USMLE images
Started by Zuhal
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That's what I chose too but the question said "foul smelling" and in the explanation they said that abscesses due to klebsiella are not usually foul smelling. Mixed anaerobes is the right answers (ex: actinomyces and other oral anaerobes)
CHF?
7-10 days? Edit: I was originally thinking that was granulation tissue, but I think it's actually just a bleed. Wavy cardiomyocytes w/contraction bands -> 4-8 hours?
Thanks for putting these up btw, good test of image knowledge
I'm going to go 1-3 daysish just to go against organic. And I see neutrophils in there
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Feel free to post any images you think might show up on the test 🙂
Yes contraction bands (pink lines running up and down the muscle fiber) = within the first 24hrs due to Ca influx.
long qt? i suck at ecg and i know im about to embarrass myself when m3 starts on monday...
Hypertrophic cardiomyopathy?
No. Here's a hint: This patient has had prolonged, excessive vomiting.
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Yes (This was actually on a friend's test)
Attachments
The heart is large, so either dialated cardiomyopathy or plain simple hypertrophied heart... since they are vomiting, I'm thinking dialation of the atria.. in that case you'd get S3 and S4....to hear S4 at a left shifted PMI (5 ICS at the point of the mid axillary line)...
With all that said, now tell me how wrong I am.... lol
Ahh, over the left sternal border? Boerhaave Syndrome.... You'll get a "mediastinal crunch" and I'd imagine L sternal border would be the best post for that.
Never actually seen a CXR of that.
Nice one!
lol im counting it as a win for myself anyway since hypokalemia causes long qt and the qt in the first image was waaaay over .44sec
No no no the question basically said pt comes to you with very broad cardiac s/s, give you a similar ekg as the one i posted and then ask which of the following fits the description of this pt
so u had to know that it was hypokalemia (extra wave after the T wave called U wave) AND then you had to figure out from a bunch of options that a patient who has been vomiting excessively may have hypokalemia (alkaline tide) and hence an extra U wave on their EKG.
Misunderstanding. The hint was in reference to Goober's EKG guess.
Yes it is dialated cardiomyopathy! So he would most likely have an S3 which is best heard at the apex (L 5th ICS)
I don't know/remember the association between intractable vomiting and Dialated Cardiomyopathy.
Anyone care to job my memory? I was pretty sure it was ruptured esophagus after your vomiting clue.
No vomiting has NOTHING to do with dialated cardiomyopathy. I was referring to the previous question on hypokalemia.
dialated cardiomyopathy---> wet beri beri, alcohol abuse, pregnancy, viral infection, chaga's, cocaine etc
Sorry about that, I'll try to number the images to avoid confusion.
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Ha ha, phew. Well now I'm not sure if my second guess was correct since I thought your mention of vomiting was in relation to the pathological heart sound from the chest X-ray of the big heart.
Great idea for a thread by the way. I love when I can goof off on SDN and still be learning something.
My bad... that sort of threw me off too.. but had to make some sort of connection with dilation of the heart... wrong connect - right answer, lol.
But, in cases of mitral stenosis, we can get left atrial dilation causing hoarseness with obstruction of the esophagus (trouble swallowing) - I was thinking it may activate gag relfex (way off!!!!)
That's a really good point actually. It can also cause mural thrombus
Dude you're so good lol! Have you taken the test yet?
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Good for you!
The answer is melanoma (MC metastasic cardiac tumor), it likes to hit the pericardium and cause pericardial effusion.
S100 is the tumor marker
FA2012 pg. 303
wow. nice one!
Nice, I was thinking Pericardial Mesothelioma, but there's not a marker that I'm aware of.
At least it was pericardial! There's hope for me.
Good lord that doesn't even sound familiar
Relatively easy one
What maternal pathology could have contributed to this ?
lithium
Relatively easy one
What maternal pathology could have contributed to this ?
Bipolar?
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