USMLE images

[Zuhal]

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

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[addo]

polyarteritis nodosa. I knew there was something about the dilation and constrictions lol. or am i wrong

no, good job, you got it. PAN associated with HBV and affects medium sized vessels. Vasculitis is necrotizing arteritis with fibrinoid necrosis

 

[sharklasers]

Can someone explain subclavian steal briefly? I don't see it in first aid anywhere, but it sounds important haha.

 

[Jonari]

Can someone explain subclavian steal briefly? I don't see it in first aid anywhere, but it sounds important haha.

best site ive found that explains it...

http://lmgtfy.com/?q=what+is+subclavian+steal

 

[sharklasers]

best site ive found that explains it...

http://lmgtfy.com/?q=what+is+subclavian+steal

damn lmao.

instead of sincerely asking for help, i should have said something like "Great job, now explain the pathogenesis"

That would have definitely worked

 

[loveoforganic2]

Proximally blocked carotid receives retrogade collateral circulation distal to blockage via vertebral a., "steals" perfusion from brain

 

[Jonari]

damn lmao.

instead of sincerely asking for help, i should have said something like "Great job, now explain the pathogenesis"

That would have definitely worked

on being a good sport and not getting mad for trying to bring humor to the board

 

[sharklasers]

Proximally blocked carotid receives retrogade collateral circulation distal to blockage via vertebral a., "steals" perfusion from brain

thanks!

this actually helps me understand wikipedias description

" retrograde (reversed) flow of blood in the vertebral artery or the internal thoracic artery, due to a proximal stenosis (narrowing) and/or occlusion of the subclavian artery. The arm may be supplied by blood flowing in a retrograde direction down the vertebral artery at the expense of the vertebrobasilar circulation. This is called the subclavian steal."

 

[tiedyeddog]

damn lmao.

instead of sincerely asking for help, i should have said something like "Great job, now explain the pathogenesis"

That would have definitely worked

lol

 

[tiedyeddog]

disease name?

 

[MLT2MT2DO]

disease name?

Count Von Recklinghausen's?

 

[tiedyeddog]

Count Von Recklinghausen's?

yup, or otherwise known as NSF1.

 

[Jamiu22]

disease name?

Lisch Nodules (NF, type 1)

 

[Jonari]

anybody know what's the function of the protein the gene encodes for...

 

[tiedyeddog]

anybody know what's the function of the protein the gene encodes for...

no idea, but I'd like to know.

 

[tiedyeddog]

what's the pathology here?

 

[Jamiu22]

what's the pathology here?

Lead-lines? it typically deposits at the epiphyseal plates...

 

[tiedyeddog]

Lead-lines? it typically deposits at the epiphyseal plates...

you the got the inciting cause but be more specific about where in the bones they occur?

 

[tiedyeddog]

ok, 1 more before I start pounding FA this morning:

little history: 1 year old who didn't receive any vaccinations. sick over past few days, had to be admitted to the NICU yesterday:

 

[Jamiu22]

you the got the inciting cause but be more specific about where in the bones they occur?

Oh I'm guessing since the gaps is the the unfused epiphyseal plate....then that must be the distal end of the diaphysis?

 

[tiedyeddog]

Oh I'm guessing since the gaps is the the unfused epiphyseal plate....then that must be the distal end of the diaphysis?

I have they are always metaphyseal(would I think would be distal end of diaphysis)? sorry for being nitpicky

 

[Jamiu22]

I have they are always metaphyseal(would I think would be distal end of diaphysis)? sorry for being nitpicky

lol. you are right.. the distal end of the diaphysis is the metaphysis...hope I don't make that mistake in my the actual exam... good question. Good luck hitting that FA today buddy! I'm going for NBME12

 

[tiedyeddog]

lol. you are right.. the distal end of the diaphysis is the metaphysis...hope I don't make that mistake in my the actual exam... good question. Good luck hitting that FA today buddy! I'm going for NBME12

good luck with 12!!!

 

[Jonari]

no idea, but I'd like to know.

that's the spirit ya ole chap...

both NF1 and 2 code for tumor suppressor genes by the names of neurofibromin & merlin, respectively.

ok, 1 more before I start pounding FA this morning:

little history: 1 year old who didn't receive any vaccinations. sick over past few days, had to be admitted to the NICU yesterday:

looking at the 2nd pic looks like the adrenals are shot...im guessing waterhouse...baby has petechiae all over the body...

feel like im wrong, because haven't seen a question about waterhouse in a 1year old...more so a kid in the early double digits stage (ie 10, 11, 12, etc etc)

 

[Jonari]

lesion at letter C would cause what:

multiple names for this...so not looking for something specific...

 

[tiedyeddog]

that's the spirit ya ole chap...

both NF1 and 2 code for tumor suppressor genes by the names of merlin and neurofibromin, respectively.



looking at the 2nd pic looks like the adrenals are shot...im guessing waterhouse...baby has petechiae all over the body...

feel like im wrong, because haven't seen a question about waterhouse in a 1year old...more so a kid in the early double digits stage (ie 10, 11, 12, etc etc)

you're right with the cause. I should have said the kid was 2 or 3, making the lack of immunization important. what typically causes FW syndrome?

 

[tiedyeddog]

lesion at letter C would cause what:

multiple names for this...so not looking for something specific...

I have no idea, locked in syndrome?

 

[Jonari]

you're right with the cause. I should have said the kid was 2 or 3, making the lack of immunization important. what typically causes FW syndrome?

neisseria meningitidis...basically causes collapse of the whole adrenal system. my statement about petechiae is actually incorrect, lol...forgot that G- bacteria, especially neisseria causes DIC...so that's probably what the kid is going through in the picture...

 

[Jonari]

I have no idea, locked in syndrome?

C is pointing to CN 6...one of the 3 CN's located in the middle of the brainstem. the other two are CN3 and CN12. lesions to CN 6 usually lead to strabismus...where're you can't ABduct the eye. this case, the patient's left eye wouldn't be able to ABduct when asked to

 

[tiedyeddog]

neisseria meningitidis...basically causes collapse of the whole adrenal system. my statement about petechiae is actually incorrect, lol...forgot that G- bacteria, especially neisseria causes DIC...so that's probably what the kid is going through in the picture...

exactly, strong work Jonari

 

[Jonari]

treatment for this adult patient?

 

[Michfgael]

best site ive found that explains it...

 

[Suncrusher]

treatment for this adult patient?

EDTA, dimercaprol, etc? (lead poisoning, burton's lines)

 

[Jonari]

EDTA, dimercaprol, etc? (lead poisoning, burton's lines)

yup...& for kids you can give succimer...now

so the rest of us can get a score like yours....

 

[JP2740]

that's the spirit ya ole chap...

both NF1 and 2 code for tumor suppressor genes by the names of merlin and neurofibromin, respectively.)

Just an FYI

NF1 = neurofibromin
NF2 = merlin

 

[Jonari]

Just an FYI

NF1 = neurofibromin
NF2 = merlin

nice thanks for the correction...

 

[Suncrusher]

yup...& for kids you can give succimer...now

so the rest of us can get a score like yours....

okay Now that I no longer need to take my mind off of an impending step 1 score, I promise not to answer any more questions in this thread. But if I'm bored, I might come back and contribute (questions). good luck everyone

 

[Jonari]

okay Now that I no longer need to take my mind off of an impending step 1 score, I promise not to answer any more questions in this thread. But if I'm bored, I might come back and contribute. good luck everyone

contribute with pictures & questions, but try to refrain from answering...if you don't mind...

 

[Suncrusher]

yeah, that's what I meant

 

[Zuhal]

okay Now that I no longer need to take my mind off of an impending step 1 score, I promise not to answer any more questions in this thread. But if I'm bored, I might come back and contribute. good luck everyone

Congrats on your awesome score Suncrusher!

 

[tiedyeddog]

okay Now that I no longer need to take my mind off of an impending step 1 score, I promise not to answer any more questions in this thread. But if I'm bored, I might come back and contribute. good luck everyone

contribute!

 

[Zuhal]

55 y/o smoker h/o HTN

What's the most likely location of abnormality seen on CT?

 

[Jonari]

55 y/o smoker h/o HTN

What's the most likely location of abnormality seen on CT?

aortic dissection....

proximal 10 centimeters of the aorta...for some reason im certain that's fairly wrong

 

[Zuhal]

aortic dissection....

proximal 10 centimeters of the aorta...for some reason im certain that's fairly wrong

No h/o of any penile ulcers or long extremities lol

 

[Jonari]

dx?

 

[Zuhal]

dx?

any hints? actually nvm lets wait for other ppl to have a go at it

 

[Jonari]

No h/o of any penile ulcers or long extremities lol

AD can still happen without patient having syphilis or marfan's...

only other thing i can think of would be abdominal aortic aneurysm...below L2, but above L4

 

[Jonari]

any hints?

yeahhh...unfortunately not really...we're all so used to seeing this image in x-ray view...was surprised when i saw this come up on google search

 

[Zuhal]

AD can still happen without patient having syphilis or marfan's...

only other thing i can think of would be abdominal aortic aneurysm...below L2, but above L4

That's it. Below the renal artery but above the aortic bifurcation

 

[Jonari]

That's it. Below the renal artery but above the aortic bifurcation

tricky ?...if you hadn't given the 2nd clues...knee jerk would've been aortic dissection for sure...but i guess would also have to look for "tearing pain radiating to the back"

any clue on my image? ok...it's associated with turner's...should get it now

 

[Zuhal]

aortic coarcatation
I have no clue. tough one for sure