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NBME p2ck_form6 Answers

step2ck_form6/Block 3/Question#9 (7.0 difficulty score)
A 50-year-old woman has had progressive ...
Echocardiography๐Ÿ”,๐Ÿ“บ
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 +0 
submitted by osler_weber_rendu(112),

Why not paracentesis?

Sharp chest pain, JVD, enlarged globular cardiac silhouette, and nonspecific ST-segment changes on EKG all point to pericardial effusion/cardiac tamponade.

aneurysmclip  Thats what I chose too, but the patient isn't in acute distress so we don't need to drain fluid right away. I read a couple of articles, all said the same thing, if patient is hemodynamically unstable then you do the paracentesis. this patient has had the symptoms for 4 days so you can wait until diagnosis confirmed and do the pericardiocentesis under image guidance etc. step2 Medbullets also says you can manage conservatively but mostly the goal is to get fluid out. So I'm just remembering to poke the needle if the patient sick as shit, but if the patient seems stable than you should get the echo. +  



 +0 
submitted by keyseph(69),

Sharp chest pain, jugular venous distention, enlarged globular cardiac silhouette, and diffuse nonspecific ST-segment changes on EKG all point to pericardial effusion/cardiac tamponade.

Next best step would be to evaluate with echocardiography.