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Pathology CVS

The document describes a 67-year-old man presenting for an annual checkup with intermittent abdominal pain and a notable abdominal mass upon examination. Laboratory tests indicate normal liver function, and the most likely diagnosis is an abdominal aortic aneurysm (AAA), given the patient's history of hypertension and smoking. The document emphasizes the importance of screening for AAA in men aged 65-75 who have a history of smoking, as it can lead to life-threatening complications if not addressed.

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92 views620 pages

Pathology CVS

The document describes a 67-year-old man presenting for an annual checkup with intermittent abdominal pain and a notable abdominal mass upon examination. Laboratory tests indicate normal liver function, and the most likely diagnosis is an abdominal aortic aneurysm (AAA), given the patient's history of hypertension and smoking. The document emphasizes the importance of screening for AAA in men aged 65-75 who have a history of smoking, as it can lead to life-threatening complications if not addressed.

Uploaded by

recofa6572
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF or read online on Scribd
WS Ser BeeeUuNaaveeeseessarecarevssasu.| ery 1 > ‘7 year-old man prsons fr his anual checkup. Ho sys ho fle wall eacopt ‘or oceasonal abdominal pal He deserves the pan as 410-570 in intonsy Dhertate ‘shop and simvastatin, The pation repos a AOpack year stoking story and 2 atanolconnks acy His blo pressure 150700 mn Hy apd pulse Bm. Peripheral pusce ar 2+ bitraly al extrema. Abdominal exam rovalza brat Int eplanstic gin long wath md tenderness to palpation wth no rebound (guarding Meret soa pusate abdominal mass fet on deep palpation atthe Physical exam normal Laboratory ngs are sificant for Serum total cholesterol mai serum oa ion moet Sorum amyl 2sun Serum alenineamboransfemse(ALT) 20. Serum asparate aminowancease (AST) 16 UL (Which of no foloing tho most kay dagross nts pation? [A Aso sre snowy 8. Acie panreatts (C Mesetoicechenia Dhertcts WS See beeeuuNeayveeesercnas Lesva Explanation: Ccomact answer A: Abdominal aor anourysm (AAA) she ataon ot the bominal aorta de to atheroslere seo. esutingin atopy and ‘trucral weakness of he wal fsee mage below, Conmon racers for ‘Aad aromaio sox, smoking 2g0>60 yous land ho presence a comorbid peripheral vase dc0a58. An AAA Yypcalaisesimmodatly above he ‘2ote breton but blow the og ofthe ronal aes An AAAs UsUaby ‘symptomatic unless grows in size to grater an Sc in dante or puree. Ely sgns of mpending rupture nude abdominal Nana grin an wth retaton tote back and souls. eas BUSRd yy severssarecareevsases| bsctucio Related Videos: © iene roran © (tones thon Spe Spon, First Aid References: Fst Ad forthe USMLE Step 1 2018, 2th e300, Fst Ad forth USMLE Stop 12018, 280: 296 Fst A forthe USMLE Stop 12017, 27th ch 292 ala wah etaon tothe back ad snouts. First Aid References: f Frat doth UNE Sep 12088, 20h 200 eat Fst AM fr th UBMLE Sep (018,28 eh 208 Ft forth UME Sp 4297.27 06) 292 ict ney forte aneuyem Adonina ise ‘The classical presentation ofan AAA's mine pulse absomina mss 95, ‘soon nth patent, whi may be absertin up 1 SOX ofpatin. Screening foram AKA comstng of abdominal rounds ecommended by to United ‘States Prvertsbve Serco Tsk Force {USPSTF)m af menbetween 65-75 year fag whe have eve smoked Rupture othe aneurysms tbe most Conan compcaton ana a meccl emergency crizaly presenting with ‘he vad of peterson. apusatle mine abdominal mass and fark pan Less common conection are thomboembolzm anda macs elect causing > : " = » gee VAUBe bc as¥u usps essaecossacasec sea. o-8 ‘The cassia! presentation ofan AAA isa mine pusaleabomina mss 5, seen this patent, which may be absatin upto 50% of patents. Screening foran AAA conaistng of abdominal uasoundiseconmended by te United ‘Slates Prvertate Services Tek Force [USPSIF] nal men between 65-75 \yoor of age, hs have ever smoked Ruptre othe anes the moe commen comptcaton and isa meal emergency cncaly presenting wit {he bad of ypatension, a pulse mine abdominal mason fork pan Loss common compton ae tomboerbolsm and mass elect causing local compression symptoms Cina! signs ofoal compression ace ea ste), nausea vomiting urnary symptoms, audeaton ofa, Wedd Fetes, acelie mote ete anc paten present onthe gs ‘This patent’ past medial history of smoking, hypertension, comorbid petghera! veselor dseac0and te presentation aa pute abdominal mass ‘on phys exams stenglysuggestne of an abeminal aor near ‘OptonB: Acts pancratis presets eth ure abomal pain. Serum _amyos0 and pose levels are pea elevated n adaton Ivor uncon ‘rzymes LF] and bub eves maybe abnomal he san undying ‘ot comprbid Iver patology Since tis pans laberatery values were norma ‘the agnosis of pancreatic urbe ‘Option: Mesonter schema posers whan acute abdomen. spectcally severe fuse abdominal pain ae extreme tenderness to palpaton wih rebound ae gusting, abdominal tention, and gf the abdersa ‘all Other cmon symptom ineide rea, vont, nore, ‘aoa or constipauon Commen causes of mesenteric chem che ‘mosomtranerialtvomboss seconaary to ehroscovae disease. a ‘mesenterc areal embolism secondry toatl bittn, 8 rece S- levation myocardalinarcton ofthe eft venice wth mural thembus Lees en {he cagnons of pancoatse unl WS Ser BeeeUuNaaveeeseessarecarevssasu.| ‘Option c:Mesontere ischemia posers whan acto abdomen, spocealy ‘sever ifise abdominal pain are extreme teers opalpaton wit ‘ebound end quan, abdominal dsteniton, ad yf the abderra al ne common symptoms incude raises, vomiting, note. an ‘lores or constipavon Conen causes of mesenteric chemi chide ‘mesenterc atta tvombose secondary to eherosceate disease. ‘mosomar ail embatsm secondary to ati tion. reco ST- vation myocar nfocton ofthe lek venice ath mal thrombus Less ‘ommany, esentere venous thromble may occur we Pypecoagulble stato or ombopitc condense stool = typically ula posto, ys ‘att, tho presence of pusee midine sido! mass makes the ‘lagnors of mereneri enema ue ‘Option D: Gastiie can cricaly present with abdonina pan, arb, nd sense of ulnessn the algae region. However pusateabdominl mass ‘Option Divctcutis common patoes above 50 yrs of ago peal ‘teres wth tower quran abdominal pai,» change in tow habs ‘aurea, vomiting, and sometimes, rectal booding ar hematochora. This ‘atlonts str and prsertaon ar much more suggest ofan abdominal eric aneuram than a gross of dericuts. Loaring objective: An abdominal gore aneurysm (AAA) 9 elletation of te lbdominl aera type seconcary to atheroscertie ease, Commen ris {actors for AAA ince smoking, hypertension, nypripkema and comorbid petnherlvasculor deoase. Most cares of AAA ate asymetonstic unt thor is 3 Westreatring medical emergency. Cncally, AAA posers wh a of ypatension fan pan anda pusate abdominal mass Diagnosis confirmed by ebdominl utrescund A sreerng utrasound or he presence VAUBe bc as¥u usps essaecossacasec sea. o-8 ‘lea or consipaven Conen causes of mesentn chemi chide ‘mesenterc atta tvombose secondary to ehrosceate disease. ‘mosomtre ail embolism secondary to ata iain a recore ST levation mycirdal infocton ofthe le enrich mal thrombus Less ‘command, meserterc veneve omberls may occu wi Pypecoagulable {hut or rombophate conders. Tho stool ype gui patho Ns patent the presence ofa pustle mide abdominal mass makes the ‘agnor of mesenteric chemia une. ‘Option D: Gaetiiconcnienlyprsant wth abdonina pan, arb, 9 sonso of utess nthe algae gion. Howowepusatleabdominl mass ‘Snot consent wih goss Opbon Diverticulitis common in patents above 50 yrs af age peal torent wth tower quscranabdonial pal,» cage in bows habs nausea, vomiting, and, sometines, tect bleeding or hematochena. This ‘atlons str and prsertalon are much more suggest ofan abdominal eric aneuram than a gross of dvericuts, Lsoming objective: An abdominal arte aneurysm (AAA) 9 liton of he ledeminal aera ype secancary te atheroeceatie [Link] rk {ecors for AMA ince stoking ype, hypetipdere and comorbid petpherl vaseler dsoare. Most cases Of AAA are asymptomatic url thors 3 e-teeatring medical emergency. Cncally, AAA pesos wh at of ypatonson nan pan and a pusato abdominal mass. Diagnosss 2 2 a setzues Her past mecleal hiss significant fer hyperensoncontraled th 1snopt ana metopeol On examinaten shes drowsy but oete Popiedera is seen on optthsmarecpy. Neck lon dificult and pant The est f the ‘rams uvematkable, Her blood pressures 80/00 rm Hg, heart OOK, and temperatures 370°C (98.67 The ECG, cardiac enzymes, ac abaatny ‘openng pressure 20mm H,0 rac 50m? numbers steady over test bes ‘cleo Sim ‘cucoee soma Protoes 100 maha “ie patente adrtcto he ICU or eter management Which ofthe folio & tho mos! hay pathopyssiog based an her histty and CSF tangs? ‘A. Via nection ofthe brain parenchyma i traceretal bleed 2 © Bac ifecton of the meninges 10. Teuma curing mbar puncte 2 Rupture of to cmmuricating branches ofthe cerebral antrios WS See beeeuuNeayveeesercnas setzues Her past mecleal hiss significant fer hyperensoncontraled th 1snopt ana metopeol On examinaten shes drowsy but oete Popiedera is seen on optthsmarecpy. Neck lon dificult and pant The est f the ‘rams uvematkable, Her blood pressures 80/00 rm Hg, heart OOK, and temperatures 370°C (98.67 The ECG, cardiac enzymes, ac abaatny WS Sb Beeeeu Seay eeeseessaracacenwoaen ‘openng pressure 20mm H,0 rac 50m? numbers steady over test bes ‘cleo Sim ‘cucoee soma Protoes 100 maha “ie patente adrtcto he ICU or eter management Which ofthe folio & tho mos! hay pathopyssiog based an her histty and CSF tangs? ‘A. Via nection ofthe brain parenchyma i traceretal bleed Bacteria Infection of he mening 10. Teuma curing mbar puncte Rapture of to communicating branches of he corral ares a Bch tt > : " = » gee AGS Explanation: Ccomact answer Ths patons presentation wih the sudden onsot of severe headacho, dscibed a the worst headache ovr along wth ins of ‘meninges! wrtaten neck tess, ravees, verting, val dstrbance and CSP incdings ofa igh RAC count hat docs not change progreseno ees suggestive of a subarachnoid heverthage.A high opering pressure, slovated CSF proteins, and normalew-nora CSF gloss pnt war the ‘lagna of subrachnold Nemorhage SAH) The rupture of a Betty {CT scan may not be abnerman some eases. anthocvera on und uneture LP. de ss of RBCs ane conversion ofthe herogiobn to bin that tue the cla of CSF to yallom ea lace tndng of SAK. Bory ncuyems ecu avo to a dtac of ate wal inti ate anton of ho ommerieatng branches wth the main cereal vessels, wth the mest ‘common locaton boing theater cle of Wil. Theseoutpouchings ofthe ‘tert wate tack to normal nora ast lamina and smooth mc ayers and ae prone to pte isk actors inde hypertension. ovancing age, smoking, thorosceosis and hemodynamic sess Baty aneurysms ae ako associated th contin ‘such autosomal domeantpojeysic ley lease ADPKD} and Navan’ yrcrone thor causes of SAH include atreveraus Malormatons and Related Videos: © Samsnos ora —nrcnonata 709 First Aid References: Fst A forthe USMLE Step 1 (2019, 2h ea: 501 Fst Ad forthe USMLE Sop 12018, 28h od 497,500 Fst Ad forthe USMLE Sop 12017, 27h od) 483, 495 WS Sb Beeeeu Seay eeeseessaracacenwoaen Lesva ik races nude hypertension savancing age, snoing, those, and hemodynamic sess Bey aneursns ae also associated wth contin such autosomal dominant polycystic kidey lease ADPKD) and Mayfan's ‘Syndrome. Cina ase of SAH inclu anarlevenaus malormations and anticoagulated sae ‘Compiiatons of SAH ince neurlog defi ydrocophaus, ro-boods, fd death. Management aque ICU acmeson th gral con of logs tess eevatod, pain managoment and stess eo: prophylaxis. Bled ‘pressure contol ws Hypertension con cause mor losing whereas ypotenson can rut n ypoperson and infarction ofbrain issue Infavenouslabetaais he dug of choice Cetebal ypopertusion sweated ono = 1, = G Tnravanous betas the sug of ehnce Cotebal ypoperusion = Hosted ‘eh normal saline ison apd vasonressos ) fen rover — ‘Option A: Vil encophaties ovation f to bran pence oF of ‘bath the meninges andthe bran parenchyma eningoencephals roses wth meningeal sors along wih vl prodom seus cr exroogic efits. The most common etiology fthoherpce simplex vies (#94, This paotlack such symptoms, and her CSF fangs are ‘Option An insacotebrathemouhoge, orherorhagle stoke, may present ‘nay as a naadoene oy th patent. Tho underying mechanism sweats ‘eninge! eaten die othe acamulted ood pentating tothe aa WS Sb Beeeeu Seay eeeseessaracacenwoaen WS Sb Beeeeu Seay eeeseessaracacenwoaen Option B: An nacorerathemonhoge, or hemerhagic stoke, may proton ‘imfry as aheadache fet bythe patient. The underiang mechanism WON ‘meningeal wtaten die tothe acme ood panting ito the ‘meninges! space, Sdo-ofects may incu czar nd moat portant ‘renounced neurologie deticts which are not scene pin Ieee {any doubt aheod CT scan is impart ue out vacanal hemonhage and ‘mass fect prot parterming 3 lumbar tap an tho panto avo cerebral ‘Option ¢: The common stloies of bac mening n cuits are Sveptococcus preumonie, Group B srepteenco, Netsonamenngts, Haomoptaisintuonzoe, ana Lora manecytogonos The presentations ‘us wth over chil and neck tfnes, sometimes accompanied by eeroioglfrdings andr setues. CSF Bacteria mening howe Incroasod pelmorphonucesr cal, duced CSF glucose vols, and nigh {CSF proton level compared o SAH, RBCs f resort ae usualy 4-Sim® lmsreas nS RAC ae nt ange of au SO ‘Option: traumatic tap can present wa sr CSF pte but he ‘umber of RBCS would adualy decrease between the ita ast bes. ‘This ifretintes ror SAM, slong wits te classic presentation of tho patetin hi wont Leeming objec: A subaracnots hemerthage ust presents wth the sudden onsetof a severe heodache datlealy described as the wots, ‘headache athe patent hes ver ha. along wih sigs of moningoa wean such neck siffess, nae, vomiting, vu dstrbanc, and papiedoma ‘The patent may coe drowsy and confused lumbar puncture shows @ igh number of RACs and anfoctronia whlch is val clagnost of SAH in cases ith negate heed CT findings, The most ccrmmon cause of SAH sa een WS Sb Beeeeu Seay eeeseessaracacenwoaen "ass fect rot performing a umbar tap on the patent to avo cerebral ‘Option: The common etleies of baci mening n acuits {af Stoptococeus pnoumonia, Group B sraplococs,Molsora meng, aomophiusintwenzo, a Lena monocytogenes The presentation ‘sua th ever cil and neck stiness, somtnas secompancd By exroogiefrings andr se2ues. CSF in bac mening shows Incressed polmerpherucear esl reduced CSF glucose level, and higher (CSF proton evel compared o SAH. RECs preset ae usualy 4-5! ‘notaas in SAH, RECs ao nth rango of about Sma? ‘Option D: traumatic tap can present wis CSF peuxe but he ‘umber of RACs would paduall decroaza between the fst alot bee “This feretiates ror Sal, along win te ssc presentation of ho patantin this vignet Leaming objective: A subaractnoidhemethage usualy present withthe iuldanoneet ofa sovorehoedacho dasically deecbod a the worst headache that the patent has ever had. along with sans of meningeal tation such neck snes, nausea, vomiting, vlual dstrbance, and papiledema, ‘The patent ay lao be dowsy and cotused A lumbar puncture shows 0 gh number of RC and xanthocomio which is ew gros of SAH a cases ith negate head CT fins, The most cemmmon cause of SAH a Doty anouryam Risk factors nude smoking. hypertension, advancing ag, _thresclooss, and hemodynee sss. Bony aneurysms ar ao associated veh sitosoma! dominant ply ine dlesses ADPED) ana Marton syerome, Botte WS See beeeuuNeayveeesercnas ‘33 year-old woman presonst the clic complain ota 9-nanth stay of weights, fatgue, and a genera sense of malo Sho addtionaly complains of | ‘unusual sensaton m her chest upon rapid sng fem a supine toa tandeg Peston. Curent vals include a tempore of 368°C (98. puso ot Tim ood pressure of 18163 mm Handa reepiratoy at of in. Her BM is 2, leg Auszutaton demonstrates an ery me dase low pitched sound ate apex of he neat A ches ay evens @ poorly demarcated abnormal nthe heer snd requtes CT imaging for Keer ali What would most ely be seen on CT magna? © A Tumor wihin the roht ata © 8. Festa betwaen the gr and ot aia {6 Normal cardiac moaing 1 Tumor th te et atria © E-connecton between the punonaryanery and aon ‘33 year-old woman presonst the clic complain ota 9-nanth stay of weights, otgue and a general serse of malt. Sho addon complains of Suna! eneson ner ehee upon pid ing fom 9 eupne to. ting Peston. Curent vials incluo a tempore of 36°C (98 puso ot 72m ood pressure of 18163 mm Handa reepiratoy at of in. Her BM is 2, leg Auszutaton demonstrates an ary me date low pitched sound ate apex ofthe near A chest Kay evens a poo demarcated abnormal inthe tert ane vocures CT seg or fre arcs. Whol wo os aly be soe onc maging? ‘A Tumor within the ight atin 1. sul betwen ho ig ante ala {6 Normal cardiac moaing Tumor wth te et ata BEaags © € Connection betncen the purmonay artery and aorta Result: WS See beeeuuNeayveeesercnas Lesva > : " = » = Explanation: (Corse name D: Miya rete st commen primary cardi es sparring a ag groups: however, hey are most commonly een m females ‘urna the 36th decades of Ie Athough the majtty (90%) are sporadic a ‘atu, the rematndo ate auesoat mnant in varsmssion Pathelogely. ‘ntomas are compssed of rine connective sais sarounced bya ‘lyosaminogiycan matic Most are slay and pedunclted wha ptodlocion forme lon akan. commonly eeNod Wom th ata septum pear thefossa ora ee mage below, First Aid References: Fst Afr the USMLE Step 12019, 20h oh 336 Fst Ad forthe USMLE Step 12018, 28th: 309, Fst A forthe USMLE Step 1 2017, 27h ed 301 Mysomas frequent present with obstructive signs and symptoms slo ‘obstinate valve of poise asthe anor panes through the stl ‘valve. The symptoms ad signs may ao be psionalin nature due tothe ‘ecto gravy on tuner [Link] signs andsymptoms moy {iso be preset ncheng fever, caches maltse, wert oss anemia. and ‘ovate entvceyie cementation rate These factors oton lado fequent ‘mscagnoses suchas paraneoplastic disease of endocars. ‘option A: Wile yma can be ound win tho igh aia, the most commen location of myromas i win tho et tia WS Sb cbc eeUN Seay Eeesercnaracacewoes! ‘hat of iva valve aseae esutng mother tenes de tothe tumor ‘bsuuctng te vate of polapse asthe tunorpuses hough te al ‘te. The symptoms a igs may bob psisoalin nate is oho ‘fect of ray ov tuner postionng, Constutonal signs and symptoms mey ‘aso be preset incing fever, cachesa malase, weit oss anemia and ovate enfvcyse cadena te These factors atonal fequert msttagnoses suchas paraneoplastic disease or endocars ‘Option A: Whe moras can be fund win the ight ata the most common locaton of myromas i win tho et aia ‘Option: Atrial septal defects would Semenstat a fod ys murmur wth ‘most cases boing hamloss. ASD would not cause tho physical ndings shown above > : " = » = Option: Ths patents demonstrating sigs ofan ebstuctve tumor and woul pot have nonmalcardlac mage. MR ané CT aging ofer portant Infomation nthe dlagnass and management of myxomas regarding the shape, ste andcharacterisis of th tumor: ‘option E: Pumonary ductus avo would be unbkalyin patont a ‘98 9s most PORS esol within the fis few montis afer bth Patents wo ‘Survive to adulthood with umacoNed PDA may demonstate sermenger ‘Syndrome: with pulmonary typertenson ight to et shunting, nd pulmonary ‘janoss PDAS also presen with continous murmur at the uppe ef sternal ore. Leamingsbjeciv: Cardin mysome ar the most onion earn tuners wah the et aa being the most common lean aected Botte {8.53 youd man prsonis oho omargoncy room because of wesoning brathlessness thet began overnight He was lagnosed wth ast 3 years 00 nde bse ving sbierl and series. He oes nothave 8 pre toy lof ara aease or oor espatory dsases. Tho man feed surance agont are has ved is ete fen tho United States, Hs vital sins include respratery rate 40n ood pressure 130/90 mn Hg, pls at mr and ‘temperature 320° (985) Physical examination shows severe respratay ofthe chest reves widespreas wheezes nthe ngs and the presence of $3 (gaop yom. Theman fs acmited sheep and borate mestgations nd : zs : x = _ Eosropi eal court 76.101 40% eosnophs) : “FoponnT a5 ng : srtsvPO ANCA artbodes. poste 3 fe [Link] rege 7 Imennogobuin€ 1000 int Serological toss or HV echows, denovius, Eston Bar vs, ane pervs [B19 are negate. ECE shows regu ius tccarca with an asenee of eran Pater or ay avcence oechome,Ianeiorareechecardogaoty revels 3 fated ie venice wth an econ faction of 30% (nual 55% ogfete, Which of he folowing elagosos beat explains the crcl prsertaton and Iaboratory fangs inthis patent? ‘A Eosinapic granulomatosis with polar EPA) BEER ir9ging sues ae ordered Test resus nude the otowing 5 Wac count woxro% n Eosinophil et count 76 = 10% (40% eocinep is) : ‘Woponin 5 gm : ‘anvvP0 (ANCA antbores poste [AN OR-C ANCA, negate rmunogtobuin 600 1m. Serological tests or HV echowras. denovis, Est Bar vis, aed parry [9 are naga, ECE ehowe eg sus tenyenra tn an osanes on pattem or any ovence oechoma. Tansieraccechecerdiogreoty real ‘latd io venice wth an econ faction of 30% (normals 55% or orester, Which fhe fling elgnoses best explains te crcl presertston and laboratory fangs mths pation? WS See be aeUNNaaveeeseessarecacewse ‘A orinopie granulomatosis with poiangit EPA) 8. Chagos sease Pinay ated cationyopaty Eatin astm Botte BER ging stustes ae ordered Test resus nude the otowing 5 Wac count woxro% n Eosinophil et count 76 = 10% (40% eocinep is) : ‘Woponin 5 gm : ‘anvvP0 (ANCA antbores poste [AN OR-C ANCA, negate rmunogtobuin 600 1m. Serological tests or HV echowras. denovis, Est Bar vis, aed parry [9 are naga, ECE ehowe eg sus tenyenra tn an osanes on pattem or any ovence oechoma. Tansieraccechecerdiogreoty real ‘latd io venice wth an econ faction of 30% (normals 55% or orester, Which fhe fling elgnoses best explains te crcl presertston and laboratory fangs mths pation? WS See be aeUNNaaveeeseessarecacewse 1 A Eosinophilic granulomatosis with polyangits EPA) 8. Chagos sease Pinay ated cationyopaty Eatin astm a Bch tt WS See be aeUNNaaveeeseessarecacewse Explanation: Ccomact answer Tho mos hay alagnoss nts patois ESPA he man developed esta at a relovely advanced age (60 years) are presents ith 3 severe asthma aac ana features of congestive hear are. The presence of ‘ongostve het falure and redxcod jection action on echocartography suggest myocardial intanmation. though the patients cardine enzymes ao levate, ECG tgs do nt nccate the presence of myocardial cher oF ‘Option B: Athough Chagas deesse is a fequent cause of eesngphlla and myocar, hs paints nogathe scfeoning ost fr pases andthe sence ofa rave sory outside he Ure Stats rule cut Chagas the ‘moet aly cognose would not produce. postive BANCA ron oon ‘ns patent ‘option: though pemary asta carsonyopaty cn present wh congestive art falure and reed ecto faction on echocardiography ‘hs conan sunny to produce a postive ANCA. As wel, cardlonyopaty woud ot ge so he proton eesinopia Seen in his pation (ptonD: Atough Lecter’ endocaitis pial presents with marked ‘osinophil, he conden doe nt incide rede secon faction or other Related Videos: Plott cone -4000001ren* Leukooytes ‘6.000% ‘Sonu fren gin. ‘Serum on Zoi, Tealronbinding eapacty 450 yal Colonoscopy wth bepsy later parermod shonin a neoplasc grow i the ‘desconding clo. Which ofthe flowing is the mest ikl explanation fos tarae fring? © A Acquted CO dencency 8. vidas seplecocc) (Treponema pam 2 Malignant colonicneoplasm cotlagon vascuarscaso 2 [Link] Dsroptocoe WS See beeeuuNeayveeesercnas WS eee beeeuuNeayesesesssasacal pablo 3cm Boow tole cost margin. Hs laboratory fesse shown low. Hemoglobin aso Masa corpuscular votume 72 n> Plott cone -4000001ren* Leukooytes ‘6.000% ‘Sonu fren gin. ‘Serum on Zoi, Tealronbinding eapacty 450 yal Colonoscopy wth bepsy later parermod shonin a neoplasc grow i the ‘desconding clo. Which ofthe flowing is the mest ikl explanation fos tarae fring? ‘8 Acquired COF deiseney 8. vidas seplecocc) Treponema patti _. Malignant colonteneoplasm cotlagon vascuarscaso F Group D stoptococe sto tt 7 " = » = AGS Explanation: Major Posie blood + Sameus cuturee with + swop. geet fomony bows) ‘raonimstypial + Sep, vdans eo 1+ HACEK Hoemophitis, ‘Aggregctbactt Cardoboctium ‘amis. Ekonota sp. Kngoto ‘ingoo Echoconsstent + —* Vegetatons OR pevataar wath (one ono abscesses OR now partial fotowna) dehiscence of preset ‘ave “+ Now salar regugtaten ‘Predspositon1V drug use or predisposing heat conditions (te, prsthtc hear valve or daased ate vive) Fever 2280 (0047) ‘Vasulfdings: major ane enbal, sep pumanary Inforts, myeatic ancuryoms,nteranl omorhage onjuncwathemormages, of Janeway lesions Imenunoiogle fining: Roth spots, Osler nodes, ‘lomeruonepht,eumstoltator Microbiologie evden: postive load cuts that do nt ‘meet major crteria OF seoiogl evdence of acv nections Diagnosis + 2majrcitera + major and 3 mine cera + Sminorertenn Ccorect answer F: This an edery man presenting wth symptoms of hea ‘sease wh aortic requrgtaton secondary to efecve endocas and Hon “Svoprococeus gatos flamer bows) assocted with bot infocive _epdocrits are coleretl canst Intact. a pabents dagnoned th office endocardts, tenet clagnostc stp ito perform a colonoscopy ‘one out colorectal cancot Colonic neoplasms may ac as a rau far S ovis wth resuant bacteremia and vegetations on cardiac ales. 5 WS eee beeeuuNeayesesesssasacal WS eee beeeuuNeayesesesssasacal Comet newer F: This an oderly man presenting wth symptoms of het _asease wh ae regurgtaton secondary to fective endocads and ron. eficiency anemia secondary 1 colorectal cancet. _Sveptococus gaoius (emery bois associated with both infocive ‘endocardial cotroctlcancot infact. a pasts lagnased th offic endocars, the nest clagnostc step to perform a colonoscopy ‘onde out zs : x = " = » = Explanation: Comet answer 8: The ceil presentation fs connstent wth wet rb, richie causa by thiamine dticencyn developed cous acohotsm 2 ‘tequent causo, whotoas, in developing counties, manutioncontibtes ‘equoly High ouput cardiac are tachycardia, and abounding pulse are the ‘lassi symptoms, Thiamine supplementation apy improves the pavent ‘Option A: Vann 812 deisency coud cause an nrease mhomecyseine {sccocaton has not been erable. No dec eects onthe cardowseciar ‘System have Deen noted ‘Option ¢: Nain decency doesnot fet the carhovascuareytem, ‘Option: Vitamin D detlency doesnot couse carovsscusr symptoms pet 0. Studies have damonstiated a song assocaon between vEemin D Insuficency or the risk of crdovasola deeae CVD} ables, od metal encom, and have suggested tat wtaminD deficiency ‘redeporesnd\dls to an nese rskof incon hypartnsonechanic heart cease (HD) sudden ceric death ae heat ors OpbonE: Raton might have potacve ellecs against he tesue damage Related Video: Yamin Bt ond 82 First Aid References: Fst Ad forthe USMLE Step 1 (2019, 29h: 66,674 st A for tne USMLE Step 3 20%8, 280, 86,670 Fst A forthe USMLE Step 1 2017, 27 ed 82.653 WS Serbs aeUuauayveseseessazes| ‘requert cause, whereas, developing counties, maton contibtes uel Hig-uutcardac are, tachycardia end abounding puse are the Classic apmptome. Thiamine sypplomertaton apy impreves the paben= concen ‘Option A: Vramin B12 deiency could cause an increase homocysteine evel with an incteasein the rsk of elovasculr diseases but tis ‘sysernhave been noted ‘Option ¢: Niacin deiency doesnot aft the cadlovascusr sytem, ‘Option: Vann D decency doesnot couse carhovscuar symptoms et 2, Studies have demonstated a sueng association between vain D Insuticiency ord te ik of catdovascular seas CVD}. cabetes and ‘molabete syctome and have suggested tat vitamin Ddeficincy ‘redeporee nds to an eaee kof incon hypertension echamic ear cease (HD) sudcen cardiac death an heart ate ‘Option: Rota mighthave protective effects against he tssue damoge assoc wah schema ropartusien Alo, ibotovn may be enpotant a termining creating concentatons of hamecystene. 9s ator for ‘cardovasouar Seeaee, Leaming objective: Geir is nsec by thane defen. Clea he patontprosonts wanigh ouput catia tate, achycrea abounding ube, nd warm extonstes esholam ard moinition ar tbe most ‘oman cares. Tame sopplementiton ropa improves the patent | Botte First Aid References: Fat Aid forthe USMLE Stop 1 2018, 29th 0: 65,674 Fst A forthe USMLE Stop 12018, 28h od 6,670 Fst Ad forthe USMLE Stop 12017, 27 od 52.653 WS See beeeuuNeayveeesercnas ‘842 youd woman presents win compl of sharp, stabbing pain nner chest, upon counhing and inl, Sho says that ho pain onset acutely 2 days ogo and hoe progressvay woreenee Past merical etary agnor ors eh on her 3 Jone pains, and augue for to past few wooks. he patontafebre and tal Sons ‘are win pomal iets, On phyclexaréaton hore is alarm ash preset which spares the naselabal fos. There 3 febon ub noted at the crtoe pax that does net vary wh respon. Vic othe faloning acstona ysl ‘ran signs would moet sly be poser inthis patent? | Mido cok (© [Link] improves wth inpreton © C dispacesepcatmpuise © [Link] peed dace murmur © E Breakthrough pain (TP) which mproves wih ning forward bsctucio WS See beeeuuNeayveeesercnas ‘842 youd woman presents win compl of sharp, stabbing pain nner chest, upon counhing and inl, Sho says that ho pon onset acutely 2 days ogo and hoe progressvaly woreenee Pest mec eta igneant fora eh on het ‘ace, pales, and ateue fr ho past fon wooks. Tho patents fee ana wat signs are within normal iit On physical examination thee fa malor macuor rash present hich spares the nasolabial fl There 2 fcbon ni noted at the cardiac apex that doesnot vary wt respkaton. Which of the lowing edatona ysl enr ige would moat oly be preset spent? | Mido cok 8 £8. Pain mproves wth inspaton * (Displaced eptat impulse * [Link] itched eto murmur 18 © E-Beeaktwough pan TP] whichimprovesvith ening forward 61% Result: @ conect BSc tt " = » = Explanation: CComect newer E: This patlontprosonts wh ype and sign suggestive of systemic pus enthematosus SLE, nam ot pans fatigue. nd 2 mal ‘ah He chest pa smost hey duo to percact,the most common ‘cardovascuacompicatonassacatod wit SLE. Tho pan associated wth ercardts is pleuitc worse wth inate) and postural peoveson| ‘tng up and eening foward ‘Option A: A mid aye lee eaocatc wn valve plop, ‘Option B: This incorrect because the pan of percardtstypcaly worsens wrth nspation ‘Option: aslaced apel impulse s essociatod wth caviomegahy ‘OptonD: A high-pitched dato mum yplealy nates soto rogugtation ‘Loaming objecve: The most common crdouasularcompcaton ascite th SLE pores. I presents as chest pan that worsens with inspiration {nd proves on sting up ad learing Forward, rion ub on earse ‘usautaton pathognomonic fr pence. Related Videos: Ocean © Ms Eton First Aid References: Fiat A fore USMLE sop (2049, 2 wh. 308,402 Fst A forthe USMLE Step 12018, 2h 300,306 Fst A forthe USMLE Step 1207 27th ed 294,300, zs : x = ‘An autopsy of 75-year-old man shows cbterang endartats of tho vase vasrun ofthe aoa, Which of he flowing ivecgators wil key be posto inthis ptt? (© Penner a neuopt cytoplasm ertbody ANCA) © crease doublestandea (ts) DNA tor © Cnr toa © Oimeressed serum crestnne (© E Rapid plasma cag (poste zs : x = AGS ‘an autopsy of 75-yard man shows cbtoratng endatats of ho ves vecerum ofthe aot, Which ofthe flowing investigations wl kel be postive in this pacer © A Perinucos ent-neuoptl cytoplasmic rtd (ANCA ‘A icronsea double-stranded ts] DNA er 30x inereased keto » ©. nereaeed serum retin * Rapid plasma oagh (2 poste Result: Explanation: onset ansvr ssa on Niopstelog gs. set ae ‘nite rk iver in ery ii wich et cee cars yur er taco th Teponamapondum Pfcton wi pak Related Videos: Secondary, Terary and Cngental Spi

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