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+--- Thread: some brilliant answer this question - abrahem (/showthread.php?tid=165585)
some brilliant answer this question - abrahem - ArchivalUser - 02-27-2007
i have no answer for it
Previously healthy 42 year old woman comes to the physician becos of a 6 month history of shortness of breath with moderate exertion and pulsatile tinnitus in her left ear. She has had to decrease her daily running from 40 mts to 20 mts. at a slower pace. She takes no medications. Her last menstrual period was 5 weeks ago. She is sexually active and uses a diaphragm for contraception. She appears well. Her BP is 130/60 mm Hg, pulse is 96/min and respirations are 16/min. A bruit is heard over the left ear. The lungs are clear to auscultation. A grade 2/6, early systolic murmur is heard at the left sternal border. The cardiac apex is laterally displaced and enlarged. Peripheral pulses are bounding. An ECG shows no abnormalities except for left ventricular hypertrophy. Echocardiography shows a left ventricular ejection fraction of 50% and an increased left ventricular end-diastolic volume. Which of the following is the most likely diagnosis?
A. Aortic stenosis
B. Arteriovenous malformation
C. Hypertrophic cardiomyopathy
D. Osteitis deformans (Paget™s disease)
E. Pregnancy
F. Vitamin B (thiamine) deficiency
0 - ArchivalUser - 02-27-2007
is it wet beri beri thiamine def leading to dilated cardiomyopathy?
0 - ArchivalUser - 02-27-2007
arterio venous malformation? just guessing
0 - ArchivalUser - 02-27-2007
why not put in step2 forum? it is step2 q.
D..paget's disease increases AV shunt.
0 - ArchivalUser - 02-27-2007
It is B,
0 - ArchivalUser - 02-27-2007
agree with calmer.......
0 - ArchivalUser - 02-27-2007
c? i really don't know but check me to see if i'm thinking correctly.
enlarged septa blocks ejection towards end of systole leading to increased end diastolic volume and bounding pulse.
hypertrophy.. gives stronger contraction probably from all the running she does (sorry didn't understand what mts is) leading to turbulant blood flow and amennorrhea.
pulse is high despite exercise because of decreased outflow.
0 - ArchivalUser - 02-27-2007
pulsatile tinnitus in her left ear--early symptom of paget's.
is she alcholic? no..
0 - ArchivalUser - 02-27-2007
doh : its not C because increased left ventricular end-diastolic volume
0 - ArchivalUser - 02-27-2007
note...A bruit is heard over the left ear..sign of AV shunt..