GOGETA
Trying to get in PGY1
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1- A 20 y/o man who moved to the US from Cambodia 2 years ago presents to the ER with the sudden onset of left hemiparesis. His wife, who emigrated with him, reports that he has not felt well for at least a month and has had a weight loss of about 9 kg (20 lb). On P/E, T=38 °C (100.4 °F) and BP=116/52 mm Hg. He is somewhat cachectic and hemiparetic. The cardiac examination shows a murmur. The physical examination is otherwise normal.Which of the following tests is most likely to give the diagnosis?
(A) Blood cultures
(B) Lumbar puncture
(C) Radiography of the chest
(D) Complete blood count, differential, platelet count, and erythrocyte sedimentation rate
(E) Biopsy of inguinal lymph node
(F) head CT scan
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As a general rule, the better it felt when you said it, the more trouble it's going to get you into.
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| GOGETA
Trying to get in PGY1
Topics: 381
Posts: 3,072
|
Answer is A.The appearance of focal neurologic signs in a young person from Cambodia raises a wide differential diagnosis. Atherosclerotic cerebrovascular disease is uncommon in the 20-year-old age group. Among other diagnostic considerations are an embolic event from a cardiac source, such as a valvular vegetation associated with endocarditis or an atrial myxoma; vasculitis; tuberculomatous or bacterial brain abscess; brain tumor; aneurysm or arteriovenous malformation; and coagulation disorder such as thrombotic thrombocytopenic purpura or hyperviscosity syndrome caused by multiple myeloma.
Neurologic complications occur in 25% to 40% of patients with infective endocarditis. About 15% develop cerebral emboli with associated neurologic symptoms. The easily associated triad of new focal neurologic deficits, fever, and changing heart murmur occurs in only 33% of patients, so infective endocarditis must be considered in any patient with sudden focal neurologic deficits who has no conventional risk factors, such as atherosclerosis.
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As a general rule, the better it felt when you said it, the more trouble it's going to get you into.
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