USMLE Forum Archives - USMLE Step 2 CK - IM 2
IM 2
TheOne - 10-27-06 14:41
An 80-year-old woman comes to the urgent care clinic with dyspnea on exertion. On physical
examination, her blood pressure is 100/70 mm Hg, and her pulse is 75. She has no pulsus
paradoxus. Her jugular veins are distended, and she has distant heart sounds. In addition, she
has extra third and fourth heart sounds. Her liver is enlarged, and she has pedal edema. She
has occasional premature ventricular contractions on her electrocardiogram. A chest x-ray
reveals clear lung fields with a dilated cardiac silhouette. Her echocardiogram reveals
ventricular walls with a "speckled pattern. " Which of the following is the most likely diagnosis?
A. Alcoholic cardiomyopathy
B. Amyloidosis
C. Hemochromatosis
D. Tuberculosis
E. Viral myocarditis
TheOne - 10-27-06 14:41
An 80-year-old woman comes to the urgent care clinic with dyspnea on exertion. On physical
examination, her blood pressure is 100/70 mm Hg, and her pulse is 75. She has no pulsus
paradoxus. Her jugular veins are distended, and she has distant heart sounds. In addition, she
has extra third and fourth heart sounds. Her liver is enlarged, and she has pedal edema. She
has occasional premature ventricular contractions on her electrocardiogram. A chest x-ray
reveals clear lung fields with a dilated cardiac silhouette. Her echocardiogram reveals
ventricular walls with a "speckled pattern. " Which of the following is the most likely diagnosis?
A. Alcoholic cardiomyopathy
B. Amyloidosis
C. Hemochromatosis
D. Tuberculosis
E. Viral myocarditis
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#1
Re: IM 2 kingkong - 10-27-06 17:26 amyloidosis.not sure about this answer.please explain the correct answer.
#2
correct
TheOne - 10-29-06 15:53 The correct answer is B. In amyloidosis, the left ventricular wall appears speckled on
the echocardiogram, and there is a restrictive cardiomyopathy. In such a condition,
ventricular filling is impaired, and the cardiac silhouette may be mildly enlarged. An ECG
may reveal a host of nonspecific arrhythmias. Primary cardiac amyloidosis usually
develops into diastolic dysfunction.
Alcoholic cardiomyopathy (choice A) is typically the cause of a biventricular dilated
cardiomyopathy, which leads to both right- and left-sided heart failure. An S3 will be
heard. An echocardiogram will show enlarged left and right ventricles. The walls of the
ventricles may appear very thin and stretched, consistent with volume overload.
Hemochromatosis (choice C) also may cause a restrictive cardiomyopathy, as seen in
amyloidosis. However, the speckled pattern mentioned above would be absent. Other
noncardiac features include bronzing of the skin and diabetes.
Tuberculosis (choice D) may cause a chronic tuberculous pericarditis that can manifest
clinical symptoms similar to those seen in constrictive cardiomyopathy. The presentation
is similar to that seen with restrictive features. However, patients tend to have normal
ventricular wall thickness on echocardiogram, pericardial calcification, an absent S3, and
S4.
Viral myocarditis (choice E), like alcohol, can lead to a dilated cardiomyopathy.
Unfortunately, such conditions may progress to complete left and right ventricular failure,
ultimately requiring cardiac transplantation in refractory cases.
#4
Re: IM 2 bingousmle - 07-20-10 01:59 speckled pattern is the buzz word here for a diagnosis of cardiac amyloidosis.. and all the physical findings are suggestive of cardiomyopathy
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