Internal Medicine

0521779407-20 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:22

Thiamine Deficiency Thoracic Aortic Aneurysm 1419

tests

Laboratory

■Basic blood studies:

➣high blood pyruvate and lactate

■Basic urine studies:

➣diminished urinary thiamine excretion (<50 mcg/day)

differential diagnosis

n/a

management

n/a

specific therapy

■nutritious diet, thiamine

Side Effects & Contraindications

■None

follow-up

n/a

complications and prognosis

■Reversible with replacement

THORACIC AORTIC ANEURYSM

KENDRICK A. SHUNK, MD, PhD

history & physical

History

■Syphilis, Atherosclerosis, hypertension, inherited connective tissue

disorders (Marfans, Ehlers-Danlos, others), rheumatic (ankylosing

spondylitis), trauma, pregnancy, prior staph/strep/salmonella sep-

sis (mycotic aneurysm)

Signs & Symptoms

■Pain, cough, hoarseness, dysphagia, SVC syndrome

■Occasionally visible pulsatile masses on thorax

■Signs of sequelae, e.g. Aortic insufficiency (diastolic AI murmur,

widened pulse pressure)

■Signs of other manifestations of underlying etiology (e.g. Marfanoid

features,+Shober’s test, etc)