NCCPA PANCE Prep Online

Post-cardiac injury syndrome (Dressler syndrome) is an autoimmune-mediated pericarditis that classically occurs 1–3 weeks after myocardial infarction or other cardiac injury. The combination of fever, leukocytosis, pericardial friction rub, and new pericardial/pleural effusions most strongly supports this diagnosis. The choice mentioning a “post-infarction pulmonary infection” is less consistent because the key findings point to pericardial inflammation (friction rub and pericardial effusion) rather than a primary lung infection. The choice describing an “adverse medication reaction” does not specifically explain a friction rub and new pericardial effusion. The choice “subacute bacterial endocarditis” typically presents with signs of persistent bacteremia (e.g., murmur, embolic/immunologic phenomena) rather than a predictable 1–3 week post-MI pericarditis syndrome.

This presentation is most consistent with an acute vaso-occlusive pain crisis triggered by exertion and dehydration (dry mucous membranes, decreased skin turgor, slightly prolonged capillary refill). First-line immediate management is pain control plus isotonic IV hydration and rest/supportive care. Transfusion is generally reserved for specific complications or severe anemia (for example, acute chest syndrome, stroke, or marked symptomatic anemia), not for an uncomplicated pain crisis with only a mild drop from baseline. Hydroxyurea is a long-term preventive therapy to reduce future crises and is not an acute intervention. Iron chelation treats transfusional iron overload and does not address acute vaso-occlusion. Supplemental oxygen is indicated only if the patient is hypoxemic.

The findings (external auditory canal erythema/edema with otorrhea and pain worsened by tragal or pinna manipulation) are classic for acute otitis externa. In patients with diabetes or other immunocompromising conditions, untreated or inadequately treated otitis externa can spread beyond the canal into surrounding soft tissue and bone, causing necrotizing (malignant) otitis externa and potentially skull base osteomyelitis. "Acute otitis media with tympanic membrane perforation" is a middle-ear process and is not suggested by pain that worsens with pinna/tragus manipulation. "Sudden sensorineural hearing loss" is an inner-ear/nerve process and is not a typical complication of uncomplicated otitis externa. "Cholesteatoma" is usually related to chronic middle-ear disease and eustachian tube dysfunction rather than an acute, tender external canal infection.