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Step I USMLE images

Started by Zuhal
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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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tiedyeddog said:
Mitral prolapse?
Click to expand...

Not what I have in mind (and pretty sure no in general, but I can see the reasoning). Just got a UW q that talked about this, and 1st I've ever heard of it, so if I'm off base with this being specific to what I'm thinking, someone should correct me after (but UW gave the impression it was pretty specific to one thing)
 
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loveoforganic2 said:
Not what I have in mind (and pretty sure no in general, but I can see the reasoning). Just got a UW q that talked about this, and 1st I've ever heard of it, so if I'm off base with this being specific to what I'm thinking, someone should correct me after (but UW gave the impression it was pretty specific to one thing)
Click to expand...

It's pulsus biferiens, right?

Aortic regurg?
 
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Maybe aortic regurg? Ejection->Peak1->regurg->smaller, second ejection due to high pressure still in ventricle->Peak 2->dicrotic notch indicating closure
 
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tiedyeddog said:
It's pulsus biferiens, right?

Aortic regurg?
Click to expand...

Woops, yes, it's pulsus biferiens. Wiki has a nice page summarizing what causes it. The UW q (187) didn't call it pulsus biferiens, but described it as "bifid carotid pulse w/brisk upstroke, causing a spike and dome appearance on pressure tracing". I did a quick search looking into it, and it seemed fairly specific for HCM (what UW was associating it with), but it's definitely also associated w/ comorbid aortic stenosis + aortic regurg as well as severe aortic regurg.

My bad there
 
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loveoforganic2 said:
Woops, yes, it's pulsus biferiens. Wiki has a nice page summarizing what causes it. The UW q (187) didn't call it pulsus biferiens, but described it as "bifid carotid pulse w/brisk upstroke, causing a spike and dome appearance on pressure tracing". I did a quick search looking into it, and it seemed fairly specific for HCM (what UW was associating it with), but it's definitely also associated w/ comorbid aortic stenosis + aortic regurg as well as severe aortic regurg.

My bad there
Click to expand...

wow I'm definitely learning a lot from this thread! Thank you : )
 
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loveoforganic2 said:
Woops, yes, it's pulsus biferiens. Wiki has a nice page summarizing what causes it. The UW q (187) didn't call it pulsus biferiens, but described it as "bifid carotid pulse w/brisk upstroke, causing a spike and dome appearance on pressure tracing". I did a quick search looking into it, and it seemed fairly specific for HCM (what UW was associating it with), but it's definitely also associated w/ comorbid aortic stenosis + aortic regurg as well as severe aortic regurg.

My bad there
Click to expand...

You could've probably narrowed the choices by the S4 presence. I haven't had that q yet tho 🙁
 
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How would you expect this pt's JVP tracing to look like? specifically, what would happen to his 'a' wave?
 

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3 y/o child+ dyspnea+ SOB. ekg is performed. mother also explains that the child is deaf. weber test is performed and results indicate that the child hears the sound louder in the unaffected ear.
what's the dx?
 

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Zuhal said:
3 y/o child+ dyspnea+ SOB. ekg is performed. mother also explains that the child is deaf. weber test is performed and results indicate that the child hears the sound louder in the unaffected ear.
what's the dx?
Click to expand...

Torsades from long QT syndrome? Jervell something something syndrome
 
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Zuhal said:
3 y/o child+ dyspnea+ SOB. ekg is performed. mother also explains that the child is deaf. weber test is performed and results indicate that the child hears the sound louder in the unaffected ear.
what's the dx?
Click to expand...

Jervell-Lange-Nielson syndrome. Often confused with Romano Ward which is another congenital torsades disorder HOWEVER Romano-Ward people do not have sensorineural deafness.

Great question.
 
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Zuhal said:
3 y/o child+ dyspnea+ SOB. ekg is performed. mother also explains that the child is deaf. weber test is performed and results indicate that the child hears the sound louder in the unaffected ear.
what's the dx?
Click to expand...

jervell and lange neilsen lol. I just studied cardio 😀
 
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Goober11 said:
Soon we will have to have a brainstem day. Now to learn how to post pics on here...
Click to expand...

Just had an epiphany, when i saw the word "brainstem" ...after doing all the available NBMEs from 1-15 and doing a school sponsored CBSE...i've seen pictures being repeated many times...i think it's worth our while...to periodically post these images from the NBME and come up with different ways to see how a question can be asked using these pictures...


here are some pictures from the older NBMEs...where i've seen these pictures get shown up again...Sure, this thread is both informative and educational - but why not use the resources that we have in hand, and know the pictures that are already present on the NBMEs and study those? there was a picture on nbme 15, which i immediately recognized from an older nbme...just can't remember which nbme folder it's located in...

***NBME SPOILERS***

http://i.imgur.com/set7izT.png
http://i.imgur.com/LvZy6ZB.png
http://i.imgur.com/Xmsp77q.png
http://i.imgur.com/s4M0KkI.png
http://i.imgur.com/ndcodzM.png
http://i.imgur.com/jkJuLoP.png
 
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JP2740 said:
You could've probably narrowed the choices by the S4 presence. I haven't had that q yet tho 🙁
Click to expand...

It was an explanation for one of the incorrect answers, not the focus of the question

Goober11 said:
Jervell-Lange-Nielson syndrome. Often confused with Romano Ward which is another congenital torsades disorder HOWEVER Romano-Ward people do not have sensorineural deafness.

Great question.
Click to expand...

Is this stuff in FA? Did I just gloss over it altogether? Or is it UW? Doesn't even sound familiar. JLN anyway, RW rings somewhat of a bell
 
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loveoforganic2 said:
It was an explanation for one of the incorrect answers, not the focus of the question



Is this stuff in FA? Did I just gloss over it altogether? Or is it UW? Doesn't even sound familiar. JLN anyway, RW rings somewhat of a bell
Click to expand...

JLN is in the description talking about Torsades in FA, it's also in Kaplan Pharm talking about congenital prolonged QT interval.
 
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loveoforganic2 said:
It was an explanation for one of the incorrect answers, not the focus of the question



Is this stuff in FA? Did I just gloss over it altogether? Or is it UW? Doesn't even sound familiar. JLN anyway, RW rings somewhat of a bell
Click to expand...

JLN is in FA as a one-liner in the torsades section. RW rings a bell for you because that comes back from my Gunnertraining days. The damn program works after all, if only days were 30 hours long I might have actually finished it.
 
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Jonari said:
Just had an epiphany, when i saw the word "brainstem" ...after doing all the available NBMEs from 1-15 and doing a school sponsored CBSE...i've seen pictures being repeated many times...i think it's worth our while...to periodically post these images from the NBME and come up with different ways to see how a question can be asked using these pictures...


here are some pictures from the older NBMEs...where i've seen these pictures get shown up again...Sure, this thread is both informative and educational - but why not use the resources that we have in hand, and know the pictures that are already present on the NBMEs and study those? there was a picture on nbme 15, which i immediately recognized from an older nbme...just can't remember which nbme folder it's located in...

***NBME SPOILERS***

http://i.imgur.com/set7izT.png
http://i.imgur.com/LvZy6ZB.png
http://i.imgur.com/Xmsp77q.png
http://i.imgur.com/s4M0KkI.png
http://i.imgur.com/ndcodzM.png
http://i.imgur.com/jkJuLoP.png
Click to expand...

It's a good idea I just don't know how many people will be contributing to these photos since most people aren't finished doing NBMEs until like a week before their exam. I'd be happy to contribute but I don't wanna spoil my two NBMEs I have left to take.
 
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loveoforganic2 said:
It was an explanation for one of the incorrect answers, not the focus of the question



Is this stuff in FA? Did I just gloss over it altogether? Or is it UW? Doesn't even sound familiar. JLN anyway, RW rings somewhat of a bell
Click to expand...

I saw it in uworld today (well explained) and then I annotated it in my FA... cos I didn't see it there.
 
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loveoforganic2 said:
Woops, yes, it's pulsus biferiens. Wiki has a nice page summarizing what causes it. The UW q (187) didn't call it pulsus biferiens, but described it as "bifid carotid pulse w/brisk upstroke, causing a spike and dome appearance on pressure tracing". I did a quick search looking into it, and it seemed fairly specific for HCM (what UW was associating it with), but it's definitely also associated w/ comorbid aortic stenosis + aortic regurg as well as severe aortic regurg.

My bad there
Click to expand...
no prob, lets keep it going!! this thread is great
 
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tiedyeddog said:
got one for everyone: brain lesion, within the left cerebral hemeisphere. What feature leads to dx?

glioblastoma-brain-[1-br006-1].jpeg
Click to expand...

Jamiu22 said:
Those are pseudorosettes - Glioblastoma Multiforme
Click to expand...

tiedyeddog said:
Yup! Strong work
Click to expand...

This is incorrect.

This IS glioblastoma but on the picture those are pseudopalasaides. Pseudorosettes are associated with Ependyoma.

I'm just correcting this because I'd hate for someone to view this thread and get a question on the real thing because of this.
 
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MLT2MT2DO said:
Can we get a description from either the original poster of this pic or the guy who answered it?

I don't know what I'm seeing as far as T-cell lymphoma is it just the cells in the crypts?
Click to expand...

Celiac disease is what we're looking at. Blunting of the vili, and hyperplasia of the crypt abscesses. Pts with CD have something on their skin known due to the deposition of IgA antibodies at the tips of the dermal papillae called "dermatitis herpetiformis". It's called this because physicians initially thought it was outbreak of herpes virus.

Pt's that have CD, will all of a sudden start to relapse with their class signs and symptoms. If the patient tells you "Dr. MLT2MT2DO, i assure you i've been following my gluten free diet for a long time...not sure why it's happening" - it's possible these patients are having a neoplastic problem, called EATL - Enteropathy Associated T-Cell Lymphoma.

Cool?
 
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Jonari said:
Celiac disease is what we're looking at. Blunting of the vili, and hyperplasia of the crypt abscesses. Pts with CD have something on their skin known due to the deposition of IgA antibodies at the tips of the dermal papillae called "dermatitis herpetiformis". It's called this because physicians initially thought it was outbreak of herpes virus.

Pt's that have CD, will all of a sudden start to relapse with their class signs and symptoms. If the patient tells you "Dr. MLT2MT2DO, i assure you i've been following my gluten free diet for a long time...not sure why it's happening" - it's possible these patients are having a neoplastic problem, called EATL - Enteropathy Associated T-Cell Lymphoma.

Cool?
Click to expand...

Ok I got that. I saw blunting of villi and thought, dermatitis herpetiformis. I had that tied together.

Why is that picture a T-cell lymphoma though? It just looks like normal blunting in celiac's to me.
 
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MLT2MT2DO said:
Ok I got that. I saw blunting of villi and thought, dermatitis herpetiformis. I had that tied together.

Why is that picture a T-cell lymphoma though? It just looks like normal blunting in celiac's to me.
Click to expand...

I think he meant here's the pathology and what cancer is associated with it...
 
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MLT2MT2DO said:
This is incorrect.

This IS glioblastoma but on the picture those are pseudopalasaides. Pseudorosettes are associated with Ependyoma.

I'm just correcting this because I'd hate for someone to view this thread and get a question on the real thing because of this.
Click to expand...

you're definetely right. For some reason I assumed pseudopalisading = psuedorosettes.

Just for reference, here are psuedorosettes:

F4.large.jpg

They kind of look like a rosette:
F7.small.gif


Here is a better picture of psuedopallisading necrosis.

jdmiles___0000000000_1238886260_i.jpg
 
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