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Common Clinical Questions

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Admin:
1.WHAT ARE THE CAUSES OF SYSTOLIC AND DIASTOLIC MURMURS  OVER THE APEX?

* Diastolic murmur at the apex : Mitral Stenosis (mid diastolic), Austin flint murmur (mid diastolic)
* Systolic murmur at the apex: Mitral valve prolapse (late systolic), Mitral regurgitation (pansystolic)
2.WHAT ARE THE CAUSES OF HAEMOPTYSIS, JAUNDICE IN CARDIAC CASE?
On rare occasions the first manifestation of heart disease is jaundice, caused by passive congestion of the liver or acute ischaemic hepatitis, so if the following diseases (which are main causes of hemoptysis in heart condition) led to heart failure, the patient can present with jaundice and hemoptysis
1-Aortic aneurysm with leakage into the pulmonary parenchyma
2-Atrial myxoma
3-Fibrous mediastinitis with pulmonary vein obstruction
4-Mitral stenosis
5-Pulmonary arteriovenous malformation
6-Pulmonary embolism/infarct
7-Primary pulmonary hypertension

3.HOW CAN YOU DIFFERENTIATE CLINICALLY BETWEEN THE RHEUMATIC FEVER AND INFECTIVE ENDOCARDITIS?
Each disease has it's own criteria when diagnosing it, (Jones criteria for rheumatic fever), (Dukes' criteria for infective indocarditis) but clinically if you see the following signs in a rheumatic patient think of infective endocarditis: ( thromboembolic problems such as stroke in the parietal lobe of the brain or gangrene of fingers), Janeway lesions (painless hemorrhagic cutaneous lesions on the palms and soles), intracranial hemorrhage, conjunctival hemorrhage, splinter haemorrhages or immunologic phenomena: Glomerulonephritis, Osler's nodes (painful subcutaneous lesions in the distal fingers), Roth's spots on the retina).
Dr.Mahdi

Mutaweli:
Question (1):
Mr. Jones drove his car into the ditch last night while trying to get home after the bar closed at 1 AM. He arrives at 8 AM in the emergency room with a massive contusion in the middle of his chest. He complains of chest pain. His total CK was 400 units/L. His MB-CK was 10 units/L. His MM-CK was 380 units/L and his BB-CK was 10 units/L. You conclude that:

A He has had a heart attack
B He has a bruised chest but has had no heart attack
C He has suffered brain damage
D You cannot conclude anything because the cardiac enzymes do not rise until 8 hours after a heart attack
Question (2):
You are working with arterial blood. The patient is acidotic with a pH = 7.1. The pKa for carbonic acid is 6.1. The partial pressure of CO2 is 37 mm Hg. The concentration of CO2 is 1.1 mM. What is the concentration of bicarbonate ion?

A.44 mM
B.22 mM
C.11 mM
D.1.1mM
E.0.11 mM

Yaxya:
What are the causes of pelvi-abodminal masses associated with bleeding in women?

Diagnostic:
Causes of Pelviabdominal mass with bleeding:
1. Bladder Cancer
2. Ectopic pregnancy
3. Endometrial stromal sarcoma
4. Endometriosis
5. Malignant mixed Mullerian tumor
6. Ovarian Cancer
7. Uterine fibroids
Diagnostic

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