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|QuestionAuthor=Aarti Narayan MBBS, Raviteja Reddy Guddeti MBBS | |QuestionAuthor=Aarti Narayan MBBS, Raviteja Reddy Guddeti MBBS | ||
|ExamType=USMLE Step 3 | |ExamType=USMLE Step 3 | ||
|Prompt=A 75-year-old male presents to the ER with chest pain of 20 minutes duration. His EKG shows ST-elevation in the anterior precordial leads, and laboratory studies show an elevation of cardiac enzymes. The patient is found to have 3 vessel disease on coronary angiography. Immediate CABG is performed and the patient recovers post-surgery. He is discharged in stable condition. The patient presents again to the ER two weeks later, this time complaining of severe retrosternal chest pain that radiates to the back. On further inquiry, he mentions that his pain is aggravated by lying down and alleviated by sitting up and leaning forward. What is the most probable diagnosis? | |||
|Prompt=A 75 | |||
|Explanation=The correct answer is post-pericardiotomy syndrome. The post-pericardiotomy syndrome is inflammation of the pericardium (the sac surrounding the heart) that occurs following cardiac surgery. Symptoms can occur from days to weeks after the operation. The syndrome is thought to have an autoimmune basis. | |Explanation=The correct answer is post-pericardiotomy syndrome. The post-pericardiotomy syndrome is inflammation of the pericardium (the sac surrounding the heart) that occurs following cardiac surgery. Symptoms can occur from days to weeks after the operation. The syndrome is thought to have an autoimmune basis. | ||
|AnswerA=Dressler’s syndrome | |AnswerA=Dressler’s syndrome | ||
|AnswerAExp=Dressler's syndrome | |AnswerAExp='''Incorrect:''' [[Dressler's syndrome]] is a form of pericarditis that occurs secondary to injury to the heart, most commonly as a result of myocardial infarction. Dressler's syndrome typically occurs 2 to 10 weeks after myocardial infarction. | ||
|AnswerB=Post-myocardial infarction pericarditis | |AnswerB=Post-myocardial infarction pericarditis | ||
|AnswerBExp=Post-myocardial infarction pericarditis, | |AnswerBExp='''Incorrect:'''Post-myocardial infarction pericarditis, much like Dressler's syndrome, is a pericarditis which occurs after a myocardial infarction. However Dressler's syndrome will occur 2-10 weeks after an MI, whereas post-myocardial infarction pericarditis typically occurs 2-4 days after a myocardial infarction. | ||
|AnswerC=Post-pericardiotomy syndrome | |AnswerC=Post-pericardiotomy syndrome | ||
|AnswerCExp=Post- | |AnswerCExp='''Correct:''' Post-pericardiotomy syndrome is the correct answer. | ||
|AnswerD=Pulmonary embolism | |AnswerD=Pulmonary embolism | ||
|AnswerDExp=Pulmonary embolism | |AnswerDExp='''Incorrect:''' Pulmonary embolism refers to the blockage of the pulmonary vasculature by a substance from elsewhere in the body, most commonly a blood clot. Pulmonary embolism is associated with sudden onset chest pain, tachycardia, and shortness of breath. Risk factors for pulmonary embolism include immobility, a past thromboembolic event, and any other causes of hypercoagulable state. | ||
|AnswerE=Idiopathic | |AnswerE=Idiopathic | ||
|AnswerEExp=The history of the patient suggests that cardiac surgery is the inciting factor for the pericarditis in this case. | |AnswerEExp='''Incorrect:''' The history of the patient suggests that cardiac surgery is the inciting factor for the pericarditis in this case. | ||
|RightAnswer=C | |RightAnswer=C | ||
|WBRKeyword=Pericarditis, Myocardial, MI, Myocardial infarction, CABG, Chest pain, Chest, | |||
|Approved=Yes | |Approved=Yes | ||
}} | }} | ||
Revision as of 02:12, 2 October 2013
| Author | PageAuthor::Aarti Narayan MBBS, Raviteja Reddy Guddeti MBBS |
|---|---|
| Exam Type | ExamType::USMLE Step 3 |
| Main Category | |
| Sub Category | |
| Prompt | [[Prompt::A 75-year-old male presents to the ER with chest pain of 20 minutes duration. His EKG shows ST-elevation in the anterior precordial leads, and laboratory studies show an elevation of cardiac enzymes. The patient is found to have 3 vessel disease on coronary angiography. Immediate CABG is performed and the patient recovers post-surgery. He is discharged in stable condition. The patient presents again to the ER two weeks later, this time complaining of severe retrosternal chest pain that radiates to the back. On further inquiry, he mentions that his pain is aggravated by lying down and alleviated by sitting up and leaning forward. What is the most probable diagnosis?]] |
| Answer A | AnswerA::Dressler’s syndrome |
| Answer A Explanation | [[AnswerAExp::Incorrect: Dressler's syndrome is a form of pericarditis that occurs secondary to injury to the heart, most commonly as a result of myocardial infarction. Dressler's syndrome typically occurs 2 to 10 weeks after myocardial infarction.]] |
| Answer B | AnswerB::Post-myocardial infarction pericarditis |
| Answer B Explanation | [[AnswerBExp::Incorrect:Post-myocardial infarction pericarditis, much like Dressler's syndrome, is a pericarditis which occurs after a myocardial infarction. However Dressler's syndrome will occur 2-10 weeks after an MI, whereas post-myocardial infarction pericarditis typically occurs 2-4 days after a myocardial infarction.]] |
| Answer C | AnswerC::Post-pericardiotomy syndrome |
| Answer C Explanation | AnswerCExp::'''Correct:''' Post-pericardiotomy syndrome is the correct answer. |
| Answer D | AnswerD::Pulmonary embolism |
| Answer D Explanation | [[AnswerDExp::Incorrect: Pulmonary embolism refers to the blockage of the pulmonary vasculature by a substance from elsewhere in the body, most commonly a blood clot. Pulmonary embolism is associated with sudden onset chest pain, tachycardia, and shortness of breath. Risk factors for pulmonary embolism include immobility, a past thromboembolic event, and any other causes of hypercoagulable state.]] |
| Answer E | AnswerE::Idiopathic |
| Answer E Explanation | AnswerEExp::'''Incorrect:''' The history of the patient suggests that cardiac surgery is the inciting factor for the pericarditis in this case. |
| Right Answer | RightAnswer::C |
| Explanation | [[Explanation::The correct answer is post-pericardiotomy syndrome. The post-pericardiotomy syndrome is inflammation of the pericardium (the sac surrounding the heart) that occurs following cardiac surgery. Symptoms can occur from days to weeks after the operation. The syndrome is thought to have an autoimmune basis. Educational Objective: |
| Approved | Approved::Yes |
| Keyword | WBRKeyword::Pericarditis, WBRKeyword::Myocardial, WBRKeyword::MI, WBRKeyword::Myocardial infarction, WBRKeyword::CABG, WBRKeyword::Chest pain, WBRKeyword::Chest |
| Linked Question | Linked:: |
| Order in Linked Questions | LinkedOrder:: |