I'll add on to this thread with a few questions that I couldn't find good explanations for online.
1. Jackhammer operator has pain/swelling of right arm for 3 days. It's red and swollen with cap refill less than 3 seconds. What's the diagnosis?
A - Axillary-subclavian venous thrombosis
B - Deep venous valvular insuff
C - Superficial thrombophlebitis of basilic vein
D - Superior vena cava syndrome
E - Thoracic outlet syndrome
Answer is A.. but I found this on Uptodate which seems to make answer A synonymous with answer E:
Primary, "spontaneous" upper extremity deep vein thrombosis is rare and is defined as thrombosis of the deep veins draining the upper extremity due to anatomic abnormalities of the thoracic outlet causing axillosubclavian compression and subsequent thrombosis. The syndrome is appropriately termed venous thoracic outlet syndrome, but is also referred to as Paget-Schroetter syndrome, and alternatively as ‘effort’ thrombosis’ [
1]. It typically presents in young, otherwise healthy individuals as sudden, severe upper extremity pain and swelling following vigorous upper extremity activity. An aggressive treatment approach that includes anticoagulation, catheter-directed thrombolysis and thoracic outlet decompression is aimed at relieving acute symptoms, and minimizing complications including recurrent thromboembolism and post-thrombotic syndrome.
Can anyone enlighten me?
Next, a 67 yom w/ 1 week of nausea, generalized weakness, and malaise. PMHx CHF, HTN, CAD. Meds include lisinopril, digoxin, isosorbide, spironolactone, and metoprolol. Vitals are fine. Exam is benign except for 2+ edema BLE. Labs show Na 140, K 7.3, bicarb 18, BUN 40, Cr 1.8, AST 20. Hct 36% and WBC 10k. UA normal. "What is causing the hyperkalemia"?
Narrowed it down to "adverse effect of medication" (correct) vs "renal failure". I get that his ACE-I + digoxin + spironnolactone all have propensity for causing hyperkalemia, but I wasn't sure if meds alone would get it to 7.3. Can some explain what hyperkalemia of renal failure looks like compared to medication side effect?
Last, a 4-year-old boy with asthma comes in with an acute exacerbation and despite treatments he becomes acutely worse (extreme resp distress, BP 50/20) and has poor air movement on left, and no wheezes. Xray shows this:
Question asks what is "most likely underlying cause of this patient's hypotension. Narrowed it down to "atelectasis of the left lung" vs "decrease in cardiac output" (correct). I thought the severe atelectasis was causing the decreased CO, and thus was the "underlying cause" ... am I missing something?
Thanks everyone!
