USMLE Forum Archives - USMLE Step 3 - A 74-year-old man
A 74-year-old man
meduploader - 05-07-09 11:26
A 74-year-old man is hospitalized after a 90-minute episode of lightheadedness and severe nausea that occurred earlier today but that has now almost completely resolved. The patient had a myocardial infarction 8 years ago. He has had no chest pain since then and is quite active. Current medications are atenolol, simvastatin, and aspirin, 81 mg.
On physical examination, he appears well. Temperature is 36.7 °C (98.0 °F), pulse rate is 84/min and regular, respiration rate is 14/min, and blood pressure is 130/80 mm Hg. The remainder of the examination is normal.
Laboratory Studies
Hemoglobin
15.2 g/dL
Leukocyte count
8700/μL
Serum creatine kinase
48 U/L
Serum troponin I
0.2 mg/mL (normal:
meduploader - 05-07-09 11:26
A 74-year-old man is hospitalized after a 90-minute episode of lightheadedness and severe nausea that occurred earlier today but that has now almost completely resolved. The patient had a myocardial infarction 8 years ago. He has had no chest pain since then and is quite active. Current medications are atenolol, simvastatin, and aspirin, 81 mg.
On physical examination, he appears well. Temperature is 36.7 °C (98.0 °F), pulse rate is 84/min and regular, respiration rate is 14/min, and blood pressure is 130/80 mm Hg. The remainder of the examination is normal.
Laboratory Studies
Hemoglobin
15.2 g/dL
Leukocyte count
8700/μL
Serum creatine kinase
48 U/L
Serum troponin I
0.2 mg/mL (normal:
The correct answer and explanation will be available after you answer.
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#2
Re: A 74-year-old man
meduploader - 05-07-09 11:31 Serum troponin I
0.2 mg/mL (normal: less than0.5 mg/mL)
Blood urea nitrogen
19 mg/dL
Serum creatinine
1.1 mg/dL
INR
1.2
Serum aspartate aminotransferase
1800 U/L
Serum alanine aminotransferase
2400 U/L
Serum alkaline phosphatase
145 U/L
Serum total bilirubin
1.6 mg/dL
Serum amylase
90 U/L
An electrocardiogram shows sinus rhythm at a rate of 70/min with an occasional ventricular premature contraction, an old inferior wall myocardial infarction, and no acute ST- or T-wave changes. Ultrasonography of the right upper abdominal quadrant shows gallstones; the common bile duct and pancreas are normal.
Simvastatin is stopped; aspirin and atenolol are continued. On hospital days 1 and 2, he has three episodes of nonsustained ventricular tachycardia. On hospital day 3, results of all laboratory studies are normal.
(note: Why the moderator/ adminstrator is not fixing this prob while repeatedly asked abt that when symbols of more than or less than comes, it truncates the post)
#9
Re: A 74-year-old man zkadhem - 07-14-09 14:56 I didn't read the rest of the question.
Nice question and informative explanation.Thanks.
#20
Re: A 74-year-old man babbu5508 - 07-28-10 05:29 My answer is: a.
90-minute episode of lightheadedness and severe nausea that occurred earlier today but that has now almost completely resolved...
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