doc_clotaire
Forum Guru
Topics: 159
Posts: 1,269
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A 42-year-old man from Vietnam, who had been a bus driver in Thailand,
presents to the emergency department after having shortness of breath
while playing soccer with his son this morning. Over the last several
months, he has been having several episodes of shortness of breath.
Several of the episodes were associated with chest pain. He denies any
significant medical history. He has a 25-pack-year use of tobacco, and
he has a sedentary lifestyle. His father had a myocardial infarction
at the age of 59. His heart rate is 72/min, blood pressure is 140/66
mm Hg, and respiratory rate is 14/min. His examination shows mild
jugulovenous distention with a collapsing carotid arterial pulse. His
cardiac examination reveals a point of maximal impulse that is
displaced laterally and inferiorly and a mild diastolic blowing murmur
at the base while he sits up. His sensory examination shows loss of
vibration sense in all extremities, and an abnormal Romberg test. EKG
shows normal sinus rhythm with left axis deviation and ST-segment
depression and T-wave inversion in leads I, aVL, V5, and V6. The chest
x-ray shows an enlarged heart with dilatation of the proximal aorta.
The CBC, chemistries, and cardiac enzymes are negative. The
echocardiogram shows an ejection fraction of 60%. What is the next
best step in the management of this patient?
(A) Treat with digitalis
(B) Exercise stress test
(C) Cardiac catheterization
(D) VDRL and lumbar puncture, followed by penicillin therapy
(E) Aortic valve replacement
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The elevator to succes is broke ,you must take the stairs
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| cool doctor
Forum Junior
Topics: 1
Posts: 231
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E?
but I think usually b4 replacing valves we do cardiac cath, so Im not sure
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| neuroblastoma
Forum Guru
Topics: 105
Posts: 1,055
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i guess (D) VDRL and lumbar puncture, followed by penicillin therapy --CNS involvement in syphlictic case.His sensory examination shows loss of
vibration sense in all extremities, and an abnormal Romberg test.
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| Aashi
Forum Moderator
Topics: 113
Posts: 1,061
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Most probably syphilitic aortitis----->VDRL and lumbar puncture, followed by penicillin therapy
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"Obstacles are those frightful things you see when you take your EYES off your goal."
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| doc_clotaire
Forum Guru
Topics: 159
Posts: 1,269
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the answer is :
D) VDRL and lumbar puncture, followed by penicillin therapy
___________________
The elevator to succes is broke ,you must take the stairs
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| drduck
Forum Guru
Topics: 82
Posts: 523
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D.......
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