Underground Clinical Vignettes: Pathophysiology, Volume 1: Classic Clinical Cases for USMLE Step 1 Review - Softcover

Bhushan, Vikas; Fierro, Jose, M.; Soni, Vipal; Nguyen, Hoang; Le, Tao; Amin, Chirag; Pall, Vishal

9781890061173: Underground Clinical Vignettes: Pathophysiology, Volume 1: Classic Clinical Cases for USMLE Step 1 Review

Softcover

ISBN 10: 1890061174 ISBN 13: 9781890061173

Publisher: Wiley-Blackwell, 1999

S2S introduces the 2nd Edition of the only Step 1 review series dedicated to Clinical Vignettes. Each Underground Clinical Vignettes book presents 100+ frequently tested diseases with thousands of classic buzzwords in Hx, PE, lab, imaging and pathology.

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From the Publisher:

Buy the UCV Step 1 Bundle (0-632-04559-0) and receive a new FULL COLOR picture atlas -- completely free! - Hundreds of classic full-color photos of Histo, Path, Hem, Micro, and clinical images
- Page references to the UCV volumes for quick navigation
- Format designed for easy quizzing

ID/CC-A 48-year-old male with a history of hypertension is brought by ambulance to the emergency room because of the development of sudden sharp, tearing, intractable left chest pain with radiation to the back.

HPI-When he first arrives, he shows a declining level of consciousness, becomes pale and short of breath (DYSPNEA), has decreased urine output (OLIGURIA), and is unable to move his left arm and leg; subsequently he faints (SYNCOPE).

PE-VS: marked hypotension (BP 90/50) in left arm, with significantly higher reading in right arm (BP 170/80). PE: pallor; cyanosis; diaphoresis; indistinct heart sounds; aortic regurgitation murmur (high-pitched, blowing, diastolic decrescendo murmur); inspiratory crackles at lung bases bilaterally (due to pulmonary edema); anuria (due to decreased renal perfusion); left-sided hemiplegia.

Labs-ECG: no evidence of myocardial infarct.

Imaging-CT/MR: spiraling intimal flap with true and false lumen (DOUBLE-BARREL AORTA). Angio, aortography: confirmatory. CXR: mediastinal widening (due to hemorrhage).

Gross Pathology-Longitudinal separation of tunica media of aortic wall.

Micro Pathology-N/A

Treatment-ICU monitoring for shock; antihypertensive agents to decrease vascular shear forces (avoid arteriolar dilators such as hydralazine); surgical correction.

Discussion-Aortic dissection is a life-threatening condition requiring immediate treatment. Predisposing factors include hypertension and connective tissue diseases (cystic medial degeneration as in Marfan’s syndrome); complications include rupture and extension. Sudden death may occur with pericardial tamponade or extension of dissection into coronary arteries.

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