smitha
Forum Elite
Topics: 53
Posts: 236
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Hey guys, try the answer & xplanation of this for me.........Thanx beforehand.......
A 38 y.o.malecame to the emergency departmentafter his car skidded on a freeway & struck a pillar. Vitals...Pulse-88/min, Rs-20/min,BP-100/70 mm Hg.On physical,his JVP is not raised, cyanosis absent, breath sounds were symmetric.Which of the following is the most likely diagnosis?
1.Ruptured aortic aneurysm
2.Cardiac tamponade
3.Dissection of the thoracic aorta
4.Myocardial contusion
5.Pulmonary contusion.
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| Delusional
Forum Elite
Topics: 41
Posts: 226
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I don't see anything in the case other than the mechanism of injury which sounds like very rapid deceleration and all the choices you have there need some direct blunt trauma.....except for aortic rupture
So i suppose that the patient had a sever decelerating injury that could cause rupture of the thoracic aorta...which may be asymptomatic initially but that is if he does have anything.....
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| smitha
Forum Elite
Topics: 53
Posts: 236
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That's purrrrrrfect application delusional.......But i guess u wanted to say dissection of thoracic aorta is ur choice, right? Coz u kept mentioning rupture of thoracic aorta, but iam sorry it's not there in the options........it's either ruptured aortic aneurysm or dissection of thoracic aorta................
A rupptured aorta , according to me, wud cause tamponade which wud be visible in this pt. in the form of raised JVP, hypotension etc but it's a dissection of aorta due to deceleration injury. Dissection usually can occur at the ROOT,ORIGIN OF LIGAMENTUM ARTERIOSUM, & DIAPHRAGM.
These pt.s have small tears or effective tamponading.The intima & media r fractured leaving adventitia intact, & blood collects subjacent to adventitia........
prognosis.....poor. 85%die at the scene, only 15% make it to the hospital. Transesophageal echo confirms the diagnosis & is more accurate than arteriography.
About 1/3rd pt.s r asymptomatic after traumatic disruption of thoracic aorta.
Deceleration injuries involving frontal collisions usually lead to disruption DISTAL TO SUBCLAVIAN A.
Deceleration injuries from fall of a height tend to tear the ASCENDING AORTA , -----------leading to coronary a. compromise,ac.pericardial hemorrhage.
Hope this little info related to the MCQ helps................
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| Delusional
Forum Elite
Topics: 41
Posts: 226
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that is a beautiful answer......
No i was just confused with the word dissection..i definitely didn't want to say aneurysmal rupture but in the meantime i didn't want to say dissection cause i was putting in mind that for a tear to reach the adventitia it wld be called rupture.......
But I guess u put into play the appropriate use of the words.....
And still ur answer beats it all....... 
Keep posting some ....Good Job
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| smitha
Forum Elite
Topics: 53
Posts: 236
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Thanx for that delusional ...........surely i wud be posting whenever possible.........it's just that my exam is, just 6-8weeks ahead........
I wud like to say something here..........this site really needs more active participants, other than u, losergirl,keri etc who r doing a great job,,,,,,(i must say). Keep it up & keep posting........
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| Delusional
Forum Elite
Topics: 41
Posts: 226
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Yes ...ur right...
I got my exam in 7 weeks....too
kinda getting busy....Hey can u joing the chat now
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| Sujala
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Hi Smitha
I am Sujala. I recently gave my step 2 and I got 72%. I feit very sad. I am taking the exam again in Jan. Please suggest me some books for Step 2. I read Crush the Boards, Mock Exam Books, Kaplan Lecture notes, High yield Books. I do not know what else to read.
I really congratulate for getting 94% in Step2.
Any he;lp appreciated.
Thanks
Sujala.
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| smitha
Forum Elite
Topics: 53
Posts: 236
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Hey sujala................
First of all i'd like to ask u something..........who said that i got 94% in step2???????? :roll: :roll:
iam really surprised, coz my result is yet to come...........it's on the way...........when it's there, i'll post it definitely, if it's decent enuf................ :wink:
And coming to ur score, just don't worry about wat HAS happened and work for ur jan exam,ok? Iam sure u'll do good..............
I can advise one thing to ya...............doing a lot of MCQs helps people rather than just concentrating on NOTES,ok?
So, along with ur kaplan notes, i advise NMSR,Q BOOK,KAPLAN Q BANK,MOCK EXAM,KAPLAN SIMULATED 8HRS EXAM, and if u have time and possible, do MKSAP and HARRRISON'S PRETEST too.............
As many qs as possible..................ok? That HELPS more than ur theory alone..............that's all i can advise ya for now.............and as for my exam xperience and stuff, u can look in the step2 support forum where i posted my xperience and books needed ......................
ALL THE BEST sujala................i'd always say NEVER GIVE UP!!!!!!!!!!!
and iam sure u'll be able to do great this time..................
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| sujala
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Hi Smitha
Thank u very much for your advice.I will try to do more questions. I saw some body with the name Smitha saying that she got 94%. So I thought it was you. Anyway wish u good luck on your exam results.
I have few questionshere
1. In the case of Hyperkalemia, what do u do first
Take EKGto see the tall T waves ans so on or first give Calcium chloride? Which should be preffered if both are given.
2. In the case of Mania where the pt is acutely maniac, what do u do first? Give Halopiridal or Lithium. I think it has to be Halopiridal What do u think.
My e mail address is mkodumagulla @ nc.rr.com
Please give me your e mail address .
Thanks
Sujala.
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In acute mania antipsychotics are preferred to antimanics since antimanics take a few weeks.(I can't remember exactly how long)
Also for hyperkalaemia...if your suspicion is confirmed by lab results, why wait for an ECG to initiate management? An ECG may show changes(tented Ts etc), but that will not change your management.
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