nbme form 2 q

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nbme form 2 q

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mazinger
Forum Guru
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Topics: 46
Posts: 920

10/14/06 - 10:06 AM

I found this in another forum and I just got a little intrigued... so guys what do you think is the answer?

A 67-year-old man comes to the physician because of a 2-month history
of progressive shortness of breath. He has had a 4.5-kg (10-lb) weight
loss over the past 4 months. He has not had chest pain. He has
congestive heart failure treated with furosemide, digoxin, and enalapril. He
has smoked two packs of cigarettes daily for 30 years. He appears
alert and is in no acute distress. His temperature is 37.2 C (99 F), blood
pressure is 140/85 mm Hg, pulse is 84/min, and respirations are 18/min.
Examination shows no jugular venous distention. There is dullness to
percussion, and breath sounds are decreased at the left base. Cardiac
examination shows a laterally displaced point of maximal impulse, normal
S1 and S2, and an S3 at the apex. There is 1+ edema over the
extremities. An x-ray film of the chest shows an enlarged cardiac silhouette,
left hilar fullness, and a moderate-sized left pleural effusion.
Thoracentesis yields straw-colored fluid. Laboratory studies show:

Serum
Glucose 90 mg/dL
Protein 7 g/dL
Lactate dehydrogenase 300 U/L

Pleural fluid
pH 7.25
Glucose 75 mg/dL
Protein 4.5 g/dL
Lactate dehydrogenase 280 U/L

Leukocyte count 2000/mm3
Segmented neutrophils 15%
Lymphocytes 85%

A Gram's stain and acid-fast stains are negative for any organisms.
Which of the following is the most likely cause of this patient's pleural effusion?

A
) Bacterial pneumonia

B
) Collagen vascular disease

C
) Congestive heart failure

D
) Malignancy

E
) Pulmonary embolus with infarction

F
) Viral pleuritis

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original mazinger z

p00nam
Forum Newbie

Topics: 4
Posts: 13

10/14/06 - 02:50 PM

i would say viral pleuritis because it is an exudative effusion and there is leukopenia with lymphocytosis.

mazinger
Forum Guru
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Topics: 46
Posts: 920

10/14/06 - 04:00 PM

good point on that, but this could also be thinking of a possible neoplasm... I am not sure which one to pick, but from my perspective its definetely not a transudate nor related to pyo bacteria..

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original mazinger z

p00nam
Forum Newbie

Topics: 4
Posts: 13

10/14/06 - 06:22 PM

i think malignancy is the right answer, bcoz lymphocytosis is one of the features of malignancy.
i just jumped to the answer.
thanks

Renegade
Forum Elite

Topics: 18
Posts: 171

10/15/06 - 05:00 PM

Thoracentesis liquid is suggestive for viral, but can't exclude malignancy.

mazinger wrote:
He has had a 4.5-kg (10-lb) weight
loss over the past 4 months

No virus does this.

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«The desire to take medicine is perhaps the greatest feature which distinguishes man from animals.» W. Osler

kikeenrique
Forum Newbie

Topics: 0
Posts: 1

10/16/06 - 06:53 AM

left hilar fullness
has smoked two packs of cigarettes daily for 30 years
He appears alert and is in no acute distress. (No A,E,F)
Thoracentesis yields straw-colored fluid (No B, C).

Malignancy !!!

Guptashutosh
Forum Elite

Topics: 35
Posts: 354

10/16/06 - 12:15 PM

viral inf , bact inf, pul embolus..will not have months of history, aef out
ccf wil give transudate , c out
no evidence of collagen dis , b out
D is the ans

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