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Presentation on theme: "SHARPEN YOUR CLINICAL SKILLS 16 TH FEBRUARY, 2012 Prof. Dr. S. Arulrhaj, MD., FRCP(Glasg)"— Presentation transcript:


2 X RAY 55 Yr/M alcoholic admitted with C/O fever with chills, blood vomiting & tarry stools. O/E: BP: 80/50mmhg, pallor+, icterus+ RS: Bilateral crepts+. After primary resuscitation he was taken for gastroscopy which reveals Gr III oesophageal varices. banding done. Total 13 units blood transfused and IV fluids. On 4 th day he developed breathlessness. X ray for diagnosis? Bil. Lung opacity with mild cardiomegaly What are the posibilities? Fluid load ALI due to Sepsis ? Malarial ?Transfusion ?Aspiration CVP was normal. What is the line of management? Antibiotics and PCV with PEEP, steroids Read the Follow up X ray? Clearing lung fields, ET tube in situ What is Final diagnosis? ALI Etiology? Sepsis, Blood Transfusion LESSON : MASSIVE TRANSFUSION ALI IS A RISK

3 X RAY 33 Yr/M admitted with C/O breathlessness, abdominal pain & Lt knee joint swelling O/E: Pallor+, RS: Decreased Air entry on left side X ray chest for diagnosis? Lt side mod. pleural effusion How to proceed? Thoracocentesis What is the fluid seen here? Haemorrhagic fluid What are the causes? Bleeding / Coagulation Disorder Tuberculosis, Neoplasm, Trauma, Sarcoidosis, Exanthemata Evaluation revealed low christmas factor 2 nd Xray shows? Minimal Lt side pleural effusion Final diagnosis? Haemophilia B, Haemorrhagic pleural effusion LESSON : NEVER MISS HAEMOPHILIA

4 X Ray 32Yr/M admitted with c/o cough with yellowish sputum & fever since 4 days O/E: RT basal Bronchial breathing, fine crepts+, tachypnoea +. What does the X ray chest PA & LAT. Show ? RT basal opacity with cystic areas What are the causes? Pneumonia - Staphylococcus, Tuberculosis Hepato-pulmonary amoebiasis Infected cyst How to proceed? Suitable antibiotics ATA, sputum c/s & AFB CT Chest & Bronchoscopy After course of antibiotics, read X- ray chest? Shadow cleared well Antibiotics? - Targocid, Ceftriaxone Final diagnosis? Right basal pneumonia with cavity- Staphylococcus. LESSON : CAVITATING PNEUMONIA REMEMBER STAPH.

5 CT SCAN 36 year male smoker, k/c/o DVT came with c/o breathlessness, persistant cramp in the lower calf, Rt sided chest pain. O/E: tachypnea, BP= 100/70mmHg Read his X ray chest? X ray chest showing dilated main PA with abrupt tapering of Rt decending PA What is the echo finding? severe PAH. What are the possibilities? Pulmonary Thromboembolism, Primary PulmonaryHTN, cor pulmonale, Pneumonia, COPD How to confirm ? CT angiography of pulmonary artery What are the findings? Dilated main pulmonary artery Partial intra luminal filling defect in Rt sup. Lobar, Rt inf. Lobar & left inf. Lobar arteries. Final diagnosis? Embolic pulmonary HTN How to manage? Adequate Anticoagulation LESSON : DVT CAN PRODUCE PTE & PHT

6 MRI 39 year female a case of MS, close MS commissurotomy done on regular treatment came with c/o backache, pain radiating through back of RT leg & numbness+. O/E: tenderness over the lumber spine+, SLR +ve 20 degree. X-ray LS AP & Lat shown here? Loss of lordosis, narrow Intervertebral spaces and Osteophytes Can you read her MRI LS? Sacralized L5 vertebre, Diffusely bulged annulus at L4-L5 level. Indenting thecal sac & compormising neural canal bilaterally. How to manage? Continuous Pelvic traction/ Discectomy LESSON : NEURO DEFICIT NEEDS INTERVENTION

7 USG ABDOMEN 83 Yr/F, Diabetic, came with complaints of pain in left lumbar region & also lower back. O/E: Pallor+, Lt Lumbar Tenderness + What does the X ray KUB show? Lt. Staghorn calculus, Osteoporosis, Compression # L1 Read her USG abdomen? Lt. GR II Hydronephrosis With Staghorn Calculus Final diagnosis? Lt. Staghorn calculus, severe Osteoporosis, Compression # L1 Procedure of choice will be useful? PCNL (Percutaneous nephrolithotomy) LESSON: REMEMBER RENAL CAUSES IN LBA

8 GASTROSCOPY 55 yr/M alcoholic admitted with C/O Fever, blood vomiting & tarry stools O/E: Icterus+, Pallor+, Liver palpable 2 cm below costal margin What Gastroscopy shows? Fundal varices oesophageal varices GR II - III What is the procedure being done? Banding LESSON: VARICEAL BLEED- EVL IS TREATMENT OF CHOICE

9 BRONCHOSCOPY 65 Yr/M farmer by occupation, came with c/o cough with white sputum, breathlessness, loss of weight about 5 kg over 1month. Read his x ray chest PA? Cardiomegaly, bil. Pulmonary shadow What does the CT chest show? Soft tissue density lesion 5x4.5x5.5cm in post. Segment of lower lobe of left lung, irregular & speculated margin. Bil. Multiple small nodular soft tissue density lesion Bronchoscopy done shows? White patchy lesion seen over Rt. Lower segmental bronchus What are the possibilities? Mass with intrapulmonary metastasis Infective granulomatous disease Candidiasis How to proceed? Biopsy, HPE LESSON: CT INVALUABLE IN RETRO CARDIAC LESION

10 ECG 76 Yr Male admitted with H/O chest pain followed by loss of consciousness, K/C/O Hypertension, Post PCI to RCA status O/E: P-40/min,BP-60/?, Sweating+. Immediately ECG taken shows? CHB, IWMI, RBBB How to proceed? Thrombolysis & Temporary Pacemaker insertion. Read 2nd ECG? Intermittent Pacing rhythm, Resolving ST elevation, VPC+ How to proceed further? C. Angiogram LESSON: TPI IN AMI IS LIFE SAVING

11 INVESTIGATION 55 years old patient has recurrent cough & wheezing more in winter. Can you read her PFT? Obstructive lung disease – severe What is the benefit of PFT? Differentiate obstruction and Restriction. Follow-up therapy LESSON: MONITORING LUNG FUNCTION IS VITAL

12 ECHO A 30 year old man presented with palpitation and on examination there were multiple heart sounds, Echo done is shown for evaluation. What is the Echo diagnosis? Ebstein’s Anomaly of Tricuspid valve. What are the complications? Atrial and ventricular arrhythmia sudden death. LESSON: PALPITATIONS CAN BE DUE TO STRUCTURAL HEART DISEASE

13  Keep the date blocked.  Excellent Scientific feast awaits you.  Knowledge & skill updating for practicing Physicians, Postgraduates & Students Dr. T. Neelambujan, MD. DNB(Cardio) Dr. Archana Ambujan, MS., OG. Medical Director – SAH Executive Director – SAH

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