A 42-year-old man with known valvular heart disease develops a fever for 1 week. He appears unwell; and has pansystolic murmur at the apex that radiates to the axilla and a soft S1 sound. He has petechiae on his conjunctiva, linear hemorrhages under a few fingernails, and painful, tender, and erythematous nodules on some of the distal fingertips. Which of the following is the most responsible mechanism for these physical findings?
سؤال مجاني 4 من 10 اليوم · اشترك وكمّل بدون حد
اعرض الإجابة
الإجابة والشرح
ادخل لحسابك عشان نحفظ إجاباتك ونوريك أخطاءك.
المصادر مختلفة. ملفات الدفعة فيها إجابتين، وما نرجّح وحدة على الثانية. سبب كل وحدة في الشرح تحت:
- إجابة: B. Immune response
- إجابة ثانية: C. Vascular phenomena
This is infective endocarditis. The lecture's Duke criteria list Osler's nodes (the painful fingertip nodules) as an immune phenomenon, which supports B. But the stem also lists conjunctival petechiae and splinter haemorrhages, which are usually counted as vascular/embolic phenomena (the lecture's vascular list names emboli and Janeway lesions). With mixed findings, C is also defensible. Step Up lists splinter haemorrhages next to Osler nodes.
ليش كل خيار صح أو غلط
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A
ليش غلط
Step Up lists local invasive complications (valve damage, paravalvular abscess) separately from peripheral signs such as Osler nodes and splinter haemorrhages, which it does not attribute to direct bacterial invasion.
✓ Step Up To Medicine 6th (Valvular Heart Disease).pdf · p. 11 -
B
ليش صح
The Duke criteria in the Valvular disease slides list Osler's node (the painful fingertip nodules), Roth spot, GN and RF as immune phenomena.
✓ Valvular disease ...pdf · p. 25 -
C
ليش صح
Step Up's Duke table lists septic arterial or pulmonary emboli, mycotic aneurysms, intracranial haemorrhage and Janeway lesions as vascular phenomena of endocarditis.
✓ Step Up To Medicine 6th (Valvular Heart Disease).pdf · p. 11 -
D
ليش غلط
Valvular damage explains the murmur and heart failure (a complication of endocarditis), not the fingertip nodules and nail-bed findings, which are listed separately as embolic or immunologic signs.
✓ Step Up To Medicine 6th (Valvular Heart Disease).pdf · p. 11
- المصدر
- Valvular disease ...pdf · p. 25
Step Up To Medicine 6th (Valvular Heart Disease).pdf · p. 11 - المحاضرة
- Valvular Heart Disease · Cardiology · Module B
- ظهر في
- Cardio bank