nbme 1 explain please

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nbme 1 explain please

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15 Posts

nadiabarati

04/26/07 - 04:48 PM

April 26, 2007 at 12:22:10:

A 67-year-old man is brought to the emergency department 4 hours after the onset of severe midlumbar back pain. He is anxious, pale, and diaphoretic. His temperature is 37.1 C (98.8 F), blood pressure is 105/65 mm Hg, and pulse is 120/min. Examination shows no other abnormalities. X-ray films of the lumbar spine show degenerative disc disease with calcifications anterior to the vertebral bodies. Which of the following is the most likely diagnosis?

A
) Aortoiliac occlusion

B
) Herniated nucleus pulposus

C
) Lumbar discitis

D
) Lumbar strain

E
) Pyelonephritis

F
) Ruptured aortic aneurysm

G
) Spinal stenosis

vradojc1
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04/26/07 - 05:09 PM

F - pain/tachy that is not explained by infection (increased temperature)/pale/hypotension

Edited by vradojc1 on 04/26/07 - 05:22 PM

coolmavs
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04/27/07 - 03:45 AM

Agree, this is Ruptured Aortic Aneurysm.

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Justice
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04/27/07 - 11:24 AM

(F) Ruptured aortic aneurysm

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ashfaque
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04/28/07 - 12:01 AM

klimt
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04/30/07 - 04:52 PM

still, how does choice F explain lumbar X-ray changes?

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vradojc1
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04/30/07 - 09:59 PM

Majority of people of that age have degenerative changes in vertebral column. Most pronunced in cervical segment though. And majority has no big problems stemming from it.

klimt
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05/01/07 - 04:24 AM

oh I see. so I was looking for some connection when there is none.....

thanx

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webjeee
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05/04/07 - 01:48 AM

klimt wrote:
still, how does choice F explain lumbar X-ray changes?

Degenerative bony spur

ManuNastai
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05/05/07 - 11:25 AM

#10

I guess there's ostephite formation which damages an aortic aneurysm

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ManuNastai
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05/05/07 - 11:26 AM

#11

agree F

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ram3
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06/07/07 - 02:59 PM

#12

a ruptured aneurysm presents with hypotension this person has slightly low blood pressure but this Not considered hypotension also a ruptured aneurysm presents with abdominal pain there is no mention of this the answer is spinal stenosis

Edited by Aashi on 06/07/07 - 09:06 PM

radonc
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06/07/07 - 08:54 PM

#13

Spinal stenosis classically presents with back pain which radiates to the lower limbs. The pain is not usually described as 'severe'.

This pt clearly is haemodynamically unstable. His PR is up, his BP is low. Ruptured abdo aneurysm does present with back pain, sometimes abdo pain. I think the answer is F, like most people say.
The X-ray changes demostrate atherosclerosis, which predisposes to aneurysm formation.

cirus
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06/16/07 - 08:57 AM

#14

In assesing blood pressure its imp to look to both parameters--> bl pr & HR as the blood pressure may be mildly decreased than normal but the patient is hemodynamically unstable (Increased heart rate) and with a pulse of 120 as in this case & the bl pr given, I'd go for rupture Aortic Aneurysm

gr8doc
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07/14/07 - 01:52 PM

#15

I don't think this is Ruptured aneurysm. The strong point against is BP is 105/65 which is not as low as i would expect with the rupture.
Also, the pain, diaphoresis secondary to pain & tachycardia due to pain are all inter related.
& Lumbar discitis is explained by the ostephytes which will impinge upon the nerve root.

Nadiabarati, do you have the correct answer from NBME ?

Appreciate any feedback & difference of opinion.

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