Random for clinical

Question 1

Pathophysiology of clubbing

Answer 1

Unknown mechanism ?PDGF from emgakaryocytes & plt emboli in nail bed causes fibroblast proliferation

Megakarocytes/plt emboli don’t usu reach arterial circulation due to lrg size which prevents passing through pulm capillaries

Conditions where plts may clump & get trapped in peripheral circulation

• IE
• R–>L shunt (bypasses pulm capillaries)
• lung disorders (not COPD, mostly suppurative)
• some GI diseases

Question 2

Causes of radial-radial & radial-femoral delay

Answer 2

Radial-femoral: Coarction (UL HTN)
radial-radial: lrg aterial occlusion by aneurysm/plaque

Question 3

Variation in BP readings (b/w arms, b/w arms/legs)

Answer 3

Arms <10mmHg
Legs can be 20mmHg higher than arms (unless Coarction)

Question 4

Pulsus Paradoxus - what & pathophy

Answer 4

BP (pulses) decrease during inspiration
- as intrathoracic Pb becomes more negative so blood pools in pulm vessels & left heart filling is reduced

If the normal reduction is EXAGGERATED = pulsus paradoxus
- Assoc w/ rise in pulse rate & fall in BP >10mmHg

Question 5

Large v waves

Answer 5

TR

Do not miss
Can see in JVP during each systole

Question 6

Apex beat

Answer 6

Can feel more easily on left side

5th IC space, 1cm medial to midclavicular line

The most lateral and inferior point that fingers are raised with each systole