Prep4USMLE Forum » USMLE Step 1 Forum » Pathology Forum |   A similar Question to Sturge's Question

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gpsbrar Forum Elite Topics: 34 Posts: 278	09/14/05 - 07:35 PM             #1 A 53 yrs old woman dies 4 days after an automobile accident. She sustained multiple injuries including a femoral fracture. Widespread petechiae are found in the cerebral white matter at autopsy. Which of the following is the most likely cause of these findings? A Adult resp distress syndrome B Countercoup injury C Fat embolization D Septicemia E Subdural Hematoma Copied from the sample Cd from the boards. ___________________ B+
Flying h4x0r Forum Junior Topics: 4 Posts: 51	09/14/05 - 08:15 PM             #2 C Edited by Flying h4x0r on 09/14/05 - 09:26 PM
gpsbrar Forum Elite Topics: 34 Posts: 278	09/14/05 - 11:15 PM             #3 please can you explain why? ___________________ B+
ssrpk Forum Fanatic Topics: 154 Posts: 2,796	09/15/05 - 03:20 AM             #4 nothing else fits the criteria for petechiae in the white matter! What happens is that fat globules enters the circulation after bony fracture, gets lodged at the microcirculation level in the cerebral and pulmonary vessels, resulting in mechanical obstruction, further exacerbated by RBC' and platelets clumping, and finally due to the release of fatty acids ,can cause endothelial injury , recruitment of polymorphs and all the inflammatory mediators! ARDS don't cause petechiae! Countercoup injuries will result in contusions rather than petechiae Septicemia will result in DIC Subdural hematoma takes 2-3 weeks to develop following a trauma! ___________________ life is guud
gpsbrar Forum Elite Topics: 34 Posts: 278	09/15/05 - 08:51 AM             #5 SSRPK, WOW! 99 percentile for you for sure. Man You made it very simple for me to understand now. I knew the answer, but it was answer due to exclusions. I didn't know the reason why the correct answer is fat embolism. Thanks buddy now I know the reason too. ___________________ B+
ssrpk Forum Fanatic Topics: 154 Posts: 2,796	09/15/05 - 09:02 AM             #6 thanks man! and don't worry, just keep up your hard work! ___________________ life is guud
sturge_weber Forum Guru Topics: 77 Posts: 1,042	09/15/05 - 09:27 AM             #7 ya c ..... if its is limited to the lungs, means has come from the venous side ,could be a dvt etc, it involves organs of the body, means an arterial thing, and could be fat embolus or others.... just take care of a paradoxical embolus, which is venous in origin, crosses to the arterial side thro an asd, and then becomes arterial clot, but in that case they will m ention in the stem of q that person had an asd Edited by sturge_weber on 09/15/05 - 09:33 AM
ssrpk Forum Fanatic Topics: 154 Posts: 2,796	09/15/05 - 09:39 AM             #8 how about fixed splitting of second heart sound upon auscultation! ___________________ life is guud
reet Forum Fanatic Topics: 152 Posts: 1,411	09/15/05 - 10:07 AM             #9 pulmonic valve (rt side) open first and close last in INSPIRATION..-splliting of 2 HS this is normal split in cardiac cycle.. am i right ssrpk??please correct me if its wrong anywhere... ___________________ Live as u were to die tommorow. Learn as if u were to live forever.
sturge_weber Forum Guru Topics: 77 Posts: 1,042	09/15/05 - 10:36 AM             #10 wel fixed splitting of second heart sound can also occur in pulmonary embolus... think so, not too sure
ssrpk Forum Fanatic Topics: 154 Posts: 2,796	09/15/05 - 11:49 AM             #11 ofcourse reet, you are correct! normally upon inspiration, P2 folloiws A2, which becomes one sound upon expiration, however if splits remains upon expiration then its abnormal, and yeah i think i agree with sturge, pulmonary microembolism resulting in pulmonary HTN may result in fixed splitting, although i hv'nt read it, but i'll confirm it! Thnx for pointing out sturge! ___________________ life is guud
Flying h4x0r Forum Junior Topics: 4 Posts: 51	09/15/05 - 05:17 PM             #12 sorry.. i should have explained why... with septicemia, you'll have microabcesses form in the white matter, in the watershed regions. right?

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