USMLE Forum Archives - USMLE Step 3 - pulmo 2
pulmo 2
conym5 - 08-12-09 01:57
A 34-year-old female nonsmoker who recently moved to the U.S. from
Mexico presents with dyspnea on exertion. Her PPD is 8 mm. On physical
examination, her pulse is 110 bpm, blood pressure is 110/70 mm Hg, and
she has mild clubbing, cyanosis, and orthodeoxia. Otherwise, her physical
exam is normal. Laboratory data: Hb 14 g/dL; Hct 42%; WBCs 11,000/μL;
differential normal. ABGs on room air: pH 7.42; PCO2 38 mm Hg; PO2 70
mm Hg.next step?
conym5 - 08-12-09 01:57
A 34-year-old female nonsmoker who recently moved to the U.S. from
Mexico presents with dyspnea on exertion. Her PPD is 8 mm. On physical
examination, her pulse is 110 bpm, blood pressure is 110/70 mm Hg, and
she has mild clubbing, cyanosis, and orthodeoxia. Otherwise, her physical
exam is normal. Laboratory data: Hb 14 g/dL; Hct 42%; WBCs 11,000/μL;
differential normal. ABGs on room air: pH 7.42; PCO2 38 mm Hg; PO2 70
mm Hg.next step?
The correct answer and explanation will be available after you answer.
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#5
Re: pulmo 2
conym5 - 08-14-09 15:21 The clinical picture with orthodeoxia suggests an arteriovenous malformation
(AVM). Congenital pulmonary AVMs of the lung represent a
direct communication between the pulmonary arteries and the veins,
bypassing the capillary bed and resulting in cyanosis due to right-to-left
shunt. Dyspnea and hemoptysis are common clinical presentations. Fifty
percent of AVMs are associated with Osler-Weber-Rendu syndrome. The chest x-ray shows a multilobulated opacity and the feeding vessels are characteristically seen on a CT scan. The
definitive diagnostic test is an angiogram.
#10
Re: pulmo 2 shahra - 02-28-10 21:59 not sure,but
for assessing situation in stroke we use CT without contrast.i mean for evaluating vessele's condition.then why is here ''with''contrast?since it is used for tumors,i was wondering could it be because AVM is like tumors morphologically?
#12
Re: pulmo 2 katamoto - 03-22-10 21:11 
posted by shahra on 02-28-10 21:59
not sure,but
for assessing situation in stroke we use CT without contrast.i mean for evaluating vessele's condition.then why is here ''with''contrast?since it is used for tumors,i was wondering could it be because AVM is like tumors morphologically?
not sure,but
for assessing situation in stroke we use CT without contrast.i mean for evaluating vessele's condition.then why is here ''with''contrast?since it is used for tumors,i was wondering could it be because AVM is like tumors morphologically?
because contrast show blood vessels and blood as hyperdensities.
#15
Re: pulmo 2 babbu5508 - 08-31-10 12:01 My answer is: e.
because
she has mild clubbing, cyanosis, and orthodeoxia. Otherwise, her physical
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