WBR0002: Difference between revisions
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|SubCategory=Cardiovascular | |SubCategory=Cardiovascular | ||
|Prompt=A 68 year old man presents to the Emergency Room after losing consciousness while climbing stairs. He denies any pre-syncopal symptoms, or any past history of neurologic conditions. However, the patient reports having experienced increasing dyspnea and chest pain on exertion over the past 3 years. Which carotid pulse pattern is most likely to be seen in this patient? | |Prompt=A 68 year old man presents to the Emergency Room after losing consciousness while climbing stairs. He denies any pre-syncopal symptoms, or any past history of neurologic conditions. However, the patient reports having experienced increasing dyspnea and chest pain on exertion over the past 3 years. Which carotid pulse pattern is most likely to be seen in this patient? | ||
|Explanation=The patient in this vignette most likely suffers from aortic stenosis. [[Aortic stenosis]] most commonly develops as an age related calcification of a three-leafed aortic valve in the elderly population (late 60s to 80s). Calcification leading to stenosis occurs earlier in patients with[[ bicuspid valves]], often in their 40s to 50s. Aortic stenosis causes pulsus parvus et tardus, a pulse which is weak/small (parvus), and late (tardus) relative to its expected character due to outflow obstruction at the aortic valve. | |Explanation=The patient in this vignette most likely suffers from aortic stenosis. [[Aortic stenosis]] most commonly develops as an age related calcification of a three-leafed aortic valve in the elderly population (late 60s to 80s). Calcification leading to stenosis occurs earlier in patients with[[ bicuspid valves]], often in their 40s to 50s. Aortic stenosis causes pulsus parvus et tardus, a pulse which is weak/small (parvus), and late (tardus) relative to its expected character due to outflow obstruction at the aortic valve. The symptoms of aortic stenosis can be remembered with the mnemonic: SAD | ||
* Syncope | |||
* Angina | |||
* Dyspnea | |||
'''Educational Objective:''' Aortic stenosis causes pulsus parvus et tardus, a pulse which is weak/small (parvus), and late (tardus) relative to its expected character due to outflow obstruction at the aortic valve. | |||
'''References:''' [http://www.youtube.com/watch?v=9a1GEuVTES8 video tutorial (2:08)] | '''References:''' [http://www.youtube.com/watch?v=9a1GEuVTES8 video tutorial (2:08)] | ||
|AnswerA=Pulsus bisferiens | |AnswerA=Pulsus bisferiens | ||
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|RightAnswer=C | |RightAnswer=C | ||
|WBRKeyword=Aortic stenosis, Waveform, Carotid waveform, Carotid pulse, Carotid, Pulse, Pulsus | |WBRKeyword=Aortic stenosis, Waveform, Carotid waveform, Carotid pulse, Carotid, Pulse, Pulsus | ||
|Approved= | |Approved=Yes | ||
}} | }} | ||
Revision as of 12:11, 27 September 2013
| Author | PageAuthor::Raviteja Reddy Guddeti |
|---|---|
| Exam Type | ExamType::USMLE Step 2 CK |
| Main Category | MainCategory::Internal medicine |
| Sub Category | SubCategory::Cardiovascular |
| Prompt | [[Prompt::A 68 year old man presents to the Emergency Room after losing consciousness while climbing stairs. He denies any pre-syncopal symptoms, or any past history of neurologic conditions. However, the patient reports having experienced increasing dyspnea and chest pain on exertion over the past 3 years. Which carotid pulse pattern is most likely to be seen in this patient?]] |
| Answer A | AnswerA::Pulsus bisferiens |
| Answer A Explanation | [[AnswerAExp::Pulsus bisferiens is a pulse characterized by two strong systolic peaks separated by a midsystolic dip, most commonly occurring in pure aortic regurgitation with stenosis.]] |
| Answer B | AnswerB::Pulsus paradoxus |
| Answer B Explanation | [[AnswerBExp::Pulsus paradoxus is the hallmark of tamponade. It is defined as drop in systolic blood pressure by more than 10 mm Hg during inspiration. It is also seen in asthma and COPD.]] |
| Answer C | AnswerC::Pulsus parvus et tardus |
| Answer C Explanation | AnswerCExp::See explanation |
| Answer D | AnswerD::Pulsus alternans |
| Answer D Explanation | [[AnswerDExp::Pulsus alternans refers to a pulse showing alternating strong and weak beats. It is observed in congestive heart failure and its presence carries a poor prognosis.]] |
| Answer E | AnswerE::Pulsus bigeminus |
| Answer E Explanation | [[AnswerEExp::Pulsus bigeminus refers to a “bigeminal” pulse: a pulse characterized by two beats occur in rapid succession, the groups of two being separated by a longer interval. It is seen in hypertrophic cardiomyopathy.]] |
| Right Answer | RightAnswer::C |
| Explanation | [[Explanation::The patient in this vignette most likely suffers from aortic stenosis. Aortic stenosis most commonly develops as an age related calcification of a three-leafed aortic valve in the elderly population (late 60s to 80s). Calcification leading to stenosis occurs earlier in patients withbicuspid valves, often in their 40s to 50s. Aortic stenosis causes pulsus parvus et tardus, a pulse which is weak/small (parvus), and late (tardus) relative to its expected character due to outflow obstruction at the aortic valve. The symptoms of aortic stenosis can be remembered with the mnemonic: SAD
Educational Objective: Aortic stenosis causes pulsus parvus et tardus, a pulse which is weak/small (parvus), and late (tardus) relative to its expected character due to outflow obstruction at the aortic valve.
References: video tutorial (2:08) |
| Approved | Approved::Yes |
| Keyword | WBRKeyword::Aortic stenosis, WBRKeyword::Waveform, WBRKeyword::Carotid waveform, WBRKeyword::Carotid pulse, WBRKeyword::Carotid, WBRKeyword::Pulse, WBRKeyword::Pulsus |
| Linked Question | Linked:: |
| Order in Linked Questions | LinkedOrder:: |