Aashi
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A 14-year-old boy is brought to the emergency department after he collapsed on the high school football field during a game. He is awake and alert but is unable to tell you exactly what happened. His teammate says that the patient was running down the field and was about to catch the ball, but he collapsed before he even made contact with the ball. The patient remembers becoming dizzy before he collapsed, but he did not experience any arrest of motion during this time. He has no medical conditions and does not take any medications. He is sexually active with 2 different girls and they "sometimes" use condoms for protection. His temperature is 36.7 C (98.0 F), blood pressure is 110/70 mm Hg, pulse is 100/min, and respirations are 14/min. Physical examination is normal. Blood is drawn and sent for evaluation of electrolytes, BUN, creatinine, magnesium, and calcium. The most appropriate next step is to
A. admit him for cardiac monitoring
B. order echocardiography
C. order electrocardiography
D. order electroencephalography
E. request consultation with a neurologist
F. schedule a tilt-table test
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| CocaCola
Forum Guru
Topics: 35
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C - ECG
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| prathapdoctor
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first i will go for tilt table test,if its negative then i will go for echo cardiography.
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| drashishmahajan
Forum Senior
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B--
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| Guptashutosh
Forum Elite
Topics: 35
Posts: 354
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echo wiil r/o hypertrophic cardiomyopathy common in athletes
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| Aashi
Forum Moderator
Topics: 113
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The correct answer is C---> EKG
This young, healthy, athletic patient had a syncopal episode, which can be cardiogenic or neurogenic in origin. After the history and physical, blood work is usually sent to rule out anemia, infections, hypocalcemia, or hypomagnesemia and an EKG must be performed. An EKG may show evidence of cardiac abnormalities such as Wolf-Parkinson-White syndrome (r wave slurring), idiopathic hypertrophic subaortic stenosis, or congenital prolonged QT syndrome.
It is inappropriate to admit him for cardiac monitoring (choice A) before even performing an EKG. You need to first try to distinguish the etiology of this syncopal episode, therefore an EKG and other studies should be done in the emergency department. Cardiac monitoring may be necessary if an arrhythmia is found.
An echocardiogram (choice B) may be necessary to evaluate cardiac abnormalities, however this should not be done until an EKG is perfomed
A tilt-table test (choice F) is useful in establishing the diagnosis of vasovagal/neurocardiogenic syncope, which is caused by venous pooling, decreased venous return, inappropriate vasodilatation, hypotension, and relative bradycardia. A positive test will show hypotension and bradycardia, and syncope. This test is not part of the initial evaluation of a single syncopal episode in a young, healthy, athletic patient. It is usually used in patients with multiple unexplained syncopal episodes. An electrocardiogram is easier to perform and is more likely to help establish a diagnosis in this patient at this time.
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| dr.wad
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C) ECG
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