Question of the Week # 80, 81

Q80) A 55 y/o male with history of lung cancer recently had a porta cath placed in the SVC. However, one week later he presents to your office with increasing swelling of this face, neck and upper extremities and increasing jugulovenos distension. You diagnose SVC syndrome and your suspicion is confirmed by an SVC venogram. You send the patient to interventional radiologist for SVC dilatation. In the radiology OR patient suddenly becomes unresponsive and hypotensive. His heart rate was 140 and B.P 78/40. He responds well to IV fluids but tachycardia persists. He is then transferred to ICU. You pay him a visit in the ICU and examine him. At the time of your exam he suddenly becomes unresponsive again and his blood pressure drops to 80/40. You restart IV fluids. Chest is clear to auscultation. Heart sounds are audible and normal. He has increased JVD but wife reports he has had this for past one week. The EKG is shown.

Any clue to Etiology of Shock on this EKG?

 

 The most important test that will best help you in diagnosis:

 A) 2D ECHO 

B) Cardiac enzymes

C) Chest X-ray

D) Electrocardiogram

E) Blood cultures

Q81) Next Step in management  of this patient :

 A) Tube thoracostomy

B) Pericardiocentesis

C) Intraaortic balloon counterpulsation

D) Percutaneous transluminal coronary angioplasty

E) IV Antibiotics

16 Responses

  1. A
    B

  2. PNO
    C
    A

  3. a /b

  4. this patient hascardiac tamponade acording toekg /clinical picture so answerwillbe a/b

  5. a
    b
    goooooog one

  6. A and B

  7. C ,A

  8. b,d

  9. E,e

  10. Electrical alternans on EKG, symptoms here that are suggestive suggestive sudden sincope, signs are hypotension, JVD, here is cardiac tamponade, right answers A, and B.

  11. a,b

  12. C
    A

  13. Dr, Red , anybody can let me know the ans, By the way Dr. REd if you read post, do u have any IN. Medicine Qbank, please let me know

  14. pericarp effusion and pericardiocentasis, ekg low electrical complex, e/altenan in ekg is too much to imagine

  15. A,B

  16. With symptoms and signs indicative of SVC syndrome and concomitant EKG finding of varying amplitudes in the wave pattern suggestive of electrical alternans,hence my choices as above .

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