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{{WBRQuestion
{{WBRQuestion
|QuestionAuthor={{Rim}} {{Alison}}
|QuestionAuthor={{Rim}}
|ExamType=USMLE Step 1
|ExamType=USMLE Step 1
|MainCategory=Pathology
|MainCategory=Pathology
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|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, 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?
|Prompt=A 63 year old male patient presents to the emergency department with severe chest pain and dyspnea.  Following rapid work-up, the diagnosis of myocardial infarction (MI) is made. The patient undergoes appropriate management and is discharged home.  The patient returns 5 weeks later to the emergency department with complains of a new-onset low grade fever and chest pain that radiates to the back and is relieved when leaning forward.  Cardiac auscultation shows friction rub. Which of the following pathologic processes is responsible for this patient’s new condition?
|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]].
|Explanation=[[Dressler’s syndrome]] is an [[autoimmune]] process that occurs 4-6 weeks after [[MI]].  It results in [[fibrinous pericarditis]] and causes symptoms of low-grade fever and characteristic pericarditis-induced chest pain that is classically described as radiating to the back and is relieved by leaning forward.  Patients typically have signs of [[pericarditis]] on physical examination, such as pericardial [[friction rub]].


|EducationalObjectives= [[Dressler’s syndrome]] is an autoimmune [[fibrinous pericarditis]] that typically manifests 4-6 weeks following MI.
Educational Objective:
|References= First Aid 2014 page 288
Dressler’s syndrome is an autoimmune fibrinous pericarditis that typically occurs 4-6 weeks after 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 patient's symptoms and manifestations do not suggest LV failure.
|AnswerAExp=LV failure is a complication of MI, but the symptoms and signs of the patient in the vignette 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.  Frequent manifestations of [[cardiac tamponade]] are chest pain, hypotension, [[jugular venous distension]], and [[pulsus paradoxus]].
|AnswerBExp=Ventricular free wall rupture and subsequent cardiac tamponade are life-threatening emergencies.  Symptoms of cardiac tamponade are chest pain, hypotension, jugular venous distension, and pulsus paradoxus.
|AnswerC=Recent 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 manifestation would likely not resemble what is described in the vignette.
|AnswerCExp=Cardiac arrhythmias could result post-MI but their presentation would not be like that in the vignette.
|AnswerD=Autoimmune process that causes fibrinous disease
|AnswerD=Autoimmune process that causes fibrinous disease
|AnswerDExp=[[Dressler syndrome]] is an autoimmune process that frequently results in [[fibrinous pericarditis]].
|AnswerDExp=Dressler’s syndrome is an autoimmune process that causes fibrinous pericarditis.
|AnswerE=Post-procedural stent thrombosis
|AnswerE=Post-procedural stent thrombosis
|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.
|AnswerEExp=Post-procedural stent thrombosis is a complication of percutaneous interventions (PCI).  Symptoms and signs would not be similar to the patient in the vignette that are strongly suggestive of a pericardial disease rather than a coronary disease.
|RightAnswer=D
|RightAnswer=D
|WBRKeyword=Dressler syndrome, myocardial infarction, MI, pericarditis fibrinous, chest pain, autoimmune
|WBRKeyword=Dressler's, syndrome, myocardial, infarction, pericarditis, fibrinous, chest, pain, autoimmune
|Approved=Yes
|Approved=No
}}
}}

Revision as of 19:42, 18 September 2014
Author [[PageAuthor::Rim Halaby, M.D. [1]]]
Exam Type ExamType::USMLE Step 1
Main Category MainCategory::Pathology
Sub Category SubCategory::Cardiology
Prompt [[Prompt::A 63 year old male patient presents to the emergency department with severe chest pain and dyspnea. Following rapid work-up, the diagnosis of myocardial infarction (MI) is made. The patient undergoes appropriate management and is discharged home. The patient returns 5 weeks later to the emergency department with complains of a new-onset low grade fever and chest pain that radiates to the back and is relieved when leaning forward. Cardiac auscultation shows friction rub. Which of the following pathologic processes is responsible for this patient’s new 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 symptoms and signs of the patient in the vignette 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. Symptoms 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 presentation would not be like that in the vignette.
Answer D AnswerD::Autoimmune process that causes fibrinous disease
Answer D Explanation AnswerDExp::Dressler’s syndrome is an autoimmune process that causes fibrinous pericarditis.
Answer E AnswerE::Post-procedural stent thrombosis
Answer E Explanation [[AnswerEExp::Post-procedural stent thrombosis is a complication of percutaneous interventions (PCI). Symptoms and signs would not be similar to the patient in the vignette that are strongly suggestive of a pericardial disease rather than a coronary disease.]]
Right Answer RightAnswer::D
Explanation [[Explanation::Dressler’s syndrome is an autoimmune process that occurs 4-6 weeks after MI. It results in fibrinous pericarditis and causes symptoms of low-grade fever and characteristic pericarditis-induced chest pain that is classically described as radiating to the back and is relieved by leaning forward. Patients typically have signs of pericarditis on physical examination, such as pericardial friction rub.

Educational Objective: Dressler’s syndrome is an autoimmune fibrinous pericarditis that typically occurs 4-6 weeks after MI.
Educational Objective:
References: ]]

Approved Approved::No
Keyword WBRKeyword::Dressler's, WBRKeyword::syndrome, WBRKeyword::myocardial, WBRKeyword::infarction, WBRKeyword::pericarditis, WBRKeyword::fibrinous, WBRKeyword::chest, WBRKeyword::pain, WBRKeyword::autoimmune
Linked Question Linked::
Order in Linked Questions LinkedOrder::
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