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Program Director, Joan C. Edwards School of Medicine at Marshall University
A B C* D Saddle pulmonary embolism Pulmonary arterial hypertension Pulmonary valve stenosis Pulmonary angiosarcoma Rationale: A: the main pulmonary artery and the right and left pulmonary arteries are well opacified and patent medications mitral valve prolapse discount seroquel 300 mg free shipping. B: the central pulmonary arteries - main medications bad for liver purchase seroquel on line amex, right and left - are enlarged in patients with pulmonary arterial hypertension treatment hpv buy cheapest seroquel. In this case there is marked enlargement of the main pulmonary artery and less pronounced enlargement of the left pulmonary artery with a normal caliber right pulmonary artery medications management buy seroquel 50mg with visa. Radiographs will show mild-moderate enlargement main and left pulmonary artery and a normal sized right pulmonary artery and peripheral arteries as well as a normal size heart. The jet of blood through the stenotic valve is directed toward the main and left pulmonary arteries, resulting in enlargement. Because the right pulmonary artery arises at a right angle to the main pulmonary artery, it does not experience the turbulent flow. Based on the clinical presentation and the imaging findings, what is the diagnosis? A B C D* Rationale: Unicuspid aortic valve Bicuspid aortic valve Tricuspid aortic valve Quadricuspid aortic valve A: Although unicuspid valves can occur, there are four distinct valve leaflets in this case. Valvular regurgitation usually develops as a result of fibrous thickening and incomplete central coaptation of the valve leaflets. A B C D* Renal infarction Lower extremity ischemia Bowel ischemia Myocardial ischemia Rationale: A: this case demonstrates an aortic dissection with the right coronary origin arising from the false lumen. B: this case demonstrates an aortic dissection with the right coronary origin arising from the false lumen. C: this case demonstrates an aortic dissection with the right coronary origin arising from the false lumen. The dissection does not involve the descending aorta, making acute mesenteric, lower extremity or renal ischemia unlikely. D: this case demonstrates an aortic dissection with the right coronary origin arising from the false lumen with diminished enhancement. This patient underwent radiofrequency catheter ablation therapy for paroxysmal atrial fibrillation 6 months ago. This case does not have the characteristic features of pneumomediastinum, mediastinal hemorrhage, gas/vegetations in the left atrium, or hemorrhage in the esophagus. C: the pulmonary arteries should not be affected with this therapy, and are unremarkable in this case. D: the pulmonary arteries should not be affected with this therapy, and are unremarkable in this case. A* B C D Rationale: Cardiac myxoma Cardiac fibroma Primary cardiac osteosarcoma Thrombus the mass is pedunculated and arises from the interatrial septum at the fossa ovalis. These findings, and the location of the mass, make cardiac myxoma the most likely diagnosis. Cardiac fibromas usually occur in pediatric patients or young adults and are typically intramural and located in the ventricular wall or interventricular septum. Although cardiac fibroma may contain calcifications, the location of the tumor in this case makes the diagnosis of cardiac myxoma more likely. Although it occurs in the left atrium and can calcify, it typically has a more aggressive appearance. The tumor in this case is well circumscribed, pedunculated and attached to the atrial septum at the fossa ovalis. However, the location of most thrombi are in areas of low flow, such as in a left ventricular aneurysm, and in the left atrial appendage. Chest Radiology In-Training Exam Questions for Diagnostic Radiology Residents July 2020 Sponsored by: Commission on Publications and Lifelong Learning Committee on Residency Training in Diagnostic Radiology © 2020 by American College of Radiology. A* B C D Lymphoma Metastatic prostate cancer Mediastinal Fibrosis Hematoma Rationale: A. Metastatic prostate cancer will appear as individual nodes in the mediastinum/hilar regions.
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Evaluation symptoms questionnaire buy generic seroquel 50mg line, Risk Stratification medicine lux discount 300mg seroquel otc, and Management of Arrhythmogenic Cardiomyopathy lattice symptoms high blood pressure discount 100 mg seroquel with mastercard. There are three filamin proteins: filamin-A (isoform) symptoms multiple myeloma generic 200 mg seroquel amex, filamin-B (isoform), and striated muscle-specific filamin-C (isoform). Filamin-C (-filamin) is one of the major proteins that serves as a link between the costamere and Z-disc and is involved in signal transduction with integrins. Trp2710*, in the last exon of the human filamin-C gene interferes with its dimerization process and causes filamin-C to aggregate within skeletal muscle fibers, a phenomenon that eventually leads to myofibrillar myopathy. Review of the details on the patients with pathologic variants in the genes encoding these proteins with disturbance of protein function, has demonstrated a significant association with early-onset arrhythmias, conduction system disease, and sudden cardiac arrest or death, consistent with an arrhythmogenic form of cardiomyopathy. Evaluation, Risk Stratification, and Management of Arrhythmogenic Cardiomyopathy sarcomeric Z-lines via -actinin-2, thus connecting Nav1. After ruling out pathologic variants in the 5 desmosomal genes, genetic testing using next-generation sequencing was performed on the proband, who had a long-standing history of presyncope. However, the patient died in the operating room during the surgical procedure as a result of an anesthetic complication. Evaluation, Risk Stratification, and Management of Arrhythmogenic Cardiomyopathy Alpha-actinin-2 is a prominent member of the Z-disc found in cardiac muscle, has an N-terminal actin-binding domain, and creates a lattice-like structure that is essential for the rigidity that the Z-disc needs to serve as a structural anchor site, while still allowing for the flexibility needed to be responsive to contractile forces. The 22year-old female proband presented syncope and a family history of premature sudden unexplained death (her 25-year-old sister died in her sleep). In most of these patients, frequent premature atrial contractions that developed into atrial fibrillation or flutter represented the initial clinical manifestation. These arrhythmic manifestations were an essential part of the phenotypic spectrum. The onset of supraventricular arrhythmias followed a common pattern, initially presenting with very frequent premature atrial contractions, proceeding to paroxysmal atrial fibrillation (between 3050 years of age) and then to permanent atrial fibrillation, requiring a pacemaker due to slow ventricular conduction. There are 3 filamin proteins, with actin-binding domain, there is a Z-disc localization motif(310). Filamin-C is one of the major proteins that serves as a link between the costamere and Z-disc and is involved in signal transduction with integrins. Filamin-C directly interacts with 2 protein complexes that link the subsarcolemmal actin cytoskeleton to the extracellular matrix: the dystrophin-associated glycoprotein complex and the integrin complex. The authors also identified 54 pathologic variant carriers among 121 screened relatives. Penetrance was >97% in carriers over 40 years of age, and there was an autosomal dominant inheritance pattern. Unlike patients with pathogenic lamin A/C, emerin, or desmin pathogenic variants, these patients had mild and infrequent cardiac conduction abnormalities. The extramyofibrillar cytoskeleton also provides support for subcellular structures, organizes the cytoplasm, regulates sarcolemma topography, and transmits intercellular and intracellular mechanical and chemical signals. Evaluation, Risk Stratification, and Management of Arrhythmogenic Cardiomyopathy enveloping Z-discs, extending from one Z-disc to another. A120D identified a severe intrinsic filament formation defect causing cytoplasmic aggregates in cell lines and of the isolated recombinant protein. Model variants of codon 120 indicated that ionic interactions contributed to this filament formation defect. These muscle disorders are referred to as experiencing increasing muscle weakness. These disorders are associated with a wide spectrum of clinical phenotypes, even within the same family, and range from scapuloperoneal, limb girdle, and distal myopathic phenotypes with variable cardiac or respiratory involvement to pure cardiomyopathies. Evaluation, Risk Stratification, and Management of Arrhythmogenic Cardiomyopathy pathogenic variant p. Evaluation, Risk Stratification, and Management of Arrhythmogenic Cardiomyopathy Specifically, inborn fatty acid oxidation errors result in metabolite buildup proximal to the enzyme defect and in deficient formation of energy-yielding substrates after the block. In the defects downstream from carnitine palmitoyltransferase I, the acylcarnitine that accumulates has detergent properties, which may explain its toxicity. Indeed, amphiphilic lipid metabolite, and play a pivotal role in the production of arrhythmias. Incorporation of long-chain acylcarnitine in the sarcolemma elicited electrophysiological anomalies analogous to those seen in acute myocardial ischemia. Carnitine is not catabolized in humans, and its only metabolic conversion is through ester formation, with most esterified carnitine excreted in urine.
Antimicrobial resistance impacts clinical outcome of granulomatous colitis in boxer dogs symptoms after conception buy seroquel with american express. Inflammation-associated adherent-invasive Escherichia coli are enriched in pathways for use of propanediol and iron and M-cell translocation medicine song 2015 buy generic seroquel canada. Hostmicrobe interactions have shaped the genetic architecture of inflammatory bowel disease medicine 7253 buy cheap seroquel online. Association between granulomatous colitis in French Bulldogs and invasive Escherichia coli and response to fluoroquinolone antimicrobials medications herpes buy cheap seroquel 300 mg on line. Adherent and invasive Escherichia coli is associated with granulomatous colitis in boxer dogs. This presentation will discuss common causes, diagnostics, and treatments for equine joint disease. Case studies will be used to highlight the value of objective gait analysis for monitoring response to treatment. Lameness Evaluation and Objective Gait Analysis Lameness examination in the horse typically involves evaluation at a walk and trot in hand. Induced lameness is lameness that becomes apparent as a result of manipulation, such as a flexion test or applied pressure. In cases of subtle lameness, horses are best evaluated under a variety of conditions, including in hand, on soft and firm footing, lungeing in both directions, and under saddle examination performing discipline-specific maneuvers. The Equinosis Q is not the only objective gait analysis system available; however, the nature of the inertial sensor-based system and laptop offers the advantage of mobile, ambulatory use. Other objective gait analysis systems include the EquiGait inertial sensor-based system and Qualisys Gait Analysis, which is an optical-based system for locomotion assessment with high precision and accuracy; however, the optical system is not mobile and only accessible on a referral basis. In addition to being able to quantitate lameness more precisely, objective gait analysis offers the ability to more objectively evaluate response to diagnostic analgesia or, more importantly, the response to treatment over longer time scales. Objective analysis also helps to eliminate bias, conscious or unconscious, by the veterinary practitioner. The most common sites for osteochondral fragmentation in the carpus are the distal and proximal intermediate carpal bone and distal radial carpal bone. Flexed lateromedial radiographs of the carpus and elevated angle oblique (20 degrees above horizontal and 15-20 degrees dorsal to a standard lateromedial projection) radiographs of the fetlock joints help delineate the sites of osteochondral fragmentation. In addition to osteochondral fragmentation, osteochondral fracture, soft tissue injuries, subchondral cystic lesions and osteochondrosis can all precipitate joint disease in the racehorse2. Diagnosis of subtle injuries, especially involving subchondral bone, can be challenging and may require volumetric imaging. Diagnosis of Joint Disease in the Non-Racehorse Predispositions for specific joint disease will depend upon breed, conformation and discipline. Likewise, horses with sickle-hocked conformation will be predisposed to distal tarsal joint disease, while carpal and fetlock angular limb deformities or offset knees can predispose to joint disease secondary to uneven mechanical loading and stresses on these joints. However, although it is helpful for the equine practitioner to be aware of certain breed and discipline predispositions to joint disease, it is also important to keep an open mind. For example, although metacarpal/tarsal condylar fractures are far more common in racehorses, they do occasionally occur in non-racehorses. Treatment of High-motion Joint Disease Treatments for high-motion joint disease typically involve pharmaceutical and biological therapies that will be discussed in depth, along with emerging experimental therapies, in a subsequent session, "Frontiers in Management of Joint Disease. In young, growing foals, the veterinarian may be able to intervene to help correct angular deformities, flexural deformities or other conformational faults. Arthrodesis may allow affected animals to go on to their intended purpose, with a better prognosis for hindlimb pastern arthrodesis than forelimb. Although non-surgical methods for facilitated ankylosis of the pastern joint have been described, non-surgical methods have a lower success rate and typically take longer for the joint to fuse than surgical arthrodesis. For this reason, non-surgical methods should be offered as an alternative option where clients are reluctant to perform surgery and where radiographic evidence of arthritis is already moderately advanced. In a retrospective study on facilitated pastern ankylosis using intra-articular ethanol injections in 34 horses, 50% of horses were sound at 6 months follow-up, 38% of horses were improved but not sound, one horse showed no improvement in lameness, and 3 horses were lost to follow-up3,4.
Recognize acute and chronic infectious keratitis including bacterial medicine stick discount seroquel 200 mg overnight delivery, viral treatment plan template 300mg seroquel fast delivery, fungal symptoms nausea headache fatigue generic 100mg seroquel amex, and parasitic medications joint pain order genuine seroquel online, with emphasis on herpes simplex, herpes zoster, adenovirus, acanthamoeba, and contact lensassociated problems. Recognize noninfectious keratitis including marginal keratitis, central ulcerative keratitis, epitheliopathy, endothelialitis, and interstitial keratitis. Recognize anterior segment anomalies, including various anomalies associated with specific genetic abnormalities, corneal dystrophies, and corneal degenerations. Recognize autoimmune and immunologic diseases of the anterior segment including allergy, corneal graft rejection, and cicatrizing conjunctivitis. Recognize and be familiar with oral and topical immunosuppression and antiallergy medications. Describe fundamentals of anterior segment anatomy, chemistry, physiology, and wound healing including tear formation and function, corneal topography/tomography, endothelial cell function, and maintenance of corneal clarity. Understand principles of anterior segment pharmacology including antimicrobial, anti inflammatory, ocular hypotensive and immunosuppressive agents, with emphasis on bioavailability, mechanism of actions, relative efficacy, safety, and potential complications. Demonstrate fundamental knowledge of contact lens physiology, design and materials, and complications for both cosmetic and therapeutic use. Develop proficiency in performing diagnostic techniques including biomicroscopy, specular microscopy, corneal topography/tomography, vital stains of the ocular surface, corneal biopsy techniques and interpretation, and corneal pachymetry. Develop proficiency in medical and surgical management of corneal thinning and perforation, including techniques of pharmacological manipulation; and office procedures, such as application of tissue glue and therapeutic contact lenses. Demonstrate a detailed understanding of cornea and conjunctival pathology results and interpretation of ocular cultures. Complete an eye-banking curriculum, including a review of specific eye banking functions (recovery, processing, storage, evaluation, and distribution of tissue), donor eligibility, and donor selection. Demonstrate skill in use of reference material, including electronic searching and retrieval of relevant articles, monographs, and abstracts. Demonstrate skill in anterior segment surgery including eyelid, conjunctival, scleral, and corneal procedures, with emphasis on corneal protective procedures (eg, tarsorrhaphy), 2. The fellow should actively participate in the postoperative management in the majority of grafts where they are part of the surgical team. Describe the basics of ophthalmic optics, including how the following affect the optics of the eye: ** a. Describe basic refraction techniques using trial lenses or phoropter for basic refractive errors, including: a. Describe the optical principles of common refractive surgery diagnostic tools, including: a. Describe the following topographic maps using different scales (ie, absolute, normalized, adjustable): a. Describe normal corneal topographic patterns, as well as topographic signs of keratoconus and ectasia. Describe elevation topography maps and their importance in screening refractive surgery candidates. Describe the complications of high myopia, high hyperopia, and pathologies related to high astigmatism. Define the clinical stages of keratoconus and forme fruste keratoconus using clinical and topographic tests. List current refractive procedures, their mechanisms of action, indications, and limitations, including: a. Describe the principles and different types (ie, linear, rotational, pendular) of mechanical microkeratomes, including their characteristics, indications, risks, and possible complications. Describe the role of femtosecond technology in refractive surgery, including advantages and limitations of flap creation with a femtosecond laser. Describe different techniques of keratoplasty and their relation with refractive surgery. Perform objective and subjective refraction, including cross cylinder and Worth 4-dot test. Prescribe spectacles for at least 20 patients with simple refractive errors (eg, myopia, hyperopia, regular astigmatism). Perform refraction on patients with extreme errors of refraction (eg, 5 patients with hyperopia over 8.
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