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That choice is incorrect because you can't assume that he has an occlusion from the information that you have.
There can be many etiologies of a heart block, and they do not have to be ischemic in nature - for example there are different microbes that can cause heart block too.
Additionally, if this guy were to have an RCA occlusion you'd likely see evidence of ischemia or infarction on the ECG but the only findings we're given are bradycardia and 3rd degree block.
Hope this helps!
Also, the two cardiac catherization options would ultimately result in a similar outcome. It's like how the poster above mentioned the two imaging are very similar that you can rule them out.
Berry Aneurysm is not CAUSED by HTN. It's caused by weakening of the arterial wall (at bifurcations). Hypertensive disease exacerbates them and causes the clinical picture of SAH (worst headache of life) when they rupture. Hope that helps -- Reference: FA CNS pathology, aneurysms.
Actually according to Goljan this is incorrect. Berry aneurysms are caused by hypertension. The weakening of the wall (no tunica media) at bifurcations is inherent in human anatomy. Basically you have to have elevated BP to cause the dilation, outside of the inherited connective tissue disorders. Hence why PKD has the berry association. However, these aneurysms present with extremely prolonged HTN, whereas our guy in this Q only has a 1 year history.
The key to answering this question is recognizing that this is MALIGNANT hypertension that is relatively acute in onset. Malignant HTN = hyperplastic arteriolosclerosis (onion rings).
This is the key to this Q!
I made the same mistake. Tsetse flies only exist in africa. African sleeping sickness is named well. Chagas is only in south america/central. Leishmaniasis is found on both continents.
The clinical presentation confused as hell, but I could recognize that Trypomastigote anywhere and definitely was not African sleeping sickness.
She has the swelling of the eye, edema, and chest pain. T cruzi causes dilated cardiomyopathy (chest pain and edema), and the eye swelling (Romana sign) is pretty buzzwordy for Chagas.
Also it looks like a trypanosome.
Water sucks! It really really sucks!
go gators, we made that shit