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Spot the diagnosis watch

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    (Original post by j00ni)
    As regards the OP's case, surely in situs inversus the AXR would be anything but unremarkable! - and would in fact give the diagnosis

    /edit: as for the 2nd case, I think the medics should let the non medics have a stab at getting some differentials, and we help them along, so that they can have a go at some PBhell, see if they like it
    Unremarkable was the wrong phrase. I meant it showed no acute pathology. I didn't want to make it too easy by saying it showed the spleen in the right hypochondrium and the liver in the left with the caecum lying in the LIF.

    On a similar theme though - I saw a lady last week on night's with known dextrocardia (no situs invertus). Her CXR had been incorrectly labelled the radiographer who did not know the lady's diagnosis and had just assumed it to lie on the left. There is also one recent case report of a similar presentation to above undergoing an abdominal CT scan as X-rays had been labelled the wrong way.

    The 2nd case is a bit harsh for pre-medics. PBL is great really guys - it gets better as the years go by.
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    (Original post by Ataloss)
    Unremarkable was the wrong phrase. I meant it showed no acute pathology. I didn't want to make it too easy by saying it showed the spleen in the right hypochondrium and the liver in the left with the caecum lying in the LIF.
    Fair enough, the only thing is that by saying the AXR was unremarkable leads to a working diagnosis of dextrocardia with normal LIF anatomy (and thus appendicitis being impossible)

    Plus, ignoring the AXR, a half decent abdo exam should have at least brought up the possibility of situs inversus.

    Personally I think Renal has either seen this case before, or has a rather bad habit of jumping to the least likely diagnosis in cases :p:
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    (Original post by j00ni)
    Fair enough, the only thing is that by saying the AXR was unremarkable leads to a working diagnosis of dextrocardia with normal LIF anatomy (and thus appendicitis being impossible)

    Plus, ignoring the AXR, a half decent abdo exam should have at least brought up the possibility of situs inversus.

    Personally I think Renal has either seen this case before, or has a rather bad habit of jumping to the least likely diagnosis in cases :p:
    - true.

    Although a patient with dextrocardia and a classical sounding history of appendicitis but in the LIF would raise your suspicions.
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    An interesting recent case - you know the game - spot the diagnosis. This one is tough.

    A female in her late teens (with no significant known medical history) was having an argument with her father. He walked out of the room and heard a noise and on returning found her collapsed. He diagnosed her as having had a cardiac arrest, called paramedics and commenced BLS.

    On the paramedics arrival she was in VF. They were able to defibrillate her back into sinus rhythm.

    Her ECG on arrival in A&E showed an atypical ST elevation in V1/V2. The chest pain specialist nurse commented if she wasn't so young he'd have thought she'd had an MI.

    What's the likely diagnosis?
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    (Original post by j00ni)
    Personally I think Renal has either seen this case before, or has a rather bad habit of jumping to the least likely diagnosis in cases :p:
    Not that Renal's bloody awesome?

    I'm offended.

    Thing is, I just worked through it as a PBL case, what could cause RAD, what could cause peritonitis symptoms only in the LIF? And so on...
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    (Original post by Ataloss)
    Her ECG on arrival in A&E showed an atypical ST elevation in V1/V2. The chest pain specialist nurse commented if she wasn't so young he'd have thought she'd had an MI.
    And she didn't have an MI?

    Pericarditis? Massive PE? :confused:
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    (Original post by Renal)
    And she didn't have an MI?

    Pericarditis? Massive PE? :confused:
    Nope.

    Much rarer.
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    (Original post by Ataloss)
    An interesting recent case - you know the game - spot the diagnosis. This one is tough.

    A female in her late teens (with no significant known medical history) was having an argument with her father. He walked out of the room and heard a noise and on returning found her collapsed. He diagnosed her as having had a cardiac arrest, called paramedics and commenced BLS.

    On the paramedics arrival she was in VF. They were able to defibrillate her back into sinus rhythm.

    Her ECG on arrival in A&E showed an atypical ST elevation in V1/V2. The chest pain specialist nurse commented if she wasn't so young he'd have thought she'd had an MI.

    What's the likely diagnosis?
    Any cytogenetic abnormalities expected? Especially any that might predispose to aortic dissection?
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    (Original post by Fluffy)
    Any cytogenetic abnormalities expected? Especially any that might predispose to aortic dissection?
    There is a genetic abnormality - but nothing that pre-disposes to aortic dissection.


    This is a real tough one. Prior to this case, I had never heard of it. It does make a couple of pages in "The ECG in practice" - but doesn't even make mention in the gospel otherwise known as Clinical Medicine by Kumar and Clark.
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    *Cries*

    I used to get excited about this stuff before I came to medical school. Now I'm just a dumbass who can talk about thalidomide for ****ing hours.
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    *Cries*

    I used to get excited about this stuff before I came to medical school. Now I'm just a dumbass who can talk about thalidomide for ****ing hours.
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    (Original post by Ataloss)
    An interesting recent case - you know the game - spot the diagnosis. This one is tough.

    A female in her late teens (with no significant known medical history) was having an argument with her father. He walked out of the room and heard a noise and on returning found her collapsed. He diagnosed her as having had a cardiac arrest, called paramedics and commenced BLS.

    On the paramedics arrival she was in VF. They were able to defibrillate her back into sinus rhythm.

    Her ECG on arrival in A&E showed an atypical ST elevation in V1/V2. The chest pain specialist nurse commented if she wasn't so young he'd have thought she'd had an MI.

    What's the likely diagnosis?
    Idiopathic VF Syndrome, possibly due to inappropriate overstimulation by the ANS (edit: vasovagal)
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    (Original post by j00ni)
    Idiopathic VF Syndrome, possibly due to inappropriate overstimulation by the ANS
    Ooohhh - someone's on fire today.

    Now more commonly called Brugada syndrome and currently thought to be due to a congenital defect causing abnormal sodium ion transport.



    In the last 2 months, have seen females less than 25 years old with VF arrests.
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    (Original post by Ataloss)
    Ooohhh - someone's on fire today.

    Now more commonly called Brugada syndrome and currently thought to be due to a congenital defect causing abnormal sodium ion transport.



    In the last 2 months, have seen females less than 25 years old with VF arrests.
    Hyperstimulation of the ANS or some kinda channelopathy would have been my next guess. Doubt I would have gotten anywhere near the actual diagnosis! With my first guess I was wondering about things like Turners and Noonans...

    I just wish I had bought 'The ECG in practice' now, rather than ECG Made Easy
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    (Original post by Ataloss)
    Ooohhh - someone's on fire today.
    Meh, just luck I guess, I just happened to have been reading some emergency medicine case studies (as bedtime reading, call me sad, but i find them often as good as most murder mystery type books )

    In case anyone's interested:

    Colman N, Wieling W, Wilde A.A.M. A patient with recurrent syncope and ST-elevation on the electrocardiogram. Europace 6: 296-300
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    (Original post by Helenia)
    *Cries*

    I used to get excited about this stuff before I came to medical school. Now I'm just a dumbass who can talk about thalidomide for ****ing hours.


    I used to get excited by it too. However, it means I have to work for 13 hours on call on Easter Monday :mad: so it is somewhat losing its appeal.
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    (Original post by j00ni)
    Meh, just luck I guess, I just happened to have been reading some emergency medicine case studies (as bedtime reading, call me sad, but i find them often as good as most murder mystery type books )

    In case anyone's interested:

    Colman N, Wieling W, Wilde A.A.M. A patient with recurrent syncope and ST-elevation on the electrocardiogram. Europace 6: 296-300
    Beats my current bedtime reading "Care of the dying: A pathway to excellence"! Talking of which, it's nearly time for my next intallment!
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    (Original post by Fluffy)
    I just wish I had bought 'The ECG in practice' now, rather than ECG Made Easy
    Nah, ECG in practice is good for revision, but doesn't come close to ECG Made Easy in combination with actual experience imo

    Made Easy gives you the basics, but reading from a book is no good for linking ecg changes to pathology - you are far better seeing real cases - so In Practice is a bit useless except as a revision aid
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    (Original post by Fluffy)
    Beats my current bedtime reading "Care of the dying: A pathway to excellence"! Talking of which, it's nearly time for my next intallment!
    I would recommend Case Studies In Emergency Medicine (http://www.amazon.co.uk/exec/obidos/...13814-2931602). It may have lots of americanisms, but it presents and discusses the cases really well
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    (Original post by Fluffy)
    Beats my current bedtime reading "Care of the dying: A pathway to excellence"! Talking of which, it's nearly time for my next intallment!
    Why wasn't someone brave enough to call it "Care of the dying : a pathway to heaven" ?

    Or even more inappropriately - "Care of the dying - your poor PRHO will soon be getting £62"
 
 
 
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