intracerebral hemorrhage

[arda]

question is attached,how do we make the differential diagnosis in this patient ? i picked charcot bouhard aneurism

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[J ROD]

correct answer? either amyloid or AV mal.

I am thinking amyloid. They cause lobar hemmorages.

 

[arda]

amyloid angiopaty

 

[Arg10Messi]

oopsiez

 

[J ROD]

Not sure how to explain except that it is a factual note. I picked that one based on multiple lobar regions.

 

[guitarguy23]

Just my thought:

First, it's multifocal so anything embolic related in an answer can be ruled out since multiple areas are affected (not A or B). It's difficult for me to imagine embolus or thrombus occuring at the same time in two different regions.

Second, he's elderly, so an AV malformation presenting this late seems unlikely. (not F)

Third, Hypoxic enceph is a "one and done thing" to me-either the whole brain is affected at once and recovery occurs (rehydration, improved bp, give dextrose, etc) or not->pt dies. (not C)

Fourth, Saccular aneurysms and charcot's don't affect these regions, at least not CLASSICALLY. Remember-the USMLE cares about the classic presentations of stuff like this (not G or H)

So now it's D, or E. Well think back to this guys age. He's elderly, and all the bleeds were in lobes. HTN would affect smaller brain areas first rather than these areas. What do old people get that involves the cerebral hemispheres? Dementia. Amyloid angiopathy is going on all over this guy's cerebral hemispheres, and at any moment focal areas could be affected by the process.

Hope that helps-again it's just MY reasoning.

 

[thehundredthone]

Just my thought:
...
Hope that helps-again it's just MY reasoning.

Good reasoning to rule out the other answers. And the short version: Lobar haemorrhages = Amyloid angiopathy

 

[guitarguy23]

Good reasoning to rule out the other answers. And the short version: Lobar haemorrhages = Amyloid angiopathy

Basically yeah, absolutely. Some of these are become "auto-click." Once you know what to look for.

I wrote it out like that though because that is literally what I think when I go through a question:

1) Age, gender, ethnicity, prior health status (if available) of pt.
2) WTF are they talking about with this pt?
3) Ah HA! I know the answer; and I look for the answer--->if not there:
3) I go back to 1) and ask: based on these things what makes sense to me given their age, gender, etc...
4) If I get it down to two answers, I choice one and NEVER change the answer even if I mark it/come back to it.

More often than not for me at least, my initial answer choice is correct in these type of situations (probably 2/3 of the time, after 6 practice tests worth)

 

[thehundredthone]

Basically yeah, absolutely. Some of these are become "auto-click." Once you know what to look for.

I wrote it out like that though because that is literally what I think when I go through a question:

1) Age, gender, ethnicity, prior health status (if available) of pt.
2) WTF are they talking about with this pt?
3) Ah HA! I know the answer; and I look for the answer--->if not there:
3) I go back to 1) and ask: based on these things what makes sense to me given their age, gender, etc...
4) If I get it down to two answers, I choice one and NEVER change the answer even if I mark it/come back to it.

More often than not for me at least, my initial answer choice is correct in these type of situations (probably 2/3 of the time, after 6 practice tests worth)

Definitely, I'm taking nothing away from your post. That's more or less how you should work with a question that isn't a gimme for you. Except step 4, where I've had some success upon changing my initial answer on review.

 

[Psai]

Basically yeah, absolutely. Some of these are become "auto-click." Once you know what to look for.

I wrote it out like that though because that is literally what I think when I go through a question:

1) Age, gender, ethnicity, prior health status (if available) of pt.
2) WTF are they talking about with this pt?
3) Ah HA! I know the answer; and I look for the answer--->if not there:
3) I go back to 1) and ask: based on these things what makes sense to me given their age, gender, etc...
4) If I get it down to two answers, I choice one and NEVER change the answer even if I mark it/come back to it.

More often than not for me at least, my initial answer choice is correct in these type of situations (probably 2/3 of the time, after 6 practice tests worth)

There are times when you have to change your answer. I had one where I was sure it was tb based on the history and demographics but then I looked at the labs again and realized that it couldn't be.

 

[notbobtrustme]

know where the hemorrhages are and what types of lesions lead to them, this **** is high yield as anything for Step 1.

Hyaline arterioloscrelosis -> ischemic infarcts, usually in the deep structures. caused by DM/HTN.
Charcot-Bouchard aneurysms -> hemorrhagic infarct, in the deep structures. caused by HTN.
amyloid angiopathy -> lobar hemorrhagic infarcts. assoc w/ AZD.

know this **** esè