a few random questions...

[westernmed007]

Spent the last few hours researching many questions I had, found out the answers to most of them, these ones still stump me

-Aortic Dissection vs Aortic Aneurysm Rupture? - anyone got a good way to differentiate these? The symptoms seem to be very similar to me, here is what I have so far:

Rupture- hypotension, L flank or groin pain, pulsatile mass, calcifications from atherosclerosis
Dissection - differential pulses, aortic insuff murmur possible, wide mediastinum CXR, "sharp tearing pain to back".


-A/V fistulas- the qbanks love these but seem to have different conflicting info

Essentially - AV fistula leads to -> H.O. heart failure, increased HR, inc Cardiac Output, inc Stroke Volume , inc venous O2 (all these kinda straight forward)

but then decreased sys. resis and decreased diastolic bp? systolic? but mean bp normal? (the banks seem to differ here, one says decreased systemic resis the other says increased by of kidney/symp response, they really waver on the blood pressure stuff).

-Kussmauls JVP sign - for board purposes mainly chronic pericarditis seen with TB vs Pulsus Paradoxus - for board purposes again mainly seen with tamponade or non-chronic pericarditis. Anyone seen these anywhere else on boards? Any other advice about these?

-A final weird one
VIT D- mech includes promoting mineralization by stimulating alkaline phosphatase release from osteoblasts. This eats pyrophosphates (hydrolyzes them) and other inhibitors of cal/phos crystalization (thus promoting bone formation)
Bisphosphonates - analogs of pyrophosphate a component of hydroxypartite, making it more insoluble and decreasing osteoclast activity. (used in osteoporosis)
Don't these seem to kinda do opposite things to you? Yet both are used to increase bone formation......

ps -Did anyone have to calculate an A-a gradient on the real thing? If so which equation did you use (there are kinda 3, two in FA and one extra in Goljan RR, I'm thinking I'm just gonna memorize the easy shortcut one in FA and understand the more theoretical one in FA)

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[obiwan]

-Kussmauls JVP sign - for board purposes mainly chronic pericarditis seen with TB vs [/SIZE]Pulsus Paradoxus - for board purposes again mainly seen with tamponade or non-chronic pericarditis. Anyone seen these anywhere else on boards? Any other advice about these?

how does pulsus paradoxus exactly work?

goljan in his audio said that there is usually a triad that accompanies cardiac tamponade/pericardial effusion (i think its called bell's triad) = kussmaul sign + muffled heart sounds + pulsus paradoxus

 

[lankysudanese]

-Kussmauls JVP sign - for board purposes mainly chronic pericarditis seen with TB vs [/size]Pulsus Paradoxus - for board purposes again mainly seen with tamponade or non-chronic pericarditis. Anyone seen these anywhere else on boards? Any other advice about these?

how does pulsus paradoxus exactly work?

goljan in his audio said that there is usually a triad that accompanies cardiac tamponade/pericardial effusion (i think its called bell's triad) = kussmaul sign + muffled heart sounds + pulsus paradoxus

bell's triad is Jugular venous distension + Muffled Heart sounds + Hypotension.

Pulsus paradoxus is the transient fall in blood pressure upon inspiration. it is due to increased venous return causing filling of right ventricle which in turn pushes the intraventricular septum. This causes reduced filling of the left ventricle and thus reduced stroke volume, which manifests as transient hypotension (until inspiration ends).

kaussmaul's sign (on the other hand) is the inability of jugular venous pressure to fall upon inspiration, due to the constriction of the heart (which, among other things, reduces the EDV of the right ventricle).

 

[ASDIC]

bell's triad is Jugular venous distension + Muffled Heart sounds + Hypotension.

I thought it was called "Beck's triad"

 

[lankysudanese]

I thought it was called "Beck's triad"

yeah, sorry for the typo

 

[agranulocytosis]

Spent the last few hours researching many questions I had, found out the answers to most of them, these ones still stump me

-Aortic Dissection vs Aortic Aneurysm Rupture? - anyone got a good way to differentiate these? The symptoms seem to be very similar to me, here is what I have so far:

Rupture- hypotension, L flank or groin pain, pulsatile mass, calcifications from atherosclerosis
Dissection - differential pulses, aortic insuff murmur possible, wide mediastinum CXR, "sharp tearing pain to back".[/quote]



I think with dissection there will be compression of arteries i.e. subclavian and/or renal arteries as opposed to aneurysm rupture chiefly presenting as hypovolemic shock. Now just a plain AAA, I remember reading somewhere that it can present as claudication and impotence, but I'm not sure as to exactly why.

Would anyone by any chance know the MCC of death with a dissection? I'm thinking rupture instead of hemopericardium. I remember a thread on this a while back but I couldn't find it.