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2021-12-05 21:19:41 Q1

The Mammary Gland is Most likely related to?

A. 10 lactiferous ducts
B. 15-20 lactiferous ducts
C. Own blood supply
D. 30 lactiferous ducts

Mammary Gland Open / Comment

2021-09-20 23:10:21 Q3:

A 68-year-old man who underwent a left knee replacement 5 days ago comes to the emergency department with sudden onset right chest pain and shortness of breath. His temperature is 37.0°C (98.6°F), pulse is 110/min, respirations are 30/min,
and blood pressure is 134/82 mm Hg. After receiving supplemental oxygen, the patient's oxygen saturation is 96%, and the patient still feels short of breath. Lungs are clear to auscultation bilaterally and the
patient denies having a cough, producing sputum, or having nasal discharge. The cardiac examination is notable for tachycardia only. The surgical incision site
on the left knee is healing normally and reveals no sign of infection, but the left calf is somewhat edematous, red, and tender. A chest x-ray reveals no effusions or infiltrates, although there is minimal
atelectasis in both lower lung fields. Which of the following is the next best step in management?

A Thoracotomy and lobectomy
B MRI of the thorax
C Empiric antibiotics
D Thoracentesis
E Empiric systemic anticoagulation, followed by further imaging

Cardiology Cases Open / Comment

2021-09-19 12:04:34 Infective endocarditis (IE) is an infection of the endocardium that typically affects one or more heart valves. The condition is usually a result of bacteremia, which is most commonly caused by dental procedures, surgery, distant primary infections, and nonsterile injections.

IE may be acute (developing over hours or days) or subacute (progressive over weeks to months).

Acute bacterial endocarditis is usually caused by Staphylococcus aureus and causes rapid destruction of endocardial tissue, while
subacute bacterial endocarditis is most commonly caused by viridans streptococci and generally affects individuals with preexisting damage to the heart valves, structural heart defects, or prosthetic valves.

Clinical features include constitutional symptoms (fatigue, fever/chills, malaise), signs of pathological cardiac changes (e.g., new or changed heart murmur, heart failure signs), and, in some cases, manifestations of subsequent damage to other organs (e.g., glomerulonephritis, septic embolic stroke).

Management is complex and infectious disease specialists should be involved early. Diagnosis is made based on the Duke criteria, the main features of which are positive blood cultures and evidence of endocardial involvement on echocardiography.

Initial treatment of IE consists of empiric IV antibiotics, which are then adapted to blood culture results and continued for several weeks. Categorization into native valve endocarditis or prosthetic valve endocarditis helps to further tailor regimens.

Surgery may be necessary for complex cases (e.g., valve perforation). Prophylaxis against IE is administered in certain circumstances, e.g., in patients with preexisting heart conditions, such as congenital heart disease, undergoing dental or surgical procedures. IE is typically fatal if left untreated. Open / Comment

2021-09-19 11:21:52 Q2:
A 43-year-old woman comes to the office because of palpitations for a month. She says that these palpitations are intermittent, but are not caused by anything in particular. Medical history is significant for a cardiac murmur since childhood. Examination shows a soft diastolic murmur loudest at the left fifth
intercostal space at the midclavicular line. Which of the following most likely represents the etiology of this patients murmur?

A Aortic annulus dilation
B Atrial septal defect
C Patent ductus arteriosus
D Pulmonary valve stenosis
E Repeated bouts of acute rheumatic fever

Explanation: Cardiology Cases Open / Comment

2021-09-08 19:22:22 Be Cautious Diagnosing Anxiety and Panic Disorder in Patients with Chest Pain and Anxiety

Misdiagnosis of a cardiopulmonary condition as anxiety is a frequent occurrence.

Patients with acute life-threatening cardiac or pulmonary conditions often present with feelings of panic or impending doom in association with chest pain.

High stress and anger have been associated with an increased incidence of cardiovascular events.

Multiple studies have shown a link between anxiety disorders and higher rates of cardiac risk factors.

Misdiagnosis of a cardiopulmonary condition as anxiety is a frequent occurrence.

Nearly 10% of self-reported missed diagnoses consisted of acute coronary syndrome (ACS), pulmonary embolism (PE), or aortic dissection.

Takotsubo Cardiomyopathy (Condition Involving ACS and Emotional Distress) is a reversible cardiomyopathy that occurs in the setting of a severe emotional event.

While “anxiety” and “panic disorder” will likely remain frequent diagnoses for ED patients with chest pain, EPs must remain cautious to not prematurely jump to these diagnoses before a thorough evaluation is performed.

#anxiety #panicdisorder #ChestPain Open / Comment

2021-09-06 12:33:33 Q41
A 45 years old man attends OPD with nephrotic syndrome, but his condition rapidly progresses with oedema of his feet extending to mid calves. On examination BP 155/100, pulse 80, temperature 37 degrees, heart lungs normal. Abdominal mild ascites With hepatic size normal, blood urea nitrogen 10mg/dl, creatinine 1.0mg/dl, urinalysis 4+ Protein, 1 RBC/HPF, no RBC cast, 24 hours urine contained 9.6g protein. Which of the following is likely to account for his illness? Open / Comment