zeloc
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A 50-year-old woman has had progressive dyspnea over the past 2 weeks and constant, sharp chest pain for 4 days. The pain is localized to the center of the chest and is worse while supine. She underwent a right, modified radical mastectomy and adjuvant chemotherapy for breast cancer 3 years ago. She has a history of hypothyroidism treated with thyroid replacement therapy. She has smoked one pack of cigarettes daily for 30 years and drinks two ounces of alcohol daily. She is dyspneic and diaphoretic. Her temperature is 37.2 C (99 F), blood pressure is 90/70 mm Hg with a pulsus paradoxus of 20 mm Hg, pulse is 110/min, and respirations are 28/min. Examination shows jugular venous distention to the angle of the mandible. The liver span is 14 cm with 4 cm of shifting abdominal dullness. Arterial blood gas analysis on room air shows a pH of 7.50, PCO2 of 30 mm Hg, and PO2 of 70 mm Hg. An x-ray film of the chest shows an enlarged cardiac silhouette with a globular configuration. An ECG shows sinus tachycardia with nonspecific ST-segment changes diffusely. Which of the following is the most appropriate next step in management?
A ) Echocardiography
B ) CT scan of the abdomen
C ) Ventilation-perfusion lung scans
D ) Bronchoscopy
E ) Paracentesis
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| Justice
Forum Fanatic
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Pericarditis
A ) Echocardiography
One could choose E but it would be wrong since paracentesis is not about tapping the pericardial sac. period. This is about abdominal tapping by definition.
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| lakshya_0_7
Forum Elite
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A or E...
A first...before i poke in my needle...
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| Kamsi
Forum Guru
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A
Cardiac Tamponade ,pt has elevated neck veins,pulsus paradoxus and compromised cardiac output.Echho is needed to confirm presence of pericardial effusion before pericardiocentesis. Paracentesis is for tapping abdominal fluid
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| liliaeliz
Forum Elite
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 yes kamsi BP 90/70
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| elitoki
Forum Guru
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A
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| radonc
Forum Senior
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My answer is E. But, let's agree to disagree on this one. This question has been discussed before; some people choose A, some choose E. BTW, paracentesis can also mean pericardiocentesis.
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| usmle-china
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I agree with radonc. The answer is E. Since the patient with BP of 90/70, therefore, emergency of pericardiocentesis is needed to treat the Cardiac Tamponade
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| Justice
Forum Fanatic
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usmle-china wrote:
I agree with radonc. The answer is E. Since the patient with BP of 90/70, therefore, emergency of pericardiocentesis is needed to treat the Cardiac Tamponade
Don't you need to first prove that the Pt has Tamponade?
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| kpmle2
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Paracentesis is a procedure during which fluid from the abdomen is removed through a needle.
Paracentesis of the chest cavity is called a thoracentesis.
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| zeloc
Forum Junior
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Paracentesis is not the same as pericardiocentesis. Where does it say that they can be used interchangeably? The answer should be A.
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| usmle-china
Forum Newbie
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This patient presents with classical Beck's triad. X-ray and ECG’s results all toward to the dignoses of cardiac tamponade.
pericardial tamponade is a medical emergency, the initial step now is to treatment, not further to perform any dignosic measurements.
The treatment of cardiac tamponade is drainage of the pericardial contents, preferably by needle paracentesis, or called pericardiocentesis.
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| usmle-china
Forum Newbie
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Believe or not. If you chose A, the patient is going to die soon.
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| dermatology
Forum Elite
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patients got classic signs of CCF ......with hepatomegaly and ascites ....
paracentesis is given to confuse whether u want to do ascitic tap ....
i wud go for echo cardiography and then manage CCF ...
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| SkiKidd
Forum Newbie
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Clearly the question here is, was the question copied right. Paracentesis is not always the same as pericardiocentesis. The important thing here is to know that the correct answer is to drain the fluid from the heart. pericardiocentesis is a diagnostic as well as therapeutic step and you would never ever ever wait to relieve a cardiac tamponade while you waited for an echo. The x-ray and ECG weren't even needed. This is a clinical diagnosis and should be treated based on clinical suspicion. JVD, muffled or decreased heart sounds, signs of CHF.
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| tamerbashir
Forum Elite
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yes E
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| Ivonne
Forum Guru
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Posts: 1,402
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A
Echocardiographic-guided pericardiocentesis has evolved over the past 20 years and now is considered the procedure of choice for removal of pericardial fluid. The technique for echocardiographically guided pericardiocentesis differs from traditional blind pericardiocentesis primarily in the site of needle entry.
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