thrombosis |
Answer E Explanation | [[AnswerEExp::Post-procedural stent thrombosis is frequently a complication of percutaneous interventions (PCI). The manifestations in the patient in the vignette are suggestive of a pericardial disease rather than a coronary disease.]] |
Right Answer | RightAnswer::D |
Explanation | [[Explanation::Dressler syndrome, an autoimmune process that occurs 4-6 weeks proceeding MI, results in fibrinous pericarditis and causes symptoms of low-grade fever and characteristic pericarditis-induced chest pain that is frequently described as radiating to the back and relieved by leaning forward. Patients typically demonstrate signs of pericarditis, such as pericardial friction rub. Educational Objective: Dressler’s syndrome is an autoimmune fibrinous pericarditis that typically manifests 4-6 weeks following MI. |
Approved | Approved::Yes |
Keyword | WBRKeyword::Dressler syndrome, WBRKeyword::myocardial infarction, WBRKeyword::MI, WBRKeyword::pericarditis fibrinous, WBRKeyword::chest pain, WBRKeyword::autoimmune |
Linked Question | Linked:: |
Order in Linked Questions | LinkedOrder:: |