By Mark D. Duncan, Lance W. Chapman, Minesh P. Shah, Veeral S. Sheth, Stanley Zaslau, Robert Casanova
Lippincott Q&A drugs focuses on high-yield info in particular designed that can assist you enhance your NBME topic examination rating. This first-of-its-kind source zeroes in on precisely what you must understand, utilizing tables, figures, mnemonics, and thousands of pattern questions in a concise, easy-to-read format—helping you are making the main of worthwhile learn time!
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Extra info for Lippincott Q&A Medicine: Review for Clinical Rotations and Exams
The patient is afebrile with a blood pressure of 143/88 mmHg, heart rate of 107 beats per minute, and respirations of 30 breaths per minute with an oxygen saturation of 93% on room air. She appears anxious and is mildly diaphoretic. Her cardiac examination shows a regular rhythm, a 2/6 systolic murmur heard at best at the left upper sternal border, and an estimated central venous pressure of 14 mmHg. In addition, she has wet rales heard along the lung bases and 2+ pitting edema bilaterally to the level of her knees.
Her tricuspid regurgitation is indicated by the murmur on examination and the pulsatile liver, which is virtually diagnostic of tricuspid regurgitation. There are no skin findings or renal involvement in this patient since her disease is limited to the tricuspid valve with emboli to the lungs. Cultures should be obtained and then empiric IV antibiotics should be started. (A, B, D) Another infectious process may be considered given her symptoms and risk factors; however, the murmur on examination with the chest x-ray showing embolic events is much more concerning for endocarditis.
If the disease is not recognized early, iron deposition can affect many organs including the liver (primary organ affected), pancreas, and heart, leading to the manifestations seen in this patient (cirrhosis, diabetes, and dilated cardiomyopathy). Because there is no physiologic mechanism to excrete large amounts of iron, the treatment of this condition is phlebotomy on a regular basis. (A) Methotrexate is a dihydrofolate reductase inhibitor used in the treatment of various cancers and autoimmune conditions.
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