Calcification of a bicuspid aortic valve

• Systolic ejection murmur at the young age of 19 indicates a congenital cause

• Aortic stenosis (due to calcified bicuspid aortic valve) → ↑ LV pressure → hypertrophy and
stiffening of the LV → S4
Supraspinatus tendon
• Pain over lateral deltoid, awaking at night (lying on affected shoulder) and pain elicited from abduction
against resistance = rotator cuff pathology
Direct current countershock
• Direct current countershock = DC cardioversion
• Wide QRS complex = ventricular tachycardia → shock
 Erythropoietin
• Corrected reticulocyte count is ~1.2%, meaning there is not enough marrow stimulation
• Chronic kidney disease → ↓ EPO production
Lisinopril therapy
• Hemorrhagic stroke are commonly caused by HTN
• Although weight reduction of 10kg lowers BP by 5-20 mmHg, this patient has already
suffered a complication of HTN and must be treated aggressively with BP medication
(while he continues to make lifestyle changes)
Prosthetic aortic valve
• Adenocarcinoma (hypercoagulable state) and prosthetic valves both require anticoagulation, but
prosthetic valves require a higher INR - prosthetic valves have a higher chance of throwing a clot
Left medial longitudinal fasciculus
• The right PPRF send a signal to the left medial rectus via the left MLF; weakness of left adduction
upon right gaze indicates a problem at the left MLF
 Labetalol
• Decreases HR, BP and LV contractility (less aortic wall stress)
• Nitro/hydralazine lower BP via vessel wall dilation, which can cause further stress and
exacerbate the tear on the aorta
Nonketotic hyperosmolar state
• Glucose > 600 = HHS
Switch from heparin to direct thrombin inhibitor therapy
• Heparin-induced thrombocytopenia → stop all heparin products and start a direct thrombin
inhibitor or fondaparinux
Fine-needle aspiration of the lesion
• Cancer risk factors → FNA
• Normal or elevated TSH → FNA
• Low TSH → Iodine 123 scintigraphy (cold nodules → FNA, hot nodule → treat hyperthyroidism)
Chest x-ray
• Pulmonary barotrauma can occur if the diver fails to expel air from lungs during ascent; as he swims
up to the surface the volume of gas expands → pneumothorax
Discharge home with home hospice care
• Without treatment, the life expectancy for stage IV non-small cell lung carcinoma is < 6 months
Hodgkin disease
• Single enlarged LN, pruritis, and absence on pharyngeal erythema make Hodgkin disease more likely than
mono
• Pathologic lymphocytes are confined to affected nodes (unless a leukemic transformation occurs) which is
why leukocyte count is not elevated
Villous atrophy in the small bowel
• D-xylose depends only on viable mucosa (not enzymatic breakdown) for absorption in the proximal
small bowel
• Celias disease → villous blunting → ↓ D-xylose absorption
Laryngoscopy and endotracheal intubation
• This patient has epiglottitis - the airway must be secured
Decreased vascular compliance
• ↑ age → stiffening of vessels → ↓ compliance
Quantitative immunoglobulin assay
• CLL → hypogammaglobulinemia
Acute tubular necrosis
• 3+ blood with no RBC’s → rhabdo → myoglobinuria → ATN