USMLE images

[Zuhal]

68 yo male patient presents to your clinic with postprandial pain. X-ray below, whats the dx?

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[Ycut]

Yep thats it
Ebsteins anomaly from maternal lithium use for bipolar disease

 

[Ycut]

Mass excised from female newborn (protruding from vagina)

 

[Jonari]

Mass excised from female newborn (protruding from vagina)

rhabdomyosarcoma...what stain is positive for it?

ps: where'd you get that picture from...pretty sure pathoma uses the same one

 

[Ycut]

Google

 

[Jonari]

lithium

Bipolar?

Ebstein's anomaly (atrialization of the RV), right?

what other defect do you see with lithium as a teratogen?

 

[Ycut]

 

[Ycut]

what other defect do you see with lithium as a teratogen?

None comes to mind

 

[Jonari]

delta-wave - WPWS?

please be right

 

[Jonari]

None comes to mind

ebstein's also shows ASD in about 50% of the patients

 

[Ycut]

Yep

 

[Jonari]

Yep

any good source/link to better learn ecg/ekg...i didn't know the answer to the one on the previous page. don't want to miss these questions on the real deal.

congrats on your score btw.

 

[JP2740]

rvh?

 

[Jonari]

1. what hormone drives this tumor
2. which other neoplasms produce a similar histology finding

 

[Ycut]

any good source/link to better learn ecg/ekg...i didn't know the answer to the one on the previous page. don't want to miss these questions on the real deal.

congrats on your score btw.

Much thx
I dont know a good source for ekgs but i got some lectures of one indian guy who gives lectures on it and its quite good for step 2 i guess

 

[SLC]

1. what hormone drives this tumor
2. which other neoplasms produce a similar histology finding

1. TSH?
2. Serous papillary cystadenoma of the ovary, Meningioma, Mesothelioma.

 

[Ycut]

Leiomyoma

 

[Jonari]

1. TSH?
2. Serous papillary cystadenoma of the ovary, Meningioma, Mesothelioma.

my fault on the poor question.

1. estrogen for meningioma
2. brah, and don't forget Papillary carcinoma of the thyroid

PSMMoma bodies - even though it's spelled wrong
Papillary carcinoma of thyroid
Serous pap cystadenoma
Meningio
Mesothe

 

[Jonari]

Lady comes in with pain when she eats. Decide to do a blood smear and see this. Dx?

 

[Anastomoses]

this thread is so sexy!

 

[Ycut]

Lady comes in with pain when she eats. Decide to do a blood smear and see this. Dx?

Looks like spherocytes

 

[Suncrusher]

Rouleaux? can be elevated protein or ESR, so...temporal arteritis?

 

[sharklasers]

Rouleaux? can be elevated protein or ESR, so...temporal arteritis?

Pain when she eats might be jaw claudication?

 

[Jamiu22]

Rouleaux? can be elevated protein or ESR, so...temporal arteritis?

I like this answer!

 

[iwanttogotomed]

Cholecystitis?

 

[MLT2MT2DO]

Rouleaux? can be elevated protein or ESR, so...temporal arteritis?

Definitely rouleaux

 

[Zuhal]

Pain when she eats might be jaw claudication?

Agreed. Jaw caludication=temporal arteritis= ESR increase

 

[sharklasers]

Just wondering, how were you guys able to associate rouleaux with high ESR?

In first aid, I only see it mentioned one time in the end section where it just talks about high yield points.

Did y'all just remember it from class or something?

 

[Zuhal]

Morning y'all!
34 y/o male presents w/ hemoptysis+cough+hematuria. see lung MRI. antibodies against which protein are likely to be elevated in this pt's serum?

 

[Zuhal]

Just wondering, how were you guys able to associate rouleaux with high ESR?

In first aid, I only see it mentioned one time in the end section where it just talks about high yield points.

Did y'all just remember it from class or something?

General pathology section of FA

 

[sharklasers]

Morning y'all!
34 y/o male presents w/ hemoptysis+cough+hematuria. see lung MRI. antibodies against which protein are likely to be elevated in this pt's serum?

alpha3 chain of collagen iv?

EDIT: wow nevermind at my last edit, i hope no one saw that lol

 

[sharklasers]

General pathology section of FA

yeah i knew that temporal arteritis causes increased ESR.

i guess my understanding isn't enough to automatically associate a high erythrocyte sedimentation rate with rouleaux formation haha

 

[Zuhal]

yeah i knew that temporal arteritis causes increased ESR.

i guess my understanding isn't enough to automatically associate a high erythrocyte sedimentation rate with rouleaux formation haha

Anytime we have inflammation, the liver makes a lot of fibrinogen and other "acute phase reactants". This fibrinogen is positively charged so when it goes out into the bloodstream and mixes with the negatively charged RBC, it causes them to clump around it and we get that stacked rouleaux appearance.

 

[Zuhal]

alpha3 chain of collagen iv?

EDIT: wow nevermind at my last edit, i hope no one saw that lol

Are you thinking Alport Syndrome? I don't think they have any lung involvement. It's mostly kidneys, ears and eyes.

 

[Jamiu22]

yeah i knew that temporal arteritis causes increased ESR.

i guess my understanding isn't enough to automatically associate a high erythrocyte sedimentation rate with rouleaux formation haha

Just think about what ESR actually means..... rate of RBC settling at the bottom of a tube; when rouleaux occurs.. the RBCs stick together and becoming heavier... and more will sink faster to the bottom of the tube, ala higher sedimentation rate.

 

[Jamiu22]

Are you thinking Alport Syndrome? I don't think they have any lung involvement. It's mostly kidneys, ears and eyes.

Alport is alpha 5 - I'm thinking he's on the tip of goodpastures!

 

[Zuhal]

Alport is alpha 5 - I'm thinking he's on the tip of goodpastures!

Good point!

No he doesn't have Goodpastures, not with this type of MRI. Another hint: He has sinusitis and otitis media.

 

[Jonari]

Alport is alpha 5 - I'm thinking he's on the tip of goodpastures!

kinda and kinda not...need a bit more info on the question. keep in mind goodpasture's also does affect the lungs, specifically the alveoli. it can be antibodies against the basement membrane or getting a bit more info it could be antibodies against neutrophils.

which one is it brah?

 

[Jamiu22]

...double post, sorry

 

[Jamiu22]

Good point!

No he doesn't have Goodpastures, not with this type of MRI. Another hint: He has sinusitis and otitis media.

the only thing jumping out to me is c-ANCA.. it's screaming "pick me" "pick me" lol but it doesn't explain the otitis media (unless the otitis media is caused by the sinusitis)

 

[Jonari]

Rouleaux? can be elevated protein or ESR, so...temporal arteritis?

nice job dude...keep it up.

next Q for the class...

1. what is this condition associated with, with respect to that organ?
2. causes of this in adults?

 

[Zuhal]

the only thing jumping out to me is c-ANCA.. it's screaming "pick me" "pick me" lol

Yes it is Wegners and yes they have c-ANCA antibodies, you're almost there.
Against which specific cellular protein/structure are these antibodies made?

 

[Zuhal]

nice job dude...keep it up.

next Q for the class...

1. what is this condition associated with, with respect to that organ?
2. causes of this in adults?

Is that a pseudocyst?
GET SMASHED

 

[Jonari]

Yes it is Wegners and yes they have c-ANCA antibodies, you're almost there.
Against which specific cellular protein/structure are these antibodies made?

i already answered this in the post above...post 137

Is that a pseudocyst?

 

[Jamiu22]

Yes it is Wegners and yes they have c-ANCA antibodies, you're almost there.
Against which specific cellular protein/structure are these antibodies made?

oh lol... it's proteinase 3 (i just added this to my first aid yesterday from a uworld question).

Although this question isn't hinting at pauci-immune mediated cresentic GN.. in that case, it would be P-ANCA (anti-myeloperoxidase)...I cheated on this one..

 

[Zuhal]

oh lol... it's proteinase 3 (i just added this to my first aid yesterday from a uworld question).

Although this question isn't hinting at pauci-immune mediated cresentic GN.. in that case, it would be P-ANCA (anti-myeloperoxidase)...I cheated on this one..

CORRECT!
It's c-ANCA (wegners is associated with RPGN), not p-ANCA

 

[Zuhal]

Pt presents with seizure, glaucoma and a red stain distributed along the trigeminal nerve pathway. What could possibly explain this pt's volume pressure loop?
(pardon the image's quality, my phone is retiring after the usmle)

 

[iwanttogotomed]

sturge weber

 

[Zuhal]

sturge weber

Right but what is it about struge weber that makes the patient have an increase in preload and a decrease in afterload?

 

[MLT2MT2DO]

Right but what is it about struge weber that makes the patient have an increase in preload and a decrease in afterload?

Decreased cross sectional area due to arterioles being non-compliant?

I'm horrible with vasculitis/heart so this is a complete shot in the dark

 

[iwanttogotomed]

AVM associated with Sturge weber -> increased preload. Not sure what exactly causes reduced after load though.