Updated 02/11/2020
With Valentine’s Day just around the corner, we thought you may need a Valentine’s Day card that really speaks from the heart. One of our healthcare-themed valentines is sure to send the message you are looking for.
Plus, if you’re studying for the boards, we’ve added in board-focused points from our Internal Medicine Core about the condition presented in some of the Valentines. They're just ridiculous enough that these board-focused points are sure to stick in your brain.
What You Need to Know About Premature Ventricular Contraction for the ABIM Boards
Premature ventricular contraction (PVC):
- The QRS complex occurs earlier than expected (premature), is wider than normal, and has a higher amplitude than normal.
- P wave is obscured in the QRS complex.
- T wave is inverted .
- The next RR interval is longer than normal. This is called a full compensatory pause. The SA node is not reset by the ventricular depolarization–hence, the P wave march out normally.
A ventricular escape beat can occur if the sinus pause is long enough and no atrial or junctional pacemakers kick in. The PVC comes early; the escape beat comes late.
Remember: junctional escape = narrow (40-60 bpm), and ventricular escape = wide
(20-40 bpm). Medication and certain illnesses can affect these rates.
What You Need to Know About Pleural Effusion for the ABIM Boards
Pleural effusions are either transudative or exudative. They are distinguished by comparing total protein and LDH in the effusion to that in the serum. Also, LDH level (in units/L) in the effusion is an independent indicator. One can send labs in 2 stages or, as is more commonly done, send all at once, particularly if the etiology is not clear or if there is concern for infection (I.e. empyema and/or parapneumonic effusion).
PA chest–right-side pleural effusion
Source: Vinay Maheshwari, MD
What You Need to Know About Middle Cerebral Artery Strokes and Aphasia for the ABIM Boards
Most middle cerebral artery (MCA) stem occlusions are from emboli. MCA strokes result in:
- Contralateral weakness (hemiplegia), which is denser if the internal capsule is involved;
- Contralateral sensory loss (hemianesthesia); and a
- Contralateral homonymous hemianopia.
CT of MCA Stroke
The weakness pattern follows a lateral homunculus pattern: The face and arm are more affected than the leg on the contralateral side of the body compared to the brain lesion.
If the dominant hemisphere is involved (the left side in most people, even left-handed individuals), these patients experience aphasia. Examples of dominant hemisphere MCA strokes and their presenting signs:
- A lesion that affects the lower part of the left frontal lobe (Broca area) causes expressive (a.k.a Broca) aphasia. These patients understand language, but they have trouble forming words and sentences, so their speech is nonfluent and effortful.
- A lesion at the boundary of the temporal and parietal lobes causes a fluent or sensory aphasia, called Wernicke aphasia. These patients cannot comprehend written or spoken language and have errors in their spontaneous speech, often speaking in invented words, called neologisms.
- An extensive infarction can produce global aphasia, which is both expressive and sensory.
What You Need to Know About Ventricular Tachycardia for the ABIM Boards
Ventricular tachycardia (VT) is defined as ≥ 3 sequential QRS complexes of ventricular origin at a rate of ≥ 100 bpm.
Nonsustained: duration of < 30 seconds
Sustained: duration of > 30 seconds, or causes hemodynamic collapse in < 30 seconds
ECG criteria indicative of VT
- AV dissociation
- Fusion and capture beats
- Northwest axis (between -90° and +/- -180°)
- Positive or negative concordance in precordial leads
- Absence of rS complex in all precordial leads
- If rS is present, r to S time > 100 msec
- QRS width of > 140 msec with a RBBB
- QRS width of > 160 msec with a LBBB
What You Need to Know About Coarctation of the Aorta for the ABIM Boards
Know that a bicuspid aortic valve occurs in ~50% of patients with coarctation of the aorta (COA)!
Some Other Fun Healthcare Related Valentines
Share a laugh with a friend this Valentine's Day by sharing your favorite Valentine with them! And check out the Core for more about premature ventricular contractions, pleural effusions, aphasia, and tachycardia.
Happy Valentine’s Day from MedStudy.
