Answers
1. A 78 year old male presents with the diagnosis of syncope. He was walking in his garden when he felt lightheaded and then collapsed. There are no injuries to find. His vitals are HR 48 bpm, BP 97/57. He is afebrile and mentating normally.
He is admitted for monitoring. What is the diagnosis on the ECG?
He is admitted for monitoring. What is the diagnosis on the ECG?
Answer: This is a Mobitz II block with a 2:1 block.
There is a p wave hidden in every T wave.
2. A 60 yo woman presents with increased shortness of breath. What does the Xray show?
All X-rays are taken from the European Society of Radiology
What is the answer?
(a) Right Pleural Effusion
(b) Left Pleural Effusion
(c) Bilateral Pleural effusions R>L
(d) Bilateral Pleural Effusions L>R
Answer: d. There are bilateral pleural effusions. If you look at the image, the gastric bubble is on the patients right here and should be on the left. The radiographer has made a mistake in labelling.
3. A 45 year old woman presents with a swollen, red and painful forearm. Her recent past history is that she sustained a forearm fracture 6 weeks ago. Her plaster was removed a week ago. This morning she woke with a swollen, erythematous and painful forearm as in the photo. What is the diagnosis?
Answer: Reflex Sympathetic Dystrophy or Regional Pain Syndrome
It is usually as a result of surgery or trauma and the diagnosis is made clinically; and include pain, swelling and vasomotor dysfunction.
Reflex sympathetic dystrophy tends to have 3 stages. The acute stage lasts approximately 3 months and is marked by burning pain, redness and swelling. If the condition doesn’t respond to treatment or treatment is not initiated, then it may progress to the second stage, where there is swelling, constant pain, with progressive loss of function.
It takes about one year for the process to enter the chronic phase, which may last for many years. It involves loss of function and stiffness of the limb, with fibrosis around the joints, which may progress to a claw hand.
TREATMENT
The earlier the treatment is commenced the better the potential outcome. Treatment at a later stage of the disease has reduced effectiveness. Treatment may include:
4. A 60 year old patient presents with palpitations and Shortness of breath for over one hour. He states that he has had SVT before. He is afebrile with BP of 118/62 and sats of 94% on room air.
You perform an ECG. What is the diagnosis and why?
Answer: Ventricular Tachycardia: There is AV dissociation and R/S >1
What else do we look for to diagnose VT? Watch the video
5. A patient presents with trauma to the wrist and wrist pain. You do an x-ray. What do you think?
Answer: Scapho-lunate Dissociation or Rotatory Subluxation
It is sometimes knows as the Terry Thomas sign. It is a disruption of the scapholunate ligament with resultant instability. The cause is usually trauma and the complication is degenerative arthritis of the joint. The x-ray of the wrist will demonstrate a widened scapholunate space, usually greater than 4mm. This is best seen on a clenched fist view.
Image from www.radiopaedia.com
The scapholunate ligament is U shaped and divided into three compartments. A complete tear of the dorsal part, results in dissociation.
This is known as the Terry Thomas Sign for obvious reasons.
Treatment is by surgical repair. If this isn’t repaired there Is a migration of the capitate between scaphoid and lunate which results in longer term degenerative disease.
6. A 2 year old child is brought into the emergency department by ambulance. He was secured in the back seat of the family car, whilst his mother was driving. She was involved in an accident that has seen the car flip on its side.
The mother has some neck pain and 2 right fractured ribs. The child is does not appear injured, is alert but is unsettled and occasionally crying. The vitals are all at the upper level of normal. How do you clear the child's cervical spine?
(a) With no obvious injuries and the low rate of cervical injuries in children, I would clear using NEXUS Criteria.
(b) Plain xray, but must get AP, Lat and the Canadian C spine rule
(c) Plain Xray, AP and Lat and clinical examination
(d) CT
(e) MRI
Answer: This is a controversial topic. The answer is (c) most likely, although an MRI may also be needed. We will speak about this at the teaching.
All X-rays are taken from the European Society of Radiology
What is the answer?
(a) Right Pleural Effusion
(b) Left Pleural Effusion
(c) Bilateral Pleural effusions R>L
(d) Bilateral Pleural Effusions L>R
Answer: d. There are bilateral pleural effusions. If you look at the image, the gastric bubble is on the patients right here and should be on the left. The radiographer has made a mistake in labelling.
3. A 45 year old woman presents with a swollen, red and painful forearm. Her recent past history is that she sustained a forearm fracture 6 weeks ago. Her plaster was removed a week ago. This morning she woke with a swollen, erythematous and painful forearm as in the photo. What is the diagnosis?
Answer: Reflex Sympathetic Dystrophy or Regional Pain Syndrome
It is usually as a result of surgery or trauma and the diagnosis is made clinically; and include pain, swelling and vasomotor dysfunction.
Reflex sympathetic dystrophy tends to have 3 stages. The acute stage lasts approximately 3 months and is marked by burning pain, redness and swelling. If the condition doesn’t respond to treatment or treatment is not initiated, then it may progress to the second stage, where there is swelling, constant pain, with progressive loss of function.
It takes about one year for the process to enter the chronic phase, which may last for many years. It involves loss of function and stiffness of the limb, with fibrosis around the joints, which may progress to a claw hand.
TREATMENT
The earlier the treatment is commenced the better the potential outcome. Treatment at a later stage of the disease has reduced effectiveness. Treatment may include:
- Anti-Inflammatories: They are used for analgesia, but don’t affect the course of the illness
- Steroids (Prednisolone 40mg/day): reduce pain and swelling
- Sympathetic Block
4. A 60 year old patient presents with palpitations and Shortness of breath for over one hour. He states that he has had SVT before. He is afebrile with BP of 118/62 and sats of 94% on room air.
You perform an ECG. What is the diagnosis and why?
Answer: Ventricular Tachycardia: There is AV dissociation and R/S >1
What else do we look for to diagnose VT? Watch the video
5. A patient presents with trauma to the wrist and wrist pain. You do an x-ray. What do you think?
Answer: Scapho-lunate Dissociation or Rotatory Subluxation
It is sometimes knows as the Terry Thomas sign. It is a disruption of the scapholunate ligament with resultant instability. The cause is usually trauma and the complication is degenerative arthritis of the joint. The x-ray of the wrist will demonstrate a widened scapholunate space, usually greater than 4mm. This is best seen on a clenched fist view.
Image from www.radiopaedia.com
The scapholunate ligament is U shaped and divided into three compartments. A complete tear of the dorsal part, results in dissociation.
This is known as the Terry Thomas Sign for obvious reasons.
Treatment is by surgical repair. If this isn’t repaired there Is a migration of the capitate between scaphoid and lunate which results in longer term degenerative disease.
6. A 2 year old child is brought into the emergency department by ambulance. He was secured in the back seat of the family car, whilst his mother was driving. She was involved in an accident that has seen the car flip on its side.
The mother has some neck pain and 2 right fractured ribs. The child is does not appear injured, is alert but is unsettled and occasionally crying. The vitals are all at the upper level of normal. How do you clear the child's cervical spine?
(a) With no obvious injuries and the low rate of cervical injuries in children, I would clear using NEXUS Criteria.
(b) Plain xray, but must get AP, Lat and the Canadian C spine rule
(c) Plain Xray, AP and Lat and clinical examination
(d) CT
(e) MRI
Answer: This is a controversial topic. The answer is (c) most likely, although an MRI may also be needed. We will speak about this at the teaching.