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Saturday challenge | 不平来战

Saturday challenge | 不平来战

本文摘要:阿尔法医学英语 5天前学习最好的方法,没有之一用每周六,一个病例,一道题,一个知识点,掌握专业医学英语如果以为每周一题不外瘾,猛戳文末阅读原文哦!这里的题库是美国医学生都看的经典题库,每道题都是经由大咖审核,谜底中的评述可能比题目还长,融合了最新的医学希望。可谓是一篇小综述。你,挑战吗?

爱游戏app下载

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阿尔法医学英语 5天前学习最好的方法,没有之一用每周六,一个病例,一道题,一个知识点,掌握专业医学英语如果以为每周一题不外瘾,猛戳文末阅读原文哦!这里的题库是美国医学生都看的经典题库,每道题都是经由大咖审核,谜底中的评述可能比题目还长,融合了最新的医学希望。可谓是一篇小综述。你,挑战吗?Medical CaseA 45-year-old woman is admitted with a 2-week history of progressive dyspnea, orthopnea, chest pain without exertion, and a mild, nonproductive cough. She denies any fever.Two years ago, she was diagnosed with stage III invasive ductal carcinoma of the left breast that had the following immunohistochemical profile: estrogen-receptor–negative, progesterone-receptor–negative, and human epidermal growth factor receptor 2–positive. She was treated with neoadjuvant chemotherapy consisting of docetaxel, carboplatin, and trastuzumab, followed by surgery, radiation, and one year of trastuzumab, which she completed one year ago.Upon admission, her blood pressure is 90/70 mm Hg, her heart rate is 110 beats per minute, her jugular venous pressure is measured at a height of 10 cm, and she has muffled heart sounds. She does not have lung crackles or pedal edema.Laboratory testing shows a normal complete blood count, a normal D-dimer level, and negative cardiac enzymes. An electrocardiogram shows low voltage and a sinus tachycardia.QuestionWhat is the most likely diagnosis in this case?A. Radiation-induced restrictive cardiomyopathyB. Acute viral myocarditisC. Trastuzumab-induced cardiomyopathyD. Malignant pericardial effusionE. Pulmonary embolism点击下方空缺区域检察谜底▼AnswerCorrect Answer: DKey PointThe most likely diagnosis in a patient with breast cancer who presents with progressive dyspnea, chest pain, tachycardia, low systolic blood pressure with low pulse pressure, jugular venous distention, and muffled heart sounds is malignant pericardial effusion.Detailed FeedbackMalignant pericardial effusion should be suspected in a cancer patient who presents with progressive dyspnea, chest pain, tachycardia, low systolic blood pressure with low pulse pressure, jugular venous distention, and muffled heart sounds. An echocardiogram should be performed to rule out cardiac tamponade, which would require urgent pericardiocentesis, a pericardial window, or both.Trastuzumab-induced cardiomyopathy usually manifests as a congestive heart failure syndrome and is unlikely to occur one year after the end of trastuzumab therapy. Clinical trials have shown cardiotoxic effects in 27% of patients treated concurrently with trastuzumab and anthracyclines, 13% of those treated with trastuzumab and paclitaxel, and 5% of those treated with trastuzumab alone.Acute viral myocarditis is unlikely because of the absence of clinical or electrocardiographic signs of myocarditis.Pulmonary embolism would not be associated with muffled heart sounds.In a patient with restrictive cardiomyopathy, physical examination findings would also be consistent with right heart failure, including peripheral edema, hepatomegaly, and ascites. In addition, the patient would likely have normal (rather than muffled) heart sounds.你的支持,我的动力!文末点个「赞」「在看」或者「分享」一下吧!BibliographyHudis CA. Trastuzumab--mechanism of action and use in clinical practice. N Engl J Med 2007 Jul 6; 357:39.Xiong W and Shi C. Images in clinical medicine. Malignant pericardial effusion. N Engl J Med 2011 Mar 4; 364:e18.Maisch B et al. Evaluation and management of pericardial effusion in patients with neoplastic disease. Prog Cardiovasc Dis 2010 Aug 24; 53:157.Burazor I et al. Malignant pericardial effusion. Cardiology 2013; 124:224.AlphaMedEnglish泉源:NEJM编辑:Briony审核:TS封面及插图https://www.behance.net/gallery/52980811/FOND-。


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