Mehlman embolism (PE, amniotic, fat, air) 03-11 (3) Flashcards
PE. simple mechanism?
DVT that has embolized up the venous circulation to the pulmonary arteries
PE. CP + risk?
present as tachy + shorthness of breath
+
has risk factors: post surgery, sedentation (eg due to hip trauma), OCP use, thrombotic disorders (ie FVL, prothrombin mutation, MTHFR).
PE. most specific ecg finding, but ,,non existent” on usmle?
S1Q3T3.
,,will get you questions wrong”.
PE. what ecg will be mentioned?
SINUS TACHYCARDIA
PE. first step management?
heparin
PE. you give heparin –> next?
do spiral CT of chest
PE. Patient is already on warfarin + gets PE –> first step –> next step?
first: do CT
next: IVC filter
DO NOT choose IVC prior to confirming PE on CT.
PE. one question had tPA as the answer for PE in patient with obstructive shock (ie low BP due to PE).
.
PE. Dx imaging in pregnancy?
V/Q scan is done instead of CT
PE. Q. V/Q shows multiple sub-segmental perfusion defects –> what Dx?
recurrent pulmonary embolism
PE. MCC of death?
Ventricular fibrillation -> acute right heart strain from a saddle embolus precipitates the Vfib.
PE. acid/base arrows.?
acute respiratory alkalosis (same as in asthma attack)
CO2 decr. (due to hyperventilation aka incr. RR)
bicarb normal, since it takes time to compensate
pH incr.
PE. one PE Q gave decr. CO2 and decr. pH why?
Patient has lactic acidosis (hence decr. bicarb) due to ischemia from poor perfusion.
HY for USMLE to know, that any type of shock can cause lactic acidosis and low bicarb.
PE. what VQ disturbance?
Dead space
Amniotic. Shorthenes + tachy + gets these symptoms 30s-2 min after delivery of the placenta. answer?
sounds like PE, but since its few min post delivery , its amniotic.
Amniotic. Shorthenes + tachy + gets these symptoms 2 days after C-section. answer?
PE
NOT amniotic fluid embolism
Amniotic. delivery of placenta –> get oozing from IV sites. Dx?
DIC
Amniotic. kas sitas sukelia DIC, tai tipo weird fact.
.
Fat. long bone fracture (eg femur) + SOB + petechia (eg shoulder/chest) = A?
fat embolism
Fat. what change seen in complete blood count?
thrombocytopenia
Fat. petechia is why?
NOT due to thrombocytopenia
literature suggest that it might be related to microvascular plugging by fat in the dermis
Fat. Pulmonary biopsy with Oil red/Sudan black.
what is dyed?
strains of fat.
Air. Insertion of CVK + sudden death. cause?
air goes to lung -> kills patient
Cholesterol. will present as 2 ways on usmle.
.
Cholesterol. 1st way: AAA repair –> purple lesions on feet. mechanism?
cholesterol plaque launches off to feet + they show feet photo
Cholesterol. 2nd way. Hx of AAA + foot lesions (no photo) + maltese crossers are seen.
Obscure, but if maltese crossers = they indicate cholesterol.
