NBME Step 2 CK Form 6 Diffuse hypokinesia and dilation of the ventricles (NBME Answers)

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Retired NBME Step 2 CK Form 6 Answers

step2ck_form6/Block 1/Question#18 (reveal difficulty score)
A 27-year-old man comes to the physician ...
Diffuse hypokinesia and dilation of the ventricles 🔍 / 📺 / 🌳 / 📖
tags: cardio

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submitted by ∗sugaplum(487)

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Viral myocarditis can lead to acute decompensated heart failure. can be d/t parvo, coxsackie or bacterial infections

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submitted by ∗carolebaskin(109)

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This guy has a gallop, not a specific murmur, so it can't be (b) bicuspid AV or (e) MVP

SOB + peripheral edema + JVD + crackles = HF, so that rules out (a) and leaves (c) or (d)

(c): The hypokinesia of the LV apex would be more likely for a distal LAD occlusion or some other post MI HF, but this is a 27M and he had a recent "bad cold," so think viral

(c) diffuse hypokinesia and dilation of the ventricles describes dilated cardiomyopathy, which is especially common after cocksackie B

Treatment is supportive.

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kingfriday adding on, i believe dyskinesia of the LV apex [apical ballooning] can also occur in the setting of takatsubos (occurs after emotional stress) +2

jlbae This is definitely not Takotsubo cardiomyopathy. If it were a postmenopausal woman with dypnea and chest pain after some emotional trigger then maybe, but the echo finding you're talking about (apical ballooning) comes from HYPERkinesia of the basal walls https://www.mayoclinicproceedings.org/article/S0025-6196(11)61258-5/pdf +2

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submitted by ∗step_prep7(71)

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Young patient who presents with acute signs of heart failure (elevated JVP, bilateral basilar crackles, displaced PMI, S3, lower extremity edema, etc.) most likely represents myocarditis, especially in setting of recent viral URI
Asymmetric septal hypertrophy = HOCM = Sudden cardiac death or exertional syncope in young adult
Bicuspid aortic valve with stenosis presents as symptomatic AS (syncope, angina, dyspnea) often in a 50-60 year old

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