Sameer Bahal
28th January 2013
 Chest X –Rays
 Abdo X-rays,
 CT Head,
Case 1
• A 34-year-old woman, immigrant from Eastern
• Complaints of vague chest discomfort 5 days after an
upper respiratory tract infection.
• Not a smoker
• BCG vaccination as child.
• Physical examination is normal.
• PPD is 10-mm induration
• Induced sputum for acid-fast bacilli is negative.
Where is
Case 2
25 year old with sudden onset chest pain
Case 3
80-year-old male smoker with history of
Presents with lower chest pain and
worsening of shortness of breath.
PH 7.30, CO2 3.6
Types of consolidation
Case 4
73 year presents with 1 week history of
increased drowsiness. Recently started
feeling Nauseous and loss of appetite.
History of stroke and AF
DH: Warfarin
 MRI is better for:
Soft tissue (ligaments)
Younger Patients
Cerebellar Imaging
Case 5
70 yea old patient, longstanding history of
HTN, AF, Diabetes, CRF and Dementia.
Admitted after fall with increasing
On Examination
 Chest Clear,
 Heart Sounds: I + II + ESM,
 Abdo: SNT, BS present
 AMTS: 3/10, (Normally 7/10)
 Bloods Normal
Normal Pressure Hydrocephalus
•Triad of:
–Gait Disturbance
–Urinary Incontinence
–CT scan (enlarged ventricles)
Case 6
30 year old admitted with headache and
Hematoma type
Between the skull and
the dura
Between the dura and
the arachnoid
Involved vessel
Temperoparietal locus
(most likely) - Middle
meningeal artery
Frontal locus - anterior
ethmoidal artery
Bridging veins
Occipital locus transverse or sigmoid
Vertex locus - superior
sagittal sinus
Lucid interval followed
by unconsciousness
Gradually increasing
headache and
CT appearance
Biconvex lens
Case 7
You are a busy on call F1 Doctor. A nurse
bleeps you, she has inserted an NG tube
and wants to check the position.
Step 1, Check pH,
Results: 6
Step 2, CXR
Case 8
50 year old patient in hospital following MI.
Develops SoB at night
Acute Pulmonary oedema
• Chest X-ray will show fluid in the alveolar walls,
• Kerley B lines,
• increased vascular shadowing in a classical batwing perihilum pattern,
• upper lobe diversion (increased blood flow to the superior
parts of the lung),
• pleural effusions. In contrast, patchy alveolar infiltrates are
more typically associated with noncardiogenic edema
These are short parallel lines at the lung periphery. These lines represent interlobular s
Kerley B Lines
Case 9
4 year old lady Ms Amin presents to A+E
with SoB. Pt unable to speak English
Chest Exam: Inspiratory Crackles
Case 10
50 year old patient admitted with Nausea
and vomiting.
Recently developed severe abdo pain
PHM, perforated duodenal ulcer,
Case 11
60 year old Patient admitted with Abdo
Pain. Not opened bowel for 4 days.
Case 12
60 year old Patient admitted with Abdo
Pain. Not opened bowel for 4 days.
Recent history of weight loss,
OE: Abdominal Distension
Case 13
30 year old patient presents with sudden
onset abdo pain.
Multiple abdominal surgeries in the past.
WCC 30,
CRP 100,
BP 85/60
HR 130,
Sats 96% Room Air
Case 14
30 year old patient with Fibromuscular
Has History of Uncontrolled Hypertension.
Presents with history of lethargy and
fatigue, with recent vomiting
 Na 145
 K 6.3
 Ur 21
 Cr 430
 GFR 15
 What investigation of choice
Case 15
46 year old Nigerian lady arrives in UK from
Nigeria and visits A+E with Sob. 6 months
ago she spent time with a ill relative who
turned out to have active TB.
Never had BCG
While you see her she coughs up blood
stained phlegm.
Case 16
Case 17
44 year old man on ward
History of Dementia, AF, Stoke, MI
You are asked to see him at 0200 due to
chest pain.
Unable to give clear history.
 ABG: pH 7.36
 O2 8.4
 CO2: 5.8
 WCC 11, CRP 30, (70),
 Hb 10.8 (11.6)
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