Wednesday, January 30, 2008

Vol 2:5 Question





Shock
A 79-year-old woman with a history of coronary artery disease who underwent a coronary artery bypass graft surgery in 2000 is brought to the ED by her family for two days of worsening shortness of breath. For the past 2 days, she has not gotten out of bed and is confused. She does not have chest pain, fevers, or cough. Her temperature is 98.1°F, blood pressure is 85/50 mm Hg, heart rate is 125 beats per minute, and respiratory rate is 26 breaths per minute. On exam, she is unable to follow commands and is oriented only to name. The cardiovascular exam reveals tachycardia with no murmurs. Her lungs have rales bilaterally at the bases. The abdomen is soft, nontender, and nondistended. Lower extremities have 2+ edema to the knee bilaterally. Which of the following is the most likely diagnosis?
a. Hypovolemic shock
b. Neurogenic shock
c. Cardiogenic shock
d. Anaphylactic shock
e. Septic shock

Please submit your answer in the "comment" section. The person with the most correct entries at the end of six weeks will receive a copy of the book PreTest Emergency Medicine.

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13 comments:

AMiB said...

c) due to cardiac hx and presentation

Luke said...

Cardiogenic Shock

WongML said...

C. Cardiogenic

Petri said...

A: Hypovolemic shock

Lack of fluids has lowered blood pressure and made the blood more viscous. The heart has to work harder and thus becomes tachycardic. Not sure how it explains the edema.

ERP said...

Cardiogenic Shock

The T-Dude said...

Is there jugular venous distention? Results from a echocardiogram?

Hmmmm. Because of the rales, and no fever I'm going with...

C: Cardiogenic Shock

Rune said...

c. cardiogenic

NPG said...

C. Cardiogenic shock

prnpenguin said...

I keep thinking that this is a trick question, but I'm going with the obvious:

c. Cardiogenic shock

Nurse K said...

That would be cardiogenic shock.

AtYourCervix said...

C - cardiogenic shock (?)

Doctor David said...

I vote for cardiogenic shock, based on the rales and 2+ pitting edema, both suggestive of heart failure (specifically biventricular failure). You didn't mention hepatomegaly -- is that because there was none?

I guess I should have asked... are pediatric oncologists allowed to play?

Rana said...

c: cardiogenic shock