I am the Object of My Pimp's Affection

[merseur]

I am very weak in cardiology, so I am thinking S4. For FU cardiac echo?

[JenGintheED]

 

ischemic ventricles are less mobile, less compliant --> S4 when atrial contraction pushes blood into noncompliant ventricle

 

Thanks, Monica... this thread is fun... so pimp away :)

[Monica]

You guys are all over it! Yes, it is most definitely an S4 murmur!:) pahopeful, you absolutely may hear rales w/ failure...but the key to the question is "acute" MI & the most common sign. Good job!

 

Ok, here's another...

 

Name (4) drugs that can cause pericarditis.

 

There is a pneumonic for this one that can help you remember.

[JenGintheED]

Hmmmm.. don't know.

 

Ergotamines are associated with fibrosis of the serous membranes, including the pericardium

[Marlene G]

procainamide, hydralazine, phenytoin, and isoniazid

some blood thinners

some antibitoics

some antiarrythmics

some antiseizure meds

[Monica]

procainamide, hydralazine, phenytoin, and isoniazid

some blood thinners

some antibitoics

some antiarrythmics

some antiseizure meds

 

Yes!

 

All true...the pneumonic I was referring to was HIPP:

 

1. hydralazine
   
2. INH
   
3. procainamide
   
4. penicillin
   

[JenGintheED]

procainamide, hydralazine, phenytoin, and isoniazid

some blood thinners

some antibitoics

some antiarrythmics

some antiseizure meds

 

 

Here's one --> what's a unique (and troubling) side effect of procainamide & hydralazine?

[Marlene G]

Here's one --> what's a unique (and troubling) side effect of procainamide & hydralazine?

 

Drug-induced lupus erythematosus

[Monica]

RCDavis very kindly educated me about other drugs associated with causing pericarditis, especially the chemoagents listed here:

 

5fu, cyclophosamide, bronocriptine, minoxitil, actinomycin-d, mesalamine, sulfasalazine, phenylbutazolidine (not used in humans any more: the old butazolin).

 

Thanks RC!! Your pearls of wisdom are priceless to us!:D

[Guest BariatricsBound]

Here's one:

 

What is the difference between a stunned myocardium and hibernation?

[JenGintheED]

Drug-induced lupus erythematosus

 

Yup! And I remember when you felt you didn't have anything to contribute to this thread... ;)

[Guest scott]

I believe both refer to an abnormality of contractile function due to ischemia, but hibernation refers to the return of function after revascularization. Scott.

[Monica]

I believe both refer to an abnormality of contractile function due to ischemia, but hibernation refers to the return of function after revascularization. Scott.

 

Hopefully we will get a confirmation soon on your answer from BB...hint hint...chime in BB!:)

[Flotsam]

It's been awhile since I've studied cardiac phys, but I believe that the difference between stunned & hibernating refers to the function of the myocardium in relation to blood flow: Decreased blood flow/decreased myocardial activity , then increased blood flow leads to increased activity in hibernating myocardium. In stunned myocardium, the deficit persists (not necessarily permanently), and does not immediately return to normal once the blood supply is normalized.

 

Sam

[Guest BariatricsBound]

Holy crap, I forgot I posted a question. Sorry!!!!!!!!!!!!!!!!!!!!!!

 

Anywho, the definition of stunning is a postischemic, reversible contractile dysfunction , provided that the contractile abnormality is completely reversible and that the dysfunctional myocardium has normal or near-normal blood flow. It is also responsive to inotropic agents.

 

The oxyradical hypothesis states that the generation of oxygen-derived free radicals, with subsequent oxidative injury could account for myocardial stunning. The calcium hypothesis states that impaired calcium homeostasis, resulting in increased intracellular calcium which leads to excitation-contraction uncoupling could also account for myocardial stunning.

 

Hibernation refers to a myocardial contractile dysfunction associated with decreased coronary blood flow but preserved myocardial viability. That's really the main difference.

[ajnelson]

Ok, I've got what I think is a good one. I came home and looked this up, because the only person who knew the name for this was the ED attending.

 

What is luxatio erecta? And, what common injuries are associated with it, how does the patient usually present, and what is the usual HPI?

[EMEDPA]

if I am remembering correctly it's an atypical type of shoulder dislocation which usually presents with the arm in abduction instead of internal rotation ....

reduced one of those a while ago....and it wasn't easy......

[JenGintheED]

Isn't the arm mostly/fully over the head?

[ajnelson]

Good job!

It is an inferior dislocation of the shoulder, which is the rarest type of dislocation of the shoulder. It is usually assosciated with a fx, usually of the greater tuberosity, but the acromion, coracoid process, or clavicle may be involved. There is also usually some type of nerve involvement, and there may be dmg to the chest wall from the force. The inferior capsule is almost always torn as well.

The patient always presents with their arm either above or resting on his head. They sustain the injury with their arm in full abduction or hyperabduction.

So as for my pt, he fell 20 feet off of a ladder, landing on his knees. We deduced from his injuries that he must have tried to stop himself from falling by grabbing onto the ladder with his left arm, thus causing the luxatio erecta dislocation. When EMS brought him in, he had both arms over his head, he would bring the uninjured arm down to his side, but not the injured one. You could also palpate the humeral head in the armpit...it was very cool. He was pretty easy to reduce, we used a traction countertraction technique after he was sedated with Atomidate. He turned out to also have a fracture of the greater tuberosity & some pretty messed up knees as well.

[v_chicky]

ajn, i think we saw your patient last week! when did you see this guy?

[ajnelson]

This happened late Fri afternoon. He's probably still at the hospital. The ortho isn't going to even repair all of his fractures for at least 2 weeks. He ended up with not only the greater tuberosity fx, but fxs of both of his knees too (a tibial plateau fx on one side & an avulsion fx of the tibial spine on the other).

[jmj11]

Sorry to easedrop on this student thing, but this pimping topic got my attention. At times I thought my SP was a pimp . . . but for different reasons.

 

Anyway, I just read the entire, THAT's THE ENTIRE, 19-page, postings. Do you know how it made me feel? Dumb as a fence post. I got only about 2-3 off the top of my head. That's what happens when you've been out of school for 20+ years and you have a Crayon up your nose.

 

Okay, I'll throw out one that's easy for me (although the others posted were tough). A 21-year-old female presents with a new daily headache. I'll spare some of the other findings to avoid making this too easy. I will mention that her only meds are TCN for acne and her headache is worse laying down that standing.

 

What is one diagnosis that you certainly don't want to miss?

How is it caused?

How is it treated?

 

Mike

[rcdavis]

where are the students here? this is a great diagnosis.to make..nobody wanna take a guess?

 

too burned from the first few weeks? of class/rotations?

[ajnelson]

Okay, I'll throw out one that's easy for me (although the others posted were tough). A 21-year-old female presents with a new daily headache. I'll spare some of the other findings to avoid making this too easy. I will mention that her only meds are TCN for acne and her headache is worse laying down that standing.

 

What is one diagnosis that you certainly don't want to miss?

How is it caused?

How is it treated?

 

Psuedotumor cerebi :confused: She fits the age group & sex prevalence & it is a SE of TCN. If not caught early can cause blindness (due to the HTN). I'm not quite sure how the HA being worse lying down would fit in with this...

Pseudotumor cerebi is due to increased ICP, usually from a combination of impaired venous return & impaired reabsorption of CSF. It tends to occur in overweight women of childbearing age, so if this is actually what she has, then I would encourage her to lose weight, take her of the TCN & lower the BP, probably with just a diuretic.

[Marlene G]

Nice, AJ. It seems to fit. Thank you. Makes me research it.

 

"Pseudotumor cerebri (PTC) is encountered most frequently in young, overweight women between the ages of 20 and 45. Headache is the most common presenting complaint, occurring in more than 90 percent of cases. Dizziness, nausea, and vomiting may also be encountered, but typically there are no alterations of consciousness or higher cognitive function. Tinnitus, or a "rushing" sound in the ears, is another frequent complaint. Visual symptoms are present in up to 70 percent of all patients with PTC, and include transient visual obscurations, general blurriness, and intermittent horizontal diplopia. These symptoms tend to worsen in association with Valsalva maneuvers and changes in posture. Reports of ocular pain, particularly with extreme eye movements, have also been noted."

"Many conditions and factors have been proposed as causative agents of PTC, including excessive dosages of some exogenously administered medications (e.g., vitamin A, tetracycline, minocycline, naladixic acid, corticosteroids), endocrinologic abnormalities, anemias, blood dyscrasias, and chronic respiratory insufficiency. However the majority of cases remain idiopathic in nature."

http://www.revoptom.com/handbook/SECT53a.HTM