Title: Underground Clinical Vignettes: Pathophysiology, Volume 1: Classic Clinical Cases for USMLE Step 1 Review
Publisher: Lippincott Williams & Wilkins
Publication Date: 2001
Language: English
ISBN 10: 0632045515
ISBN 13: 9780632045518
Binding: Soft cover
Condition: Acceptable

About this title

Synopsis

Blackwell's Underground Clinical Vignettes: Pathophysiology, Volume 1, Step 1, Third Edition is your primary source for clinically relevant, case-based material essential for USMLE Step 1 review. This clinical vignette book presents approximately 100 cases with over 1,000 classic buzzwords in history taking, physical examination, lab, imaging, pathology, and treatment. Sections of Volume 1 cover cardiology, dermatology, endocrinology, ENT/ophthalmology, and gastroenterology. Blackwell's Underground Clinical Vignettes: Pathophysiology, Volume 1, Step 1, Third Edition is perfect for medical students. Physician assistants, nurse practitioners, and related health professionals will also find Underground Clinical Vignettes valuable.

Excerpt. � Reprinted by permission. All rights reserved.

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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