Cardiovascular Pathology, Pathology, USMLE Step 1 - Full Vignette with Extended Explanations скачать в хорошем качестве

Cardiovascular Pathology, Pathology, USMLE Step 1 - Full Vignette with Extended Explanations

A 37-year-old transgender man with complex medical history, including severe chest pain radiating to the back, hypotension, syncope, hypoxemia, and neurological symptoms, presents after lifting a suitcase. On exam, he appears ill with abnormal cardiac findings and systemic signs of instability. Which historical details and bedside physical exam clues are most crucial for narrowing down the diagnosis in this critically ill patient with acute, severe cardiopulmonary compromise? VIDEO INFO Category: Cardiovascular Pathology, Pathology, USMLE Step 1 Difficulty: Moderate - Intermediate level - Requires solid foundational knowledge Question Type: Differential Physical History Case Type: Emergency - Emergency scenario requiring urgent decision-making Explore more ways to learn on this and other topics by going to https://endlessmedical.academy/auth?h... QUESTION A 37-year-old transgender man (assigned female at birth; prior ectopic pregnancy) is brought to the ED by EMS for abrupt, tearing retrosternal pain radiating to the interscapular region that began 25 minutes ago while lifting a suitcase. He reports brief syncope and transient left-hand paresthesias.... OPTIONS A. Abrupt, maximal chest pain radiating to the interscapular back with new diastolic murmur and asymmetric upper-extremity pulses. B. Sharp, pleuritic pain eased by sitting forward with a triphasic pericardial friction rub and diffuse concave ST elevation. C. Sudden unilateral pleuritic pain with hyperresonant hemithorax, absent breath sounds, and tracheal deviation away from the affected side. D. Crushing substernal pressure with diaphoresis plus 2-mm ST elevation in contiguous leads and reciprocal ST depression. CORRECT ANSWER A. Abrupt, maximal chest pain radiating to the interscapular back with new diastolic murmur and asymmetric upper-extremity pulses. EXPLANATION This vignette most strongly indicates acute aortic dissection with acute aortic regurgitation and impending cardiogenic shock. "Abrupt, maximal chest pain radiating to the interscapular back with new diastolic murmur and asymmetric upper-extremity pulses." captures the classic triad: tearing back pain, acute diastolic decrescendo murmur from aortic regurgitation, and pulse/BP asymmetry from branch-vessel malperfusion. Supporting stem data include widened mediastinum, early diastolic cusp flutter, holodiastolic flow reversal in the descending aorta, carotid-femoral pulse delay, interarm systolic difference of 25 mm Hg, and hypoxemia with pulmonary edema (diffuse B-lines) from acute severe AR. The 2022 ACC/AHA Aortic Disease guideline and 2021 Chest Pain guideline emphasize that abrupt severe pain plus new AR murmur and pulse deficit is highly specific for dissection. "Sharp, pleuritic pain eased by sitting forward with a triphasic pericardial friction rub and diffuse concave ST elevation." describes acute pericarditis, which would fit positional pleuritic pain and ECG changes the patient does not have.... Further reading: Links to sources are provided for optional further reading only. The questions and explanations are independently authored and do not reproduce or adapt any specific third-party text or content. --------------------------------------------------- Our cases and questions come from the https://EndlessMedical.Academy quiz engine - multi-model platform. Each question and explanation is forged by consensus between multiple top AI models (i.e. Open AI GPT, Claude, Grok, etc.), with automated web searches for the latest research and verified references. Calculations (e.g. eGFR, dosages) are checked via code execution to eliminate errors, and all references are reviewed by several AIs to minimize hallucinations. Important note: This material is entirely AI-generated and has not been verified by human experts; despite stringent consensus checks, perfect accuracy cannot be guaranteed. Exercise caution - always corroborate the content with trusted references or qualified professionals, and never apply information from this content to patient care or clinical decisions without independent verification. Clinicians already rely on AI and online tools - myself included - so treat this content as an additional focused aid, not a replacement for proper medical education. Visit https://endlessmedical.academy for more AI-supported resources and cases. This material can not be treated as medical advice. May contain errors. ---------------------------------------------------