01-23-2010, 02:39 AM
acute onset of multiple thrombotic events going on here seem most likely to be from heart. i could not figure out the exact cause of these emboli except that they sound more like being originated from the heart.
Answer:
© Transesophageal echocardiogram
Explanation:
The patient seems to be having episodes of emboli to the arterial structure of the body. The necrotic fingers and toes can be caused from small emboli to the distal peripheral and digital arteries. This could also account for emboli to the coronary arteries, resulting in a myocardial infarction in a patient with no risks for coronary disease beyond his age. The same reasoning would be true of what seems to certainly be an acute embolic stroke. The most effective chemotherapy for non-Hodgkin's lymphoma is still "CHOP," in which the "H" represents hydroxyadriamycin. Adriamycin may lead to cardiac toxicity, which may be predisposing to these emboli.
Protein C and S deficiency lead to the gradual onset of venous thrombosis, not the acute arterial disease described here. Homocysteine abnormalities are a risk for thrombosis, but it should never give this dramatic of a presentation. They often present with the more gradual onset of a thrombosis in development. Antiphospholipid antibodies can give arterial clots, but the PTT should be elevated. Even if this is a suspicion, you cannot leap to this diagnosis without doing the transesophageal echo first to exclude an obvious source of emboli.
Answer:
© Transesophageal echocardiogram
Explanation:
The patient seems to be having episodes of emboli to the arterial structure of the body. The necrotic fingers and toes can be caused from small emboli to the distal peripheral and digital arteries. This could also account for emboli to the coronary arteries, resulting in a myocardial infarction in a patient with no risks for coronary disease beyond his age. The same reasoning would be true of what seems to certainly be an acute embolic stroke. The most effective chemotherapy for non-Hodgkin's lymphoma is still "CHOP," in which the "H" represents hydroxyadriamycin. Adriamycin may lead to cardiac toxicity, which may be predisposing to these emboli.
Protein C and S deficiency lead to the gradual onset of venous thrombosis, not the acute arterial disease described here. Homocysteine abnormalities are a risk for thrombosis, but it should never give this dramatic of a presentation. They often present with the more gradual onset of a thrombosis in development. Antiphospholipid antibodies can give arterial clots, but the PTT should be elevated. Even if this is a suspicion, you cannot leap to this diagnosis without doing the transesophageal echo first to exclude an obvious source of emboli.
.
(sorry my friend 
..and practice makes one perfect in that.. however, the precise data recall part is still the biggie on exam..