Blood clot
Christmas tree? This is a blood clot in a perfect cast of the right bronchial tree (lung) that a guy coughed up whole! This cast was produced by a 36-year-old man who was admitted to the intensive care unit with an acute exacerbation of chronic heart failure. His medical history included heart failure with an ejection fraction of 20%, bioprosthetic aortic-valve replacement for bicuspid aortic stenosis, endovascular stenting of an aortic aneurysm, and placement of a permanent pacemaker for complete heart block. An Impella ventricular assist device was placed for management of acute heart failure, and a continuous heparin infusion was initiated for systemic anticoagulation. During the next week, the patient had episodes of small-volume hemoptysis and increasing respiratory distress. During an extreme bout of coughing, the patient spontaneously expectorated an intact cast of the right bronchial tree. Terrifying as it is, it's a fascinating illustration of the anatomy of the right bronchial tree, which consists of three segmental branches in the upper lobe (blue arrows), two segmental branches in the middle lobe (white arrows), and five segmental branches in the lower lobe (black arrows). Credit to @nejm
How could pulmonary artery thrombus get access to bronchioles ?
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Causes of systolic heart failure49.A 17-year-old boy took a tablet X for a headache. Drug X is a weak acid with a pka of 6.8. What percentage of the drug was most likely water soluble in the patient's plasma? Select one: a. 80% b. 65% c. 99% d. 1% e. 52%DERMOGRAPHISM ?WelcomeMental and physical health are interconnected. We, as a society, need to work on emphasizing the importance of the two. This would prevent people developing physical and mental diseases at earlier and earlier ages.Marfan syndrome