USMLE Forum Archives - USMLE Step 2 CK - A 65-year-old white male
A 65-year-old white male
meduploader - 05-07-09 13:58
A 65-year-old white male who is known to have benign prostatic hyperplasia presents to the emergency room with altered mental status. He is febrile and had two episodes of vomiting this morning. He is also known to have type II DM for the last seven years. His medications include aspirin, finasteride, insulin and captopril. On examination, his vitals are as follows: BP: 70/50 mmHg, Temperature: 40C (103F), RR 15/min, pulse rate 110/min. Significant findings on examination are muffled heart sounds and bilateral crackles up to the scapulae. There is no jugular venous distension or ankle edema. He is given IV antibiotics and oxygen. An indwelling urinary catheter is passed and urine output is measured at 20 ml/hour. Urine and blood are sent for culture. Right heart catheterization shows pulmonary capillary wedge pressure of 30 mm Hg and a mean right atrial pressure of 11 mmHg. Based on these findings, what is the most likely cause of shock in this patient?
meduploader - 05-07-09 13:58
A 65-year-old white male who is known to have benign prostatic hyperplasia presents to the emergency room with altered mental status. He is febrile and had two episodes of vomiting this morning. He is also known to have type II DM for the last seven years. His medications include aspirin, finasteride, insulin and captopril. On examination, his vitals are as follows: BP: 70/50 mmHg, Temperature: 40C (103F), RR 15/min, pulse rate 110/min. Significant findings on examination are muffled heart sounds and bilateral crackles up to the scapulae. There is no jugular venous distension or ankle edema. He is given IV antibiotics and oxygen. An indwelling urinary catheter is passed and urine output is measured at 20 ml/hour. Urine and blood are sent for culture. Right heart catheterization shows pulmonary capillary wedge pressure of 30 mm Hg and a mean right atrial pressure of 11 mmHg. Based on these findings, what is the most likely cause of shock in this patient?
The correct answer and explanation will be available after you answer.
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#15
Re: A 65-year-old white male Youngdoctor - 06-13-09 20:50 My answer is: a.
The Pulmonary wedge pressure (PWP) (also commonly known as a Pulmonary capillary wedge pressure or PCWP, or Pulmonary artery occlusion pressure or PAOP), as measured by a pulmonary artery catheter, is the pressure measured in a pulmonary artery distal to an occlusion of that artery.
Physiologically, distinctions can be drawn among pulmonary venous pressure, pulmonary artery pressure, pulmonary wedge pressure, and left atrial pressure, but not all of these can be measured in a clinical context.
Noninvasive estimation techniques have been proposed.
Clinical significance
Because of the large compliance of the pulmonary circulation, it provides an indirect measure of the left atrial pressure.
For example, it is considered the gold standard for determining the cause of acute pulmonary edema; this is likely to be present at a PWP of >20mmHg. It has also been used to diagnose severity of left ventricular failure and mitral stenosis
Physiological pressure: 6-12 mm Hg.
#54
Re: A 65-year-old white male ammulufy - 03-13-10 19:35 My answer is: d.
Bilateral basal crackles is suggestive of pulmonary edema,a sequelae of left ventricular dysfunction.....Rt side of d heart is absolutely normal bcos there not features suggestive of RHF....ptnt also doesnt hav any fever wid chills n rigors indicative of UTI.....constrictive pericarditis presents with a characteristic chest pain with positional variation.....hence even pericardial tamponade is not the answer.
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