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Rasha A.
Internal Medicine Resident Physician
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Health and Medicine
TutorMe
Question:

An intrepid medical student notices a bounding pulse while palpating the abdomen of a patient. She is concerned that the patient could have an aortic aneurysm. What are the typical risk factors of this condition in comparison to a thoracic aortic aneurysm?

Rasha A.
Answer:

Typically abdominal aortic aneurysms (AAA) are associated with older men with long standing hypertension (or high blood pressure) which is often poorly controlled. They are often tobacco users with a family history of cardiac issues. It is due to damage from atherosclerosis Thoracic aortic aneurysms are often associated with long standing HTN, connective tissues diseases like Ehlers-Danlos, Marfan syndrome, etc, a bicuspid aortic valve, or tertiary syphillis. It is associated with cystic medial degeneration.

Medicine
TutorMe
Question:

Jimmy Kimmel recently spoke about his son's medical condition (Tetralogy of Fallot) in a heartfelt speech and described how an astute nurse noted his son was blue instead of a healthy pink. Describe the condition.

Rasha A.
Answer:

A Right to Left Shunt (where the right side of the heart's deoxygenated blood is shunted to the left side of the heart which should ordinarily just be "red" oxygenated blood and gets sent to the rest of the body) causes a discoloration in the skin, especially in newborns who have thin skin to begin with. Tetralogy of Fallot is the most common cause of early childhood cyanosis. Tetralogy of Fallot involves some form of right ventricular obstruction (ie pulmonary atresia where the pulmonic valve fails to form or pulmonary stenosis where the right ventricular outflow tract has a smaller diameter), a ventricular septal defect (allowing blood to at least leave the RV to the rest of the body in some way), right ventricular hypertrophy (this is due to a compensatory mechanism - the right ventricle increases in size to combat the increased pressure it has to pump against to get blood into the pulmonary circulation), and an overriding aorta which attempts to scoop up as much blood as it can so the baby doesn't become profoundly hypoxic (or has low oxygen)

Anatomy
TutorMe
Question:

I have a tendency to sleep in the curled-up fetal position where my elbows are bent. Sometimes I wake up with numbness and tingling in my hand. Why does this happen and which parts of my hand are affected?

Rasha A.
Answer:

Cubital Tunnel Syndrome (also known as Ulnar Nerve Entrapment) refers to the condition where the ulnar nerve (one of the three main nerves in your arm) is compressed in some way and causes numbness and tingling in your hands. The ulnar nerve runs from your neck down into your hand and there are several places it can get compressed: under your collarbone, at the wrist, or, most commonly, at the elbow in a little tunnel we call the cubital tunnel or the funny bone. The ulnar nerve gives sensation to the pinky finger and half the ring finger on both sides of the hand. Thus, leaning on your elbows for a long time, keeping your elbows bent in sleep, or irritating the nerve in another way (like hitting your funny bone!) can cause these symptoms.

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