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tremble3322
10-12-2005, 08:18 AM
System: Heart

Anyone know why IV drug users tend to get problems in their right heart? It seems like all heart problems are on the left side- so why in this case it is different?

charger5001
10-12-2005, 08:25 AM
Anyone know what is the Rheumatic heart disease and Rheumatic fever? Or maybe I should ask is their a difference?

mog
10-12-2005, 08:26 AM
Haven't learnt path yet, but I would guess because the germs (from not-completeley-sterilized shringes) get stuck onto the valves or something like that? Or is there a lot more to it that I have no idea about?

bchamp1281
10-12-2005, 08:32 AM
The reason why IV users get trouble on the right side is b/c when they inject drugs (or transfuse blood) into them where does the blood go to ? THE VEINS.

If you recall venous blood returns back to the right side of the heart. Therefore the right side of the heart, particularly the tricuspid valve is most susceptible to damage from intravenous injections.

manleyjb
10-12-2005, 08:33 AM
Intravenous drug users tend to get their right heart valves infected because the veins that are injected into enter the right side of the heart. The injured valve is most commonly affected when there is a pre-existing disease or when immunocompromised as in the case of chronic IV drug users.

bchamp1281
10-12-2005, 08:36 AM
Beat you to it Jeff ! hehe

Good Job though, it took me a few minutes to figure it out.

manleyjb
10-12-2005, 08:39 AM
RHD is the most serious complication of Rheumatic fever caused by Group A Strep. Patients develop valvular stenosis with the Mitral valve being the one most commonly affected. Remember though these findings usually occur many years post Strep A infection (as much as 10 years). Pancarditis, CHF, dyspnea, murmurs are among the most common S/S. Plenty of info in Robbins on this frequently asked disease on Step 1.

manleyjb
10-12-2005, 08:41 AM
Beat you to it Jeff ! hehe

Good Job though, it took me a few minutes to figure it out.

Your fast this morning. Keep up the good work, we will need it come Monday on that Path exam.

onesolo
10-12-2005, 09:31 AM
Your fast this morning. Keep up the good work, we will need it come Monday on that Path exam.

What semester are the two of you guys in?

charger5001
10-12-2005, 09:38 AM
They are both 4th semesters.

yo_yo_121
10-12-2005, 12:55 PM
Maine or cayman?

Junito
10-12-2005, 05:32 PM
Hey guys this thread is a great idea! I started another one on Pharm. I say we start one in all topics! What do you think? What are you covering in Path so that I can come up with some relevant questions (I used to make up my own questions while studying towards the end, and started grilling everyone who wanted some practice. Will look for those questions.

Junito
10-13-2005, 07:12 PM
Guy on the street falls into a manhole that was left uncovered. He has massive crushing injuries and multiple fractures of his pelvis and left femur. After 36 hours in the hospital the patient develops petechial lesions over his upper torso, severe dyspnea & hypoxemia. Mental abnormalities were also noted. What has the patient most likely developed? a) Disseminated Intravascular Coagulation b) toxic shock syndrome c) pulmonary embolus d) fat embolism

bchamp1281
10-13-2005, 08:09 PM
Sounds to me like this individual has a fat emboli that has traveled from the pelvic area to the lungs.

However I cant figure out why he may have petechial lesions.

manleyjb
10-13-2005, 08:16 PM
Sounds to me like this individual has a fat emboli that has traveled from the pelvic area to the lungs.

However I cant figure out why he may have petechial lesions.

Definitely Fat Embolism and I had no idea about the petechiae either but here is the explanation.

Quote from emedicine: you may notice reddish-brown nonpalpable petechiae developing over the upper body, particularly in the axillae, within 24-36 hours of insult or injury. These petechiae occur in only 20-50% of patients and resolve quickly, but they are virtually diagnostic in the right clinical setting.

http://www.emedicine.com/med/topic652.htm

Junito
10-13-2005, 08:56 PM
Very good welcome to the next level!!!! (I knew the petechial lesions would throw some off): A 72 yo woman shows up to your office with abdominal distention and is in pain. PE reveals shifting dullnesss, and the presence of induration in the rectal pouch on rectal examination & bilateral adnexal masses. No other relevant findings are seen on the rest of the PE. What does she most likely have? a) dysgerminomas in both ovaries b) Meig's syndrome c) malignant ascities d) Krukenberg's tumors of the ovaries e) serous cystadenocarcinomas of both ovaries

charger5001
10-14-2005, 11:17 PM
2 questions for you guys:

1) What is a Lacunar infarct? When is it seen?

2) What is a glioblastoma multiforme?


Thanks

bchamp1281
10-17-2005, 09:32 AM
1) lacunar infarct is seen in hypertensive patients. It is basically a focal (pin-point obstruction) ischemia of tissue

Important to note that it is purely sensory or purely motor in nature


2) Glioblastoma multiforme is highly malignant neoplasm of the CNS with a terrible prognosis. Best way to identify it is by "pseudopalisade" arrangements. Remember it usually arises in the cerebral hemisphere

bchamp1281
10-17-2005, 09:32 AM
hope that helps - Good luck today!

bchamp1281
11-23-2005, 10:42 PM
61you male is found to have a dilated aorta yet the blood vessels show no lesions. What is the most likely cause of his aortic dilation?

seagoddess
12-16-2005, 10:30 AM
Hi guys don't forget important association between IVDA and Staph aureus and right sided endocarditis.

Also note difference between acute and subacute endocarditis.

Acute: very fulminant disease (such as Staph) that chews up valve very rapidly and thus there is very little time for an immune response to develop.

Subacute: slower disease (most common pathogenic org: Strep viridans) so there is time for an immune response to develop. b/c of this only org that cause subacute endocarditis can cause immune complex disease so if a question mentions acute glomerulonephritis as a complication of endocarditis please think of SUBACUTE.

manleyjb
12-16-2005, 10:47 AM
Hi guys don't forget important association between IVDA and Staph aureus and right sided endocarditis.

Also note difference between acute and subacute endocarditis.

Acute: very fulminant disease (such as Staph) that chews up valve very rapidly and thus there is very little time for an immune response to develop.

Subacute: slower disease (most common pathogenic org: Strep viridans) so there is time for an immune response to develop. b/c of this only org that cause subacute endocarditis can cause immune complex disease so if a question mentions acute glomerulonephritis as a complication of endocarditis please think of SUBACUTE.

Thanks for your input.

Junito
01-03-2006, 01:02 PM
A patient comes in complaining of weakness in the arms. You give them a 2 lb dumbell to lift for 5 repetitions, and note that the rate of lifting each dumbell increases with each subsequent rep. What may be a possible cause for what you saw?

a) Patient has myasthenia gravis

b) patient is on neostigmine

c) patient has small cell cancer

d) patient has polymyalgia rheumatica

manleyjb
01-03-2006, 02:26 PM
A patient comes in complaining of weakness in the arms. You give them a 2 lb dumbell to lift for 5 repetitions, and note that the rate of lifting each dumbell increases with each subsequent rep. What may be a possible cause for what you saw?

a) Patient has myasthenia gravis

b) patient is on neostigmine

c) patient has small cell cancer

d) patient has polymyalgia rheumatica

This is a total elimination question for me, but I will take a shot. A pt with MG will become weaker as they rep. (eliminates A). Answer D (PR) is similar to Temproal arteritis and i cannot see the relationship. Don't know how small Ca relates either. Therefore, my answer is B.

Junito
01-03-2006, 04:57 PM
This is a total elimination question for me, but I will take a shot. A pt with MG will become weaker as they rep. (eliminates A). Answer D (PR) is similar to Temproal arteritis and i cannot see the relationship. Don't know how small Ca relates either. Therefore, my answer is B.

Sorry, guess again. Your reasoning for MG & PR was right on the dot though.

Banker794
01-23-2006, 02:40 PM
Is D the answer?

Junito
01-23-2006, 10:42 PM
Is D the answer?

Nope...It is C. Small cell cancer can initiate a myastenia syndrome.

Banker794
05-03-2006, 09:37 PM
1) Do you get all the characteristics of endocarditis (osler nodes, Janeway lesions, roth spots etc) in both acute and subacute?

2) Is there any way to differentiate acute from subacute endocarditis other than by blood culture? Any signs based on presentation?

Compassion MD
05-03-2006, 09:43 PM
You know what is funny? I am undergrad, junior year and took human anatomy (we use cadavers), EKG, system physiology, and others. I do know some of the answers that you guys are asking. But, some questions are just way ahead of me. ^^"







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