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Old 08-12-2012
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Question What represent those nodular lesions?

A 40-year-old man, with a history of heart murmur, presents with fever, chronic fatigue, anorexia, loss of visual acuity in his right eye, and subungual splinter hemorrhage. Chest auscultation reveals grade 2/6 pansystolic murmur. On examination, he has small, painful nodules in his right index finger pad and palm. The nodular lesions most likely represent which of the following?

a) Immune complexes
b) Petechiae
c) Septic microemboli
d) Splinter hemorrhages
e) Thrombi
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Old 08-12-2012
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Correct Answer

c) septic microemboli
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Old 08-12-2012
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Default Osler nodes

these would be Osler nodes but not sure about there pathophysiology.
may be "IMMUNE COMPLEX mediated"
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Quote:
Originally Posted by koolkiller88 View Post
these would be Osler nodes but not sure about there pathophysiology.
may be "IMMUNE COMPLEX mediated"
yeah..ur right that these are osler nodes...but pathophysiology is due to microembolization according to goljan

and also splinter hemorrhages,janeway lesions,petechiae..all r due to microembolization only......
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Ya goljian's is right. It happens due to micro emboli but not because of septic micro emboli but because of immune complex mediated micro emboli.
Remember these all manifestations of RF.
So rheumatic endocarditis happens because of antibodies against endocardial cells ( mimicry) not by strep. Or anyother bacterium. So its symptoms are also immune mediated.
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Old 08-12-2012
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Osler nodes are septic emboli, followed by local vasculitis due to bacterial antigens.

and to the guy above me: You're confusing rheumatic fever with endocarditis. One is due to an immunologic response with no bacteremia, and the other is an actual infection.

Last edited by smanthrav; 08-12-2012 at 05:04 AM.
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Default Wiki think like me ;-)

Quote:
Originally Posted by smanthrav View Post
Osler nodes are septic emboli, followed by local vasculitis due to bacterial antigens.
Osler's nodes are painful, red, raised lesions found on the hands and feet. They are associated with a number of conditions, including infective endocarditis, and are caused by immune complex deposition.

source wikipedia.
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Quote:
Originally Posted by koolkiller88 View Post
Osler's nodes are painful, red, raised lesions found on the hands and feet. They are associated with a number of conditions, including infective endocarditis, and are caused by immune complex deposition.

source wikipedia.
i came to know that some research is goin on these as some experts are saying septic micro emboli and some saying immune complex ..actual pathophysiology is not yet confirmed.....google it u'll come to know..../
anyways thank u for enlightening me about immune complex explanation
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Answer is A
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Quote:
Originally Posted by venky2600 View Post
i came to know that some research is goin on these as some experts are saying septic micro emboli and some saying immune complex ..actual pathophysiology is not yet confirmed.....google it u'll come to know..../
anyways thank u for enlightening me about immune complex explanation
I already did.
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Old 08-12-2012
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Default haha

Quote:
Originally Posted by venky2600 View Post
i came to know that some research is goin on these as some experts are saying septic micro emboli and some saying immune complex ..actual pathophysiology is not yet confirmed.....google it u'll come to know..../
anyways thank u for enlightening me about immune complex explanation
thanks dude, seems i got a research topic. Now can someone give me some grants.
Just kidding
Thanks venky for information. Lets wait for casandra's answer.
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Old 08-12-2012
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1) Janeway lesions (erythematous nontender lesions on palms and soles)
Osler nodes(tender lesions on finger and toes)
Splinter hemorrhages in nail bed
DUE TO EMBOLIZATION OF SEPTIC VEGETATIONS


2)Roths spot(irregular red area with central white spot in retina)
Glomerulonephritis(hematuria with rbc casts)
ARE RESULT OF IMMUNE COMPLEX VASCULITIS
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Old 08-22-2012
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Default correct answer :)

The answer is a) Immune complexes

The patient has subacute endocarditis. The nodular lesions, also known as Osler nodes, represent immune complex deposition. They are 2 to 15 mm in size and frequently are multiple and evanescent, disappearing in hours to days. Osler nodes are rare in acute bacterial endocarditis.

Option C (Septic microemboli) is incorrect. Septic microemboli, known as Janeway lesions, are hemorrhagic, macular, painless plaques with a predilection for the palms and soles. They occur with greater frequency in acute endocarditis caused by S. aureus. Janeway lesions tend to persist for several days.

Option E (Thrombi) is incorrect. Fibrin-platelet thrombi arise at a site of retinal capillary damage. These white-centered retinal hemorrhages, commonly known as Roth spots, occur in some cases of infective endocarditis.
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Old 08-11-2015
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Can anyone clear this up?

Goljan says septic microemboli which progresses to sterile vasculitis later.
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Old 08-11-2015
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First aid says
Osler nodes- immune complex deposition
Janeway lesions- septic emboli/microabscesses
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Quote:
Originally Posted by gracilis View Post
First aid says
Osler nodes- immune complex deposition
Janeway lesions- septic emboli/microabscesses
Pathoma says septic microemboli as well. I hope the real thing won't be this nitpicky, if the sources are this divergent.
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Cardiovascular-, Clinical-Signs, Pathology-, Step-1-Questions

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