Effusions Explored
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A 65-year-old female presented with breathlessness, swelling of the face and legs, and decreased urine output. Examination revealed elevated jugular venous pressure, bilateral pitting edema, and crepitations in both lung bases. Investigations showed hypothyroidism. She was diagnosed with heart failure due to acute left ventricular failure and hypothyroidism. Thyroxine replacement therapy and diuretics were started, and her symptoms improved.
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A 37-year-old female presented with acute onset weakness of all four limbs for 5 hours. On examination, she had flaccid quadriparesis with decreased tone and power in both upper and lower limbs. Investigations revealed hypokalemia, metabolic alkalosis, hypertension, and renal potassium wasting. CT angiogram showed bilateral thinning and stenosis of the subclavian arteries and diffuse aortic wall thickening. This is consistent with Takayasu's arteritis, a large vessel vasculitis most commonly affecting the aorta and its major branches in young females.
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This document provides information on CAD, gastroenteritis, and hypertension. It includes sections on causes, transmission, symptoms, and standard treatment protocols for each condition. It then presents a case study of a 58-year-old male patient with complaints of vomiting, abdominal pain, and weakness. His medical history and examination results are detailed. He is assessed as having gastroenteritis, hypertension, and CAD. A 5-day treatment plan is outlined, along with discharge instructions and counseling on lifestyle modifications and medication management.
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The document describes a case report of an 80-year-old male who presented with abdominal pain for 4 days. On examination, he had tenderness in the epigastric and right upper quadrant regions. Laboratory tests showed elevated lipase, amylase and CRP, consistent with acute pancreatitis. CT imaging revealed a relatively enlarged pancreas. He was admitted and treated supportively with IV fluids, antibiotics and pain medications. His condition gradually improved and he was discharged. Common scoring systems for evaluating severity of acute pancreatitis like Ranson's criteria and BISAP score are discussed.
Churg Strauss Syndrome
A 59-year-old Thai woman presented with weakness in her arms and legs over the past week. She had numbness that started in her right toes and progressed to involve her right leg up to the knee and left hand. She was diagnosed with inflamed nerves by a private hospital but showed no improvement with medication. Examination found weakness and impaired sensation in her extremities. Tests showed eosinophilia, positive P-ANCA, and nerve biopsy demonstrated vasculitis. She was diagnosed with Churg-Strauss syndrome.
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A 7-year-old boy presented with swelling, tea-colored urine, and irritability. He had a history of strep throat diagnosed 2 weeks prior and elevated antistreptolysin O titer. Urinalysis showed proteinuria and hematuria. The most likely abnormalities in serum complement levels would be low C3 and low C4 levels, consistent with post-streptococcal glomerulonephritis.
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This document provides an overview of a case of a 70-year-old African American female presenting with acute respiratory distress and signs of a non-ST elevated myocardial infarction (NSTEMI). It discusses her medical history of cardiovascular risk factors and presents her vital signs, physical exam findings, laboratory and imaging results supporting the diagnosis of NSTEMI. The document then outlines her pharmacological management including antiplatelet therapy, anticoagulation, beta-blockers, ACE inhibitors and statins as well as her appropriate treatment options going forward.
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A 35-year old female patient presented with easy fatiguability, cough, left chest pain, fever and breathlessness for 1 month. She has a history of SLE and was on topical hydrocortisone. Examination found reduced breath sounds and dullness on the left lung. Tests showed anemia, neutrophilia and left pleural effusion. She was diagnosed with SLE and pleural effusion and treated with antibiotics, steroids and transfusions. Her symptoms improved and she was discharged on medications including erythromycin and prednisolone to manage her conditions.
A Case of Hodgkin's Disease
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A case of a patient presenting with progressive pallor. Occupational exposure and nutritional deficiency is being considered as the source.
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Unusual case of Heart Failure
A 35-year-old female was admitted with swelling of the legs for 6 months, breathlessness for 4 months, and decreased urine output for 1 month. On examination, she had swollen joints, facial puffiness, elevated jugular venous pressure, and tender hepatomegaly. Investigations showed features of heart failure, interstitial lung disease, and a positive ANA and anti-U1RNP antibody. She was diagnosed with dilated cardiomyopathy and cardiac failure secondary to an overlap connective tissue disease syndrome.
Dr eslam osama case
This patient is a 22-year-old female with a history of chronic kidney disease, hypertension, and central nervous system vasculitis who presented with fatigue, nausea, loss of appetite, and hallucinations. Laboratory tests showed worsening kidney function with a creatinine of 12.7 and urea of 243. A renal biopsy showed chronic tubulointerstitial nephritis consistent with hypertensive nephrosclerosis with focal acute tubular injury. The patient received dialysis and medications to manage her symptoms while the underlying cause of her kidney disease is hypertensive nephrosclerosis.
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A 22-year-old male presented with jaundice, fatigue, and muscle pain for 6 months. Liver tests showed elevated bilirubin, AST, and prolonged PT/INR, suggesting a chronic liver disease. A 19-year-old female with history of chicken pox 8 months ago developed jaundice. Liver tests showed direct hyperbilirubinemia, elevated AST and markedly elevated ALP, indicating a cholestatic picture with ongoing activity. A 32-year-old alcoholic male with known cirrhosis showed mild elevation of AST and direct hyperbilirubinemia, with AST/ALT ratio of 3:1, consistent with alcoholic liver disease with ongoing activity.
A Case of Sheehan's Syndrome
This document describes a case of a 40-year-old woman presenting with symptoms of decreased urine output, abdominal pain, fever, and leg swelling. Her lab work showed signs of anemia and hypothyroidism. Her history revealed amenorrhea for 18 years and issues with lactation after her third delivery. She was diagnosed with Sheehan's syndrome, also known as postpartum pituitary necrosis, likely due to postpartum hemorrhage 18 years prior which caused necrosis of her pituitary gland. She required hormone replacement therapy for her cortisol, thyroid, and other deficiencies.
Imaging: Cortical Vein Thrombosis
A 35-year-old male chronic alcoholic presented with a week-long headache and blurry vision. On examination, he had right lateral rectus palsy. CT brain showed hyperdensity in the right frontal region, right transverse sinus, and hypodensity in the superior sagittal sinus, suggestive of parenchymal hemorrhage with cortical vein thrombosis or calcified granuloma. MRI brain found a hemorrhagic lesion in the right high parietal lobe, absence of flow voids in sinuses, and T1 hyperintensity in sinuses confirming sinus thrombosis, which was shown on MR venography. The patient was diagnosed with cerebral vein thrombosis based on imaging findings.
ECG: Findings in CNS disorders
A 73-year-old male presented with left upper and lower limb weakness. He has a history of diabetes and hypertension. On examination, his pulse was 64 beats/min, blood pressure was 160/100 mmHg, and he had left-sided hemiplegia. An ECG showed normal sinus rhythm, prolonged QT interval of 500ms, and deep anterolateral T wave inversions, which could be due to central nervous system involvement or myocardial ischemia. ECG findings associated with acute central nervous system disorders include prolonged QT interval and deeply inverted T waves in precordial leads.
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A 16-year-old boy was admitted with abnormal movements of his left thumb and left eyelid for over 1 hour. MRI scans showed lesions in his brain consistent with neurocysticercosis. Neurocysticercosis is caused by the pork tapeworm Taenia solium and has four pathogenic stages seen on imaging. The patient's symptoms, travel history, imaging findings, and positive blood tests confirmed a diagnosis of neurocysticercosis. He was treated with anti-seizure medications, anti-parasitic drugs, and steroids to reduce inflammation from degenerating parasites.
ECG: Digitalis Effect / MAT / AF
A 41-year-old female presented with breathlessness, palpitations, and chest pain for 3 days. She has a history of valvular heart disease surgery 14 years ago. On examination, she was dyspneic, tachycardic, and had pedal edema. ECG showed atrial fibrillation with a rate of 160 beats/minute. Echocardiogram revealed moderate mitral stenosis and mild tricuspid regurgitation with enlarged left atrium and moderate mitral annular calcification. The patient was diagnosed with atrial fibrillation likely due to rheumatic heart disease.
Imaging: BOOP
A 28-year-old male presented with cough, dyspnea, fever, malaise, and weight loss. Chest X-ray and CT scan showed bilateral heterogeneous airspace opacities. He did not improve with antibiotics but responded well to steroids, suggestive of idiopathic bronchiolitis obliterans organizing pneumonia (BOOP). BOOP is a non-specific inflammatory reaction of small airways that can be idiopathic or secondary to various causes. It is treated with steroids and immunosuppressants if unresponsive to steroids.
ECG: Hypokalemia
1. A 52-year-old male presented with loose stools and vomiting for 4 days. Examination found hypokalemia.
2. ECG showed ST segment depression in V3-V6 and prominent U waves, consistent with changes seen in hypokalemia.
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A 50-year-old lady presented with shortness of breath, fever, cough with sputum production, and swelling of both legs over the past two days. She has a history of type 2 diabetes and hypertension. Examination found decreased breath sounds and mild dehydration. Investigations showed diabetic ketoacidosis, urinary tract infection with E. coli growth, and cirrhosis of the liver. She was diagnosed with type 2 diabetes, hypertension, emphysematous pyelonephritis, and transferred to urology for further management.
Imaging: Multiple Pulmonary Cavitary Lesions
A 38-year-old male smoker presented with swelling all over the body for the past 4 months. Examination revealed pitting pedal edema. Investigations showed elevated ESR, CRP and P-ANCA positivity. CT scan showed multiple cavitary lung lesions. A diagnosis of Wegener's granulomatosis was made based on clinical features, lab investigations and radiological findings.
ECG: Atrial Dissociation
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CXR: Silico-Tuberculosis
A 52-year-old female patient presented with complaints of breathlessness and dry cough for the past 6 months. She has a history of treated pulmonary tuberculosis 3 years ago and treated Pott's spine 2 years ago. Examination revealed wheezing and generalized pigmentation. Chest X-ray showed bilateral lung parenchymal lesions and hilar lymph node calcifications. The final diagnosis was occupational lung disease of silicosis complicated by silicotuberculosis due to exposure to silica particles in her work in sand filtration for brick production.
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A 70-year-old woman presented with chest pain and palpitations. Her ECG showed atrial flutter with an atrial rate of 340 beats per minute and ventricular rate of 60 beats per minute. The morphology of the flutter waves indicated clockwise conduction around the left atrial circuit, consistent with type I atrial flutter. Treatment options for atrial flutter aim to control the ventricular rate, restore normal sinus rhythm, prevent recurrence, and minimize thromboembolic risk. Catheter ablation can eliminate the reentrant circuit causing atrial flutter.
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1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
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1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
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Effusions Explored
- 1. M1 UNIT DR.G.KANNAN PROF.RUKMANI REDDY EFFUSIONS EXPLORED
- 2. CASE 1
- 12. CT-CHEST:
- 22. CASE 2
- 40. CASE 3
- 57. CARCINOMA OF UNKNOWN PRIMARY (CUP)
- 80. THANK YOU