WBR0461: Difference between revisions

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{{WBRQuestion
{{WBRQuestion
|QuestionAuthor={{Rim}}, {{AJL}} {{Alison}}
|QuestionAuthor={{YD}} (Reviewed by {{YD}})
|ExamType=USMLE Step 1
|ExamType=USMLE Step 1
|MainCategory=Pathology
|MainCategory=Pathology
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|MainCategory=Pathology
|MainCategory=Pathology
|SubCategory=Cardiology
|SubCategory=Cardiology
|MainCategory=Pathology
|MainCategory=Pathology
|MainCategory=Pathology
|MainCategory=Pathology
|MainCategory=Pathology
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|MainCategory=Pathology
|MainCategory=Pathology
|SubCategory=Cardiology
|SubCategory=Cardiology
|Prompt=A 62-year-old male heavy smoker is brought to the emergency room for severe chest pain and dyspnea at rest, both manifesting 30 minutes prior to presentation. The patient has a history of hyperlipidemia, uncontrolled diabetes mellitus for more than 15 years, and hypertension. Upon appropriate work-up, you diagnose him with acute myocardial infarction (MI). The patient dies despite resuscitation efforts. Which of the following is the most likely cause of death in this patient?
|Prompt=A 62-year-old man is brought to the emergency department (ED) for severe chest pain and dyspnea at rest for the past 30 minutes. The patient has a medical history significant for hyperlipidemia, uncontrolled diabetes mellitus for more than 15 years, and hypertension. He smokes 2 packs of cigarettes each day for the past 40 years. In the ED, ECG shows ST-segment-elevation more than 2 consecutive leads, and serum troponin level is markedly elevated. The patient is diagnosed with ST-segment-elevation myocardial infarction (STEMI). Despite appropriate and timely management in the ED, the patient dies. Which of the following is this patient's most likely cause of death?
|Explanation=The most common cause of death in patients with [[myocardial infarction]] (MI) are fatal [[ventricular arrhythmias]] prior to presentation. [[Arrhythmia]] is the most frequently occurring acute adverse event in the first 12 hours following MI.
|Explanation=The most common cause of death in patients with [[myocardial infarction]] (MI) are fatal [[ventricular arrhythmias]] prior to presentation. [[Arrhythmia]] is the most frequently occurring acute adverse event in the first 12 hours following MI.
|EducationalObjectives= The most common cause of death in patients with [[myocardial infarction]] (MI) are fatal [[ventricular arrhythmias]] prior to presentation. [[Arrhythmia]] is the most frequently occurring acute adverse event in the first 12 hours following MI.
|References= First Aid 2014 page 290
|AnswerA=Arrhythmia
|AnswerA=Arrhythmia
|AnswerAExp=Fatal [[ventricular arrhythmia]] is the most common cause of death in the first few hours following MI.
|AnswerAExp=Fatal [[ventricular arrhythmia]] is the most common cause of death in the first few hours following MI.
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|AnswerC=Dressler syndrome
|AnswerC=Dressler syndrome
|AnswerCExp=[[Dressler syndrome]], an autoimmune [[fibrinous pericarditis]], occurs several weeks following MI.
|AnswerCExp=[[Dressler syndrome]], an autoimmune [[fibrinous pericarditis]], occurs several weeks following MI.
|AnswerD=Cardiac tamponade  
|AnswerD=Cardiac tamponade
|AnswerDExp=[[Cardiac tamponade]] results in an overall cardiovascular collapse due to severe hypotension. [[Cardiac tamponade]] stems from a pericardial effusion, which restricts the normal expansion of the ventricles and leads to the normalization of pressures in all cardiac chambers.  [[Cardiac tamponade]] does not typically occur acutely after MI where myocardial rupture eventually leads to fluid accumulation within the pericardium and [[cardiac tamponade]].  
|AnswerDExp=[[Cardiac tamponade]] results in an overall cardiovascular collapse due to severe hypotension. [[Cardiac tamponade]] stems from a pericardial effusion, which restricts the normal expansion of the ventricles and leads to the normalization of pressures in all cardiac chambers.  [[Cardiac tamponade]] does not typically occur acutely after MI where myocardial rupture eventually leads to fluid accumulation within the pericardium and [[cardiac tamponade]].
|AnswerE=Endocarditis
|AnswerE=Endocarditis
|AnswerEExp=[[Endocarditis]], not frequently a complication of MI, may arise in valvulopathies, potentially caused by a past MI.  
|AnswerEExp=[[Endocarditis]], not frequently a complication of MI, may arise in valvulopathies, potentially caused by a past MI.
|EducationalObjectives=The most common cause of death in patients with [[myocardial infarction]] (MI) are fatal [[ventricular arrhythmias]] prior to presentation. [[Arrhythmia]] is the most frequently occurring acute adverse event in the first 12 hours following MI.
|References=First Aid 2014 page 290
|RightAnswer=A
|RightAnswer=A
|WBRKeyword=chest pain, ventricular arrhythmia, fibrillation, cardiac arrest, cardiology, cardiovascular system, MI, Myocardial infraction
|WBRKeyword=Chest pain, Ventricular arrhythmia, Fibrillation, Cardiac arrest, MI, Myocardial infraction, STEMI, Arrhythmia, Death
|Approved=Yes
|Approved=Yes
}}
}}

Revision as of 19:14, 21 October 2014
Author [[PageAuthor::Yazan Daaboul, M.D. (Reviewed by Yazan Daaboul, M.D.)]]
Exam Type ExamType::USMLE Step 1
Main Category MainCategory::Pathology
Sub Category SubCategory::Cardiology
Prompt [[Prompt::A 62-year-old man is brought to the emergency department (ED) for severe chest pain and dyspnea at rest for the past 30 minutes. The patient has a medical history significant for hyperlipidemia, uncontrolled diabetes mellitus for more than 15 years, and hypertension. He smokes 2 packs of cigarettes each day for the past 40 years. In the ED, ECG shows ST-segment-elevation more than 2 consecutive leads, and serum troponin level is markedly elevated. The patient is diagnosed with ST-segment-elevation myocardial infarction (STEMI). Despite appropriate and timely management in the ED, the patient dies. Which of the following is this patient's most likely cause of death?]]
Answer A AnswerA::Arrhythmia
Answer A Explanation [[AnswerAExp::Fatal ventricular arrhythmia is the most common cause of death in the first few hours following MI.]]
Answer B AnswerB::Ventricular rupture
Answer B Explanation [[AnswerBExp::A ventricular rupture is a potentially fatal complication of MI, typically occurring within the subsequent 5-7 days. The severely injured ventricular wall results in a rupture, which occurs during the inflammatory response induced by the infarction process.]]
Answer C AnswerC::Dressler syndrome
Answer C Explanation [[AnswerCExp::Dressler syndrome, an autoimmune fibrinous pericarditis, occurs several weeks following MI.]]
Answer D AnswerD::Cardiac tamponade
Answer D Explanation [[AnswerDExp::Cardiac tamponade results in an overall cardiovascular collapse due to severe hypotension. Cardiac tamponade stems from a pericardial effusion, which restricts the normal expansion of the ventricles and leads to the normalization of pressures in all cardiac chambers. Cardiac tamponade does not typically occur acutely after MI where myocardial rupture eventually leads to fluid accumulation within the pericardium and cardiac tamponade.]]
Answer E AnswerE::Endocarditis
Answer E Explanation [[AnswerEExp::Endocarditis, not frequently a complication of MI, may arise in valvulopathies, potentially caused by a past MI.]]
Right Answer RightAnswer::A
Explanation [[Explanation::The most common cause of death in patients with myocardial infarction (MI) are fatal ventricular arrhythmias prior to presentation. Arrhythmia is the most frequently occurring acute adverse event in the first 12 hours following MI.

Educational Objective: The most common cause of death in patients with myocardial infarction (MI) are fatal ventricular arrhythmias prior to presentation. Arrhythmia is the most frequently occurring acute adverse event in the first 12 hours following MI.
References: First Aid 2014 page 290]]

Approved Approved::Yes
Keyword WBRKeyword::Chest pain, WBRKeyword::Ventricular arrhythmia, WBRKeyword::Fibrillation, WBRKeyword::Cardiac arrest, WBRKeyword::MI, WBRKeyword::Myocardial infraction, WBRKeyword::STEMI, WBRKeyword::Arrhythmia, WBRKeyword::Death
Linked Question Linked::
Order in Linked Questions LinkedOrder::
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