Cardio Path Q

[MudPhud20XX]

A 62-year-old man has had episodes of chest pain during the past 5 years, with a myocardial infarction documented 2 years ago. He has had episodes of abdominal pain over the past month. On physical examination, bowel sounds are present. On palpation of the abdomen there is a midline pulsatile mass. Dorsalis pedis and posterior tibial pulses are barely palpable. An abdominal CT scan reveals the lesion shown in the image. Which following laboratory test finding is he most likely to have?

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[MudPhud20XX]

 

[Transposony]

so here is with the clinical vignette.

A 25-year-old woman has had a low-grade fever and chills for 3 weeks. On physical examination a shrill systolic murmur is present. An echocardiogram reveals a ventricular septal defect. What form of endocarditis is she most likely to have?

SABE

 

[Transposony]

Mitral valve (bicuspid) with arrows pointing to fused leaflets at the margins.

 

[MudPhud20XX]

Mitral valve (bicuspid) with arrows pointing to fused leaflets at the margins.

correct.

The patient has mitral valve stenosis, which is most commonly due to chronic recurrent rheumatic fever. The patient has a history of recurrent pharyngitis most likely due to a strain of group A streptococcus that has antigens in its cell wall that are similar to antigens in the heart causing immunologic damage to the heart (type II hypersensitivity reaction). The most common valve injured is the mitral valve. Initially, the sterile vegetations that develop on the valve produce mitral regurgitation; however, with recurrent attacks of rheumatic fever, the valve becomes fibrotic and dystrophically calcified, which is evident in the figure. Note the enlarged, dilated left ventricle, which caused the chronic atrial fibrillation. Accumulation of blood in the left atrium behind the stenotic valve increases pulmonary venous and capillary hydrostatic pressure causing pulmonary edema and hemorrhage (rust-colored sputum). Pulmonary venous hypertension followed by right ventricular hypertrophy is a common complication.

 

[MudPhud20XX]

 

[Transposony]

Anterior wall MI leading to papillary muscle rupture followed by acuteŽ mitral regurgitation around 3-4 days following MI (as suggested by inflammation around the coagulative necrotic tissue).
Likely cause of death: acute pulmonary edema.

 

[MudPhud20XX]

Anterior wall MI leading to papillary muscle rupture followed by acuteŽ mitral regurgitation around 3-4 days following MI (as suggested by inflammation around the coagulative necrotic tissue).
Likely cause of death: acute pulmonary edema.

So here is the question along with the answer choices.

A 58-year-old man is hospitalized because of difficulty breathing and substernal chest pain of more than 1-hour duration. Unfortunately, the patient dies. The figure shows a cross section of the left and right ventricles; the anterior portion of the heart is at the top. How long after his initial presentation did he die?

A. 3-4 hours after the onset
B. 12-24 hours after the onset
C. 1-3 days after the onset
D. 3-7 days after the onset
E. 10-14 days after the onset

 

[MudPhud20XX]

what do you guys think?

 

[Transposony]

So here is the question along with the answer choices.

A 58-year-old man is hospitalized because of difficulty breathing and substernal chest pain of more than 1-hour duration. Unfortunately, the patient dies. The figure shows a cross section of the left and right ventricles; the anterior portion of the heart is at the top. How long after his initial presentation did he die?

A. 3-4 hours after the onset
B. 12-24 hours after the onset
C. 1-3 days after the onset
D. 3-7 days after the onset
E. 10-14 days after the onset

D
Is the picture upside down?

 

[Transposony]

what do you guys think?

The Calcium Games: Monckeberg's arteriosclerosis

 

[chizledfrmstone]

Anterior wall MI leading to papillary muscle rupture followed by acuteŽ mitral regurgitation around 3-4 days following MI (as suggested by inflammation around the coagulative necrotic tissue).
Likely cause of death: acute pulmonary edema.

<- MS1 who just finished CP1 section.

Holy ****, this is like an art. I have appreciation for the thought process that goes into this stuff.

Are most MS2 students thinking like this before boards?

 

[MudPhud20XX]

The Calcium Games: Monckeberg's arteriosclerosis

correct.

Monckeberg calcific medial sclerosis is a benign, incidental finding most often seen in the elderly. Small arteries in pelvis and extremities are typically involved. Though there can be prominent calcifications of the arterial media, the vascular lumen is not compromised.

 

[MudPhud20XX]

D
Is the picture upside down?

correct. D it is.
The gross appearance of the infarct— central yellow-tan softening with a hyperemic border—is suggestive of death at this time after the initial infarct.
why do you think the pic is upside down?

 

[MudPhud20XX]

A 58-year-old woman with a 5-year history of chronic ischemic heart disease developed an anterior myocardial infarction and died 2 weeks later of a ventricular arrhythmia. The photographs show a cross section of liver. What is the cause of the changes noted in the liver?

 

[Transposony]

A 58-year-old woman with a 5-year history of chronic ischemic heart disease developed an anterior myocardial infarction and died 2 weeks later of a ventricular arrhythmia. The photographs show a cross section of liver. What is the cause of the changes noted in the liver?

Congestive heart failure--> back pressure--->Congested liver aka Nutmeg liver.

 

[faisal 2000]

does acetylcholinesterase play role in vasovagal syncope? what is the function of acetylcholinesterase normally ?
what is the pathophysiology of vasovagal syncope?

 

[pathologyDO]

A 58-year-old woman with a 5-year history of chronic ischemic heart disease developed an anterior myocardial infarction and died 2 weeks later of a ventricular arrhythmia. The photographs show a cross section of liver. What is the cause of the changes noted in the liver?

Congestive heart failure--> back pressure--->Congested liver aka Nutmeg liver.

I agree that CHF is likely to have caused this as it does look edematous like nutmeg liver. I also notice a yellow appearance too so fatty changes have occurred which could also be due to abetalipoproteinemia, metabolic syndrome, etc, and these conditions can be linked to heart disease. Just extra thoughts but yeah, def CHF.

 

[navigator]

I have a more advanced one:
27 yo IVDU develops high grade fever and has aortic valve endocarditis inolving his right coronary cusp. He develops pulmonary edema and is transferred to the ICU to be intubated.

EKG shows sinus tachycardia. heart rate 110. QRS duration of 90ms. PR interval 260ms. EKG from 2 days ago shows a HR of 105. QRS Duration of 90ms and PR interval of 200ms.
question 1- what finding will the echo show?
question 2- what procedure do you need to do quickly?

so here are the answer choices
A. Calcific aortic stenosis
B. Cardiac myxoma
C. Cerebral mycotic aneurysm
D. Constrictive pericarditis
E. Pulmonary hemorrhagic infarction

I ruled out C bc there are no focal neurologic deficits.... unless there are and I'm missing something?

 

[Instatewaiter]

I ruled out C bc there are no focal neurologic deficits.... unless there are and I'm missing something?

The question is what complication is most likely to develop.