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Zuhal

Zuhal

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68 yo male patient presents to your clinic with postprandial pain. X-ray below, whats the dx?
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Jamiu22 said:
Klebsiella (since it's so big and focal)
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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)
 
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What's wrong with this 69 year old hypertensive pt?
 

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Heart tissue
How long ago did this happen?
 

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Zuhal said:
What's wrong with this 69 year old hypertensive pt?
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CHF?

Zuhal said:
Heart tissue
How long ago did this happen?
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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
 
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Where would you place your stethoscope to listen to this pt's murmur?
 

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loveoforganic2 said:
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
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Feel free to post any images you think might show up on the test :)

MLT2MT2DO said:
I'm going to go 1-3 daysish just to go against organic. And I see neutrophils in there
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Ycut said:
Less than 24h
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Yes contraction bands (pink lines running up and down the muscle fiber) = within the first 24hrs due to Ca influx.
 
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Since we're talking cardio, I came across this EKG today
what's wrong with this pt?
 

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SLC said:
Right 2nd ICS

(I'm assuming that's Left Ventricular Hypertrophy due to Aortic Stenosis)
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No but that's a good guess. I guess I shouldn't have called it a murmur. Where would you place the stethoscope to listen to the pathological heart sound associated with the xray findings?
 
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Zuhal said:
No. Here's a hint: This patient has had prolonged, excessive vomiting.
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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
 
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Zuhal said:
No. Here's a hint: This patient has had prolonged, excessive vomiting.
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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!
 
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JP2740 said:
I don't get it. What did they ask? The numbers associated w/ the peaks or are you tlking about the hypokalemia one.
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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.
 
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Jamiu22 said:
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
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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)
 
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Zuhal said:
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)
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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.
 
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SLC said:
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.
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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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Zuhal said:
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.
 
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#1: This one is tough
Xray finding in this pt is due to a specific tumor metastasis. What tumor marker is likely to be elevated in this patient?
 

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Zuhal said:
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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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!!!!)
 
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Zuhal said:
#1: This one is tough
Xray finding in this pt is due to a specific tumor metastasis. What tumor marker is likely to be elevated in this patient?
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5 hydroxyindoleacetic acid? but wouldn't that only affect tricuspic and pulmonic valves (not the swollen heart seen in the xray)
 
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Jamiu22 said:
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!!!!)
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That's a really good point actually. It can also cause mural thrombus
 
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Ycut said:
Yes :)
245
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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
 
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Zuhal said:
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
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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.
 
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Relatively easy one

What maternal pathology could have contributed to this ?
ynahydy9.jpg
 
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