USMLE images

Zuhal · Jan 29, 2013

68 yo male patient presents to your clinic with postprandial pain. X-ray below, whats the dx?

Zuhal · May 20, 2013

addo said:
yea i was way off on that one huh? is it a kid who ingested some weird stuff?

It is most likely a child. Here's a hint: N/V+abdominal pain

Jamiu22 · May 20, 2013

Zuhal said:
Rx?

mm... top left lesion in an infant (it looks like where the stomach is)

JP2740 · May 20, 2013

This was obtained at autopsy. The patient was suffering from edema and recurrent infections, and died from a pulmonary embolism.

Diagnosis prease?

Jonari · May 20, 2013

Felt like a potato cause others were saying GS.

Zuhal · May 20, 2013

jp2740 said:
this was obtained at autopsy. The patient was suffering from edema and recurrent infections, and died from a pulmonary embolism.

Diagnosis prease?

sle?

addo · May 20, 2013

Zuhal said:
It is most likely a child. Here's a hint: N/V+abdominal pain

kid with sickle cell?

John Lannister · May 20, 2013

JP2740 said:
This was obtained at autopsy. The patient was suffering from edema and recurrent infections, and died from a pulmonary embolism.

Diagnosis prease?

Progressive Multifocal Encephalopathy

loveoforganic2 · May 20, 2013

Jonari said:
I don't recall sattar mentioning this for some reason...just know that all the AMLs have mpo which differentiates it from ALL

It's a very short segment, but he emphasizes lack of MPO in AML-M5 monoblasts

tiedyeddog said:
might as well add it for everyone:
This: They are often painful, and the pain is reproduced when the lesion is placed in cold water?

Yes, that, thanks. Didn't want to put it up there until the question was answered, but wanted to say something lest I forget. Could see it as maybe being used as a buzz phrase distracter for Raynaud's

Zuhal · May 20, 2013

addo said:
kid with sickle cell?

Here's another hint: if this problem is not corrected promptly, it can lead to metabolic acidosis

Jonari · May 20, 2013

Zuhal said:
sle?

mcc of death in sle patients is renal failure and infections, not pe

addo · May 20, 2013

jp2740 said:
this was obtained at autopsy. The patient was suffering from edema and recurrent infections, and died from a pulmonary embolism.

Diagnosis prease?

mpgn?

Zuhal · May 20, 2013

Jonari said:
mcc of death in sle patients is renal failure and infections, not pe

Right but I see subendo deposits which are seen w/ diffuse proliferative glomerulonephritis which is seen in pt's with SLE.
SLE is a hypercoaguable state so I wouldn't be very surprised if this does turn out to be an SLE pt.

Jonari · May 20, 2013

Zuhal said:
Right but I see subendo deposits which are seen w/ diffuse proliferative glomerulonephritis which is seen in pt's with SLE.
SLE is a hypercoaguable state so I wouldn't be very surprised if this does turn out to be an SLE pt.

ahh good point...hard to see those details on a phone...

addo · May 20, 2013

Zuhal said:
Here's another hint: if this problem is not corrected promptly, it can lead to metabolic acidosis

intussusception? Im going more on the hints than on the xray on this one

MLT2MT2DO · May 20, 2013

Zuhal said:
Rx?

Is this a PA?

Zuhal · May 20, 2013

addo said:
intussusception? Im going more on the hints than on the xray on this one

______poisoning+ H2O2--> OH--> peroxidation of membrane lipids

addo · May 20, 2013

Zuhal said:
______poisoning+ H2O2--> OH--> peroxidation of membrane lipids

iron....?

tiedyeddog · May 20, 2013

Zuhal said:
Rx?

hydronephorsis due to a posterior urethral valve or vesicoureteral reflux?

addo · May 20, 2013

that was a good one... a little hard tho, had no idea what iron poisoning looked like in xray

iwanttogotomed · May 20, 2013

Zuhal said:
Here's another hint: if this problem is not corrected promptly, it can lead to metabolic acidosis

eh nvm

Zuhal · May 20, 2013

addo said:
that was a good one... a little hard tho, had no idea what iron poisoning looked like in xray

Good job!
HY for MCCEEs, not sure about the USMLE but thought i'd throw it out there just in case.

MLT2MT2DO · May 20, 2013

addo said:
that was a good one... a little hard tho, had no idea what iron poisoning looked like in xray

Is that the answer? It fits the equation but I'm confused why a kid would be more likely to have iron poisoning

Jamiu22 · May 20, 2013

iwanttogotomed said:
eh nvm

it was iron poisoning - look up

it's pretty wild... never would have thought they look like that... another xray below

addo · May 20, 2013

MLT2MT2DO said:
Is that the answer? It fits the equation but I'm confused why a kid would be more likely to have iron poisoning

Children make up the majority of those with potentially toxic iron exposures, because they may be attracted to the bright color and sugar coating of the tablets, iron tablets left over from pregnancy may be present in homes with toddlers, and iron may not be considered a poison and thus may be stored unsafely.13 Fortunately, most children remain asymptomatic or develop only minimal toxicity following exposure.

From an emergency medicine text

Zuhal · May 20, 2013

MLT2MT2DO said:
Is that the answer? It fits the equation but I'm confused why a kid would be more likely to have iron poisoning

FA2012 pg. 249
probably accidental ingestion of iron pills?

tiedyeddog · May 20, 2013

Jamiu22 said:
it was iron poisoning - look up

it's pretty wild... never would have thought they look like that... another xray below

that's ****ing awesome. Those are just pills right? no reaction needed to see them?

MLT2MT2DO · May 20, 2013

addo said:
From an emergency medicine text

Lol, here I am trying to think of the different mechanisms in kids vs adults or tying it back to lead poisoning and inhibition of hemoglobin leading to an increase of iron...all along the answer is "because they like sugar and bright colors". Sometimes I want to punch med school in the face

Jonari · May 20, 2013

MLT2MT2DO said:
Lol, here I am trying to think of the different mechanisms in kids vs adults or tying it back to lead poisoning and inhibition of hemoglobin leading to an increase of iron...all along the answer is "because they like sugar and bright colors". Sometimes I want to punch med school in the face

same thing for ethylene glycol...color is blue...and apparently it tastes like kool-aid..

Jamiu22 · May 20, 2013

Jonari said:
same thing for ethylene glycol...color is blue...and apparently it tastes like kool-aid..

Also has a sweet smell.... oooo juice!

JP2740 · May 20, 2013

addo said:
mpgn?

Ya I was trying to describe some of the weirder nephrotic symptoms (to eliminate SLE) just to reinforce them + subendothelial deposits = MPGN type 1 with tram tracking and all that. But I guess infections, embolism, and edema might be part of SLE too

loveoforganic2 · May 20, 2013

tiedyeddog said:
that's ****ing awesome. Those are just pills right? no reaction needed to see them?

Yep! Radioopaque as a metal salt

MLT2MT2DO · May 20, 2013

Jonari said:
same thing for ethylene glycol...color is blue...and apparently it tastes like kool-aid..

Yeah, I knew this one because the wife and I are big pet people. Don't want them drinking radiator fluid, fairly common way pets commit seppuku

JP2740 · May 20, 2013

loveoforganic2 said:
It's a very short segment, but he emphasizes lack of MPO in AML-M5 monoblasts

Yes, that, thanks. Didn't want to put it up there until the question was answered, but wanted to say something lest I forget. Could see it as maybe being used as a buzz phrase distracter for Raynaud's

M = myeloid cell line (everything besides lymphocytes). Think of MPO as being neutrophil specific like P-ANCA (anti neutrophil Ab against MPO). Since this AML is specifically monoblasts (which diff. into monocytes), you won't have MPO.

Jamiu22 · May 20, 2013

MLT2MT2DO said:
Lol, here I am trying to think of the different mechanisms in kids vs adults or tying it back to lead poisoning and inhibition of hemoglobin leading to an increase of iron...all along the answer is "because they like sugar and bright colors". Sometimes I want to punch med school in the face

LOL...also I remember my professor saying they sometime coat iron pill so that its sweet...all that doesn't matter... kids will put anything in their mouth.

Jonari · May 20, 2013

at this stage of the condition...mcc of death would be due to what?

John Lannister · May 20, 2013

Jonari said:
at this stage of the condition...mcc of death would be due to what?

Progressive multifocal encephalopathy.

tiedyeddog · May 20, 2013

John Lannister said:
Progressive multifocal encephalopathy.

you're getting really good at this, strong work brother.

loveoforganic2 · May 20, 2013

John Lannister said:
Progressive multifocal encephalopathy.

I will accept any and all explanations as to WTH I'm looking at

Jonari · May 20, 2013

loveoforganic2 said:
I will accept any and all explanations as to WTH I'm looking at

yeah...when i tell you...it'll be "wtf"

lets see if addo or zuhal can solve this...

Suncrusher · May 20, 2013

John Lannister said:
Progressive multifocal encephalopathy.

Never wouldve gotten that. Ruling pathology out of my future now

loveoforganic2 · May 20, 2013

Jonari said:
yeah...when i tell you...it'll be "wtf"

lets see if addo or zuhal can solve this...

Do I see CMV owl's eyes? Is PML ever the major cause of death in AIDS? If so, what's the CD4 cutoff that that's true for?

Edit: I may completely off base. lol

Jamiu22 · May 20, 2013

John Lannister said:
Progressive multifocal encephalopathy.

JC virus? I still dont see it

Jonari · May 20, 2013

Suncrusher said:
Never wouldve gotten that. Ruling pathology out of my future now

relax, dude is way off

loveoforganic2 said:
Do I see CMV owl's eyes? Is PML ever the major cause of death in AIDS? If so, what's the CD4 cutoff that that's true for?

Edit: I may completely off base. lol

Unfortunately, no CMV. CD4 count is normal.

It's all good, it's a learning experience. You should see some of the potato answers I've given for some of these things, lol.

A similar picture showed up in UWorld and I think there was a pretty high percentage of people getting it right. One liner question...and nothing else...felt like a potato.

BP87 · May 20, 2013

Zuhal said:
Good job!
HY for MCCEEs, not sure about the USMLE but thought i'd throw it out there just in case.

Is that the canadian equivalent of the usmle?

MLT2MT2DO · May 20, 2013

Jonari said:
relax, dude is way off

Unfortunately, no CMV. CD4 count is normal.

It's all good, it's a learning experience. You should see some of the potato answers I've given for some of these things, lol.

A similar picture showed up in UWorld and I think there was a pretty high percentage of people getting it right. One liner question...and nothing else...felt like a potato.

Give us the multiple choice answers that UW had and we'd probably do alright as well.

My random BS guess is Rabies. Of course this is assuming this is anything but "classical"

Jonari · May 20, 2013

MLT2MT2DO said:
Give us the multiple choice answers that UW had and we'd probably do alright as well.

My random BS guess is Rabies. Of course this is assuming this is anything but "classical"

yeah tried to look it up can't find it...

but answer is myocarditis is the mcc of death...the picture is aschoff-bodies.

MLT2MT2DO · May 20, 2013

Jonari said:
yeah tried to look it up can't find it...

but answer is myocarditis is the mcc of death...the picture is aschoff-bodies.

Heh, swear to god that was my initial reaction to that picture but once everyone started mentioning brain stuff I thought I was WAY off base. I think USMLErx has a similar pic, why I originally had that reaction

Zuhal · May 20, 2013

Jonari said:
yeah tried to look it up can't find it...

but answer is myocarditis is the mcc of death...the picture is aschoff-bodies.

oh man I knew the long cells with dark nuclei kind of looked like antiskow (spelling?) cells but the MCC death threw me off. I started thinking micro.
Good question!

tiedyeddog · May 20, 2013

ok, this is obviously lung tissue.

hx: 2 weeks ago had an MI. presents now with S3, dyspnea of exertion, and sleeps on top of 3 pillows at night

Zuhal · May 20, 2013

MLT2MT2DO said:
Heh, swear to god that was my initial reaction to that picture but once everyone started mentioning brain stuff I thought I was WAY off base. I think USMLErx has a similar pic, why I originally had that reaction

Totally hear ya on that one..I guess they really mean it when they say "don't change your answer"!

BP87 said:
Is that the canadian equivalent of the usmle?

Yes that's right. I'm not taking it anytime soon though.

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