Cardio Q Level of difficulty 6/10

[جوري]

Challenging Q and we should agree whomever gets this correctly should get rep points from ALL PARTICIPANTS ....... NO EXCPETIONS

OK here we go... and yes you are allowed to use the web on this one, because it is hard! but I expect a why not just a random pick. Even monkeys guess correctly 20% of the time.....

45 y/o man recently migrated mexican farmer comes to see you b/c of dyspnea and fatigue since the last two months. His vitals are
BP: 126/80 PR: 80 RR:16 T:37C/98F
one examination he has pedal edema, elevated JVP and (+) Kussmaul's sign, & increased abdominal girth with free fluid. Auscultation reveals reduced intensity of apex beat with early heart sound following S2. JVP tracing shows 'X', 'Y' descent

... which of the following is the most likely cause of his SX (symptoms)
A-Cor Pulmonale
B-TB
C-Viral Infxn
D- Psittocosis
E-pneumconiosis

admittedly this Q isn't as interesting as the other one... but Cardio as per request :-[

 

[جوري]

I totally forgot about this thread.. no takers?
well I suppose a long enough period has elapsed, the answer is B- TB
Pt is suffering from constrictive pericarditis, results from obliteration of pericardial space and fibrosis, number one cause of pericarditis in the immigrant population is TB.. thought I'd bring it up, now that there is a gentleman on the news who contracted some "rare" form and snuck back into the country against medical clearance... TB doesn't just cause lung disease, when it disseminates it can be quite deadly and so very very very contagious.

 

[Malaikah]

Sis what language are you speaking? :lol:

 

[جوري]

Sis what language are you speaking? :lol:

lol ukhty-- been honestly trying to rep you since yesterday for a post you'd written in comparative but I haven't regained my repping power yet!.. be that as it may.. sometime back, I decided to start this sort of "scientific riddle" for this section, and I posted a thread questioning, can a perfectly healthy normal male be born with a uterus? got so many responses, which was great, I believe the members liked it? at least from some of the feedback I received, however, I got a request to not make the q's so below the waist, a bit more cardio oriented, and so this one came about and, there were no takers, in fact I had completely forgotten about it, until this gentleman with TB made it all over the news just last week. I felt it a good time to resurrect this thread, by virtue of the sequelae of TB.
In fact, I think we should speak of it, since it is actually a pandemic still to many parts of the world as well as the prison population, and is easily transmitted by respiratory droplets..

Thanks for reading and your interest!

 

[Malaikah]

So what is TB? Thats tubular something right?:?

 

[Musaafirah]

I thought it meant Tuberculosis..:X..but I was confused as to what pedal edema was..

 

[جوري]

TB is tuberculosis-- pedal edema is a fluid collection in the lower extremities... there are grades of edema usually from 1-4 and also it is not usually limited to the lower extremities, it can go all the way up to the neck.. it is a very nondescript sign as many diseases present this way, kidney DZ, heart failure, COPD, you name it... but that is a topic for another day .. thanks so much for reading and your interest

 

[IbnAbdulHakim]

whoah !

 

[Muezzin]

This question requires copious amounts of medical knowledge, and House isn't on until Thursday.

 

[جوري]

This question requires copious amounts of medical knowledge, and House isn't on until Thursday.

I can't believe you watch that show?... that show is comical, I can't believe they get away with it without the medical communities protests... it is like medicine bordering upon the supernatural.. It is almost unheard of the stuff that the patients present with on that show, let alone in the same hospital-- some people can practice for 20 years before coming across such bizarre cases--- let alone in the same region, or in the same hospital, and there is only one smart doctor in the crew, which is really sad, as if no one else can run and get a CBC or a Chem 13 (duh, why didn't I think of that?)..
most doctors, at least most doctors I know, are so beaten, downtrodden and unkempt, with bloodshot eyes and drowning in student loans, that there is such a disconnect between being a doctor and playing one on TV.. if I had my way I'd be playing one on TV.

 

[Muezzin]

I can't believe you watch that show?

Yep. I find the character himself very funny. I don't know the first thing about medicine though, but yes, I have heard the medicine practiced in that show is... inaccurate, to say the least. Still, I watch it for Mr Laurie's sarcastic wit rather than to learn how to be a doctor.

Anyway, I was just being light-hearted. I lack the requisite knowledge to answer the question in the first post, but I eagerly await to see if anyone can answer it.

 

[جوري]

Yep. I find the character himself very funny. I don't know the first thing about medicine though, but yes, I have heard the medicine practiced in that show is... inaccurate, to say the least. Still, I watch it for Mr Laurie's sarcastic wit rather than to learn how to be a doctor.

Anyway, I was just being light-hearted. I lack the requisite knowledge to answer the question in the first post, but I eagerly await to see if anyone can answer it.

there were no takers =( but the answer is B which is TB
you have to cut through the fillers with these q's, and I know many people myself included by the way who often get distracted by the fillers. Medicine is alot of detective work, that is what is really appealing about it...
I mean in the above Q the only pertinent portions are the Kussmaul's sign which basically tells you, there is something wrong with the heart, it is telling you that the heart isn't filling properly, either there is fluid accumulating in the sac around the heart or you have a poorly compliant heart, interpreting JVP findings in and of itself is very challenging, can literally be anything from, right heart failure, to constrictive pericarditis, restrictive cardiomyopathy, to pericardial effusion.. You really have to work by process of elimination because a thousand condition can present the same way, but of the choices they have given you, which is most likely to cause these symptoms, would be eliminated down to TB.. in this case it is very much a process of elimination... I think the best clue is the patient's background, perhaps it is the give away? since psittacosis is caused by bird dropping, people who breed parrots or work at petland's discount lol, pneumoconiosis happens when someone inhales dust or silica, I mean for a living, they do this for yrs to present with this condition, and the man here is a "Mexican farmer", doesn't work in a mine or the glass industry.. I can see how one might pick Cor pulmonale which describes a failure of the right side of the heart. It is caused by prolonged high blood pressure in the right ventricle of the heart, and I can see how one would pick that, but the key thing is prolonged, you'll notice the patient has had these symptoms for only two months, and a viral infection of the heart wouldn't really present with these conditions, although certain viruses can give you cardiomyopathies but wouldn't present with these symptoms ... so basically you have to reason through this Q... and that is why when I posted it, I said you can look some of the things up on line to arrive to an answer... The only thing that is left, that is pertinent would be Tuberculosis...
it is a difficult one, I agree =)
thanks so much for participating this was delightful.. a change from the norm and the heaviness of the other sections of this board!

 

[Musaafirah]

Thanks for defining pedal edema..
I don't study medicine, but I do Biomedicine though..
The thing is I learn the outline of the disease states etc..but not many in much detail...and my knowledge of the cardiovascular system is very limited..(I can never remember much)
Though, I must say I only noticed the post today, after you'd already given the answer ..lol!

 

[جوري]

Thanks for defining pedal edema..
I don't study medicine, but I do Biomedicine though..
The thing is I learn the outline of the disease states etc..but not many in much detail...and my knowledge of the cardiovascular system is very limited..(I can never remember much)
Though, I must say I only noticed the post today, after you'd already given the answer ..lol!

Thank you for your support ukhty.. medicine is very expansive, you can either be a general practitioner and know about everything but not in great detail and reference most of your patients to the appropriate sub field, or become specialized and know great details just your area of expertise certainly the entire medical and scientific community has to work hand in hand, You have to study everything then focus your interest in one field-- no one can make it solo-- it is a team effort..
I am amused by the show "house" because, though I don't catch it as often as I like, I find it an absurdity, one day he performs autopsies, the next day he performs surgeries, the next he does internal medicine.. it is not how it works at all.. I love the human heart though, but many will tell you, it isn't as terribly complex as say the kidneys or the lungs.. it is but a pump and an efficient one at that.. All I can say is Sobhan Allah