SURVIVOR
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A 24 year old man suffers a stroke. It is found that his right leg is swollen and tender. On cardiovascular examination, there are no heart murmurs, a normal physiological split and no carotid bruit. If the clot that caused the stroke originated from his leg condition, what additional anomaly would be found in the heart?
A. Atherosclerosis of the LAD artery.
B. Mitral regurgitation
C. Patent foramen ovale
D. Ventricular Septal defect
E. Mitral stenosis
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| drgho
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Patent foramen ovale.
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| silver
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A. Atherosclerosis of the LAD artery.
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| drpswathi
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D
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| GoodGirl
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C , patent foramen ovale
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| new_n_lost
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C. Patent foramen ovale
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| arlete
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C
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| Tiff
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C
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| SURVIVOR
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drpswathi wrote:
D
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| SURVIVOR
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The write answer is D. The only way a thrombus from the calf (DVT) could reach the brain is through a shunt through the heart. The only two options possible are:
Patent foramen ovale
Ventricular septal defect.
In the former, there would be a PATHOLOGICAL FIXED SPLIT. Since the question stem mentions a physiological split, the answer has to be D. 
Was an interesting wuestion wasn't it? 
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| arlete
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Very good question.
But it's more common to have a patent foramen ovale with physiological split (because blood goes from right to left only when the chest pressure increases, for example, during cough) than a VSD with no murmur. 40% of ischemic strokes with no known causes (cryptogenic), specially under 55 yo, are related to PFO.
Besides, the direction of the blood in VSD is left to right, a thrombus going from right to left is very unlikely, unless Eisenmenger syndrome is already present. They don't say it is, they don't say it's not...
If the patient is healthy, I would still bet on PFO, in real life.
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| new_n_lost
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SURVIVOR wrote:The write answer is D. The only way a thrombus from the calf (DVT) could reach the brain is through a shunt through the heart. The only two options possible are: Patent foramen ovale Ventricular septal defect. In the former, there would be a PATHOLOGICAL FIXED SPLIT. Since the question stem mentions a physiological split, the answer has to be D. Was an interesting wuestion wasn't it ?
I have a question who told you that a VSD has no heart murmurs????? 
VSD with no murmurs damn . that is NEW
With VSD or any septal defect the smaller the defect the louder teh murmur due to ( here i really wanted to say acoustics but cant ) the smaller the defect the more turbulent the flow the through it the more the sound. Does it makes sense.
Now the defect was larger the then there would a S2 split and pul. hypertension would have developed.
And besides Arlete is right the direction taken by a Normal Everyday VSD is left to right unless Eisenmenger complex develops.
Dude where did you get the question from and moreover the explanation is the one i did like to know about.
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| new_n_lost
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VSD has a classical HOLOSYSTOLIC MURMUR.
ref is Goljan , Emedicine, NEJM and Harrison's
Patent Foramen Ovale has no symptoms nonewhatsoever and yet is the most likely culprit in the Cryptogenic Stroke of the Young read it here
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| new_n_lost
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SURVIVOR wrote: In the former, there would be a PATHOLOGICAL FIXED SPLIT. Since the question stem mentions a physiological split, the answer has to be D. Was an interesting wuestion wasn't it ?
Can you base your answers with a reference or give the explanation provided.
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| SURVIVOR
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I must admit I messed up this question! I got the question from some notes I got from someone and was confident I had solved it right!
The right answer has to be C. Thanx a lot NNL and sorry 4 the incorrect explanation!
What I learnt is: There could be a Patent Foramen Ovale without a pathological fixed split!
Sorry again!
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| arlete
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I love this kind of questions that make us study a little harder to be sure about what we are talking about.
In my step 2 CK, there were many questions I had discussed here at the forum, and had not forgotten the right answer because of it. I remembered this forum right there and was thankful for it.
Specifically for this question, I made the diagnosis of PFO in my older brother during my good times as a cardiologist, so this subject I will never forget...
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| silver
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and i learned not to do questions so late at night when i can barely open my eyes--then i mess up things!!!  
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| SURVIVOR
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@ ^
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