It is 1 am on a Saturday night. You are about to see a 30 year old man who has been assaulted at a pub. The left side of the patient’s face is swollen and the facial x-rays are as follows. What … Continue reading
This chest x-ray is from a 70 year old who has presented with dyspnoea and fever. What can you see?
Here’s a checklist for discussing or describing a procedure – whether it’s for an exam question or just for kicks… Opening statement (preamble/history) First, check indication valid and no contra-indications: Indications Contraindications Preparation Area Staff (training, credentials, universal precautions) Equipment … Continue reading
This is the supine chest/abdominal x-ray of an elderly patient who has presented with abdominal distension with pain and vomiting. Apart from the very obvious (malpositioned nasogastric tube), what interesting radiological sign can you see?
You have just seen a 20 year old patient who presents with dyspnoea and chest pain. He has been partying hard on New Year’s Eve and admits to ‘snorting’ something while at the party. The chest x-ray is as follows; … Continue reading
It is 1 am. Your resident has just seen a 22 year old man with wrist injury sustained in a MVA and would like your opinion on the wrist x-ray. His plan is to reduce the fracture under sedation and place a below elbow … Continue reading
These ankle x-rays are from a 15 year old patient who has injured his left ankle while skateboarding and is unable to weight bear since injury. What can you see?
It is 3 am and you are about to see a 38 year old female patient brought in by paramedics with complaints of dyspnoea. Her vital signs are bit concerning; she is tachypnoeic with a respiratory rate of 30 and her O2 sats … Continue reading
This chest x-ray is from a 60 year old female patient presenting with chief complaints of dyspnoea. She has had her symptoms for few weeks now and denies fever. Her only history of note is 20 pack year smoking history. What can you see?
Any idea when pulse oximetry became available? Pulse oximetry was developed in the 1970s. The first pulse oximeter became commercially available in 1981. Pulse oximetry became standard of care for general anaesthesia in 1987 in the USA. How was oxygenation status assessed … Continue reading
Toxic megacolon = colonic dilation (>6cm) with systemic toxicity, usually due to a acute colitis of different causes. It can involved the whole colon or only one segment. Causes: Clostridium difficile pseudomembranous colitis Other infections – Salmonella, Shigella, Entamoeba Ulcerative colitis Crohn’s … Continue reading
Your patient is an elderly man who has been brought in by his wife with a history of high fever, cough and mild confusion. You order a chest x-ray to see what is going on and the PA and lateral … Continue reading
What is Darier’s sign? It is found in patients who suffer with mastocytosis and have skin involvement (multiple brown-red macules, usually on the trunk). They “urticate” (get red, itchy, swollen) when they are touched. Systemic mastocytosis is a cause of … Continue reading
Argyll Robertson pupils = bilateral small, irregular, unequal pupils that react to near accommodation but not to light This sign is pathognomonic for neurosyphilis. You can see it here.
Injury of the suprascapular nerve This is a rare injury that can occur secondary to: - scapula fracture - penetrating trauma at the base of the neck - impingement secondary to repetitive movements as seen in weight lifters, painters, boxers or in … Continue reading
Injury of the musculocutaneous nerve This is a rare injury that can occur secondary to: - shoulder dislocation - penetrating trauma of the axilla or the arm - impingement of the upper brachial plexus (heavy backpacks) Signs: - decreased sensation radial … Continue reading
The final post about relocating dislocated shoulders – if you want to teach you patient with recurrent shoulder dislocations how to relocate it themselves: http://shoulderdislocation.net/relocation/boss-holzach-matter A patient handout that you can print is available on the site as well.
This ankle x-ray is from a 19 year old patient who inverted his ankle while running. His ankle is swollen and he is unable to weight-bear. What can you see? All you can see is a red dot on the AP and … Continue reading
I thought we’ll stay with how to relocate dislocated shoulders for now. This is another technique – takes longer, but you don’t need to sedate the patient. It might not work for all patients – especially the ones who can’t … Continue reading
Today a video link for you to watch the new method (FARES) to reduce a dislocated shoulder and a nice revision of other methods: http://www.youtube.com/watch?v=NXFPWxSTK5c
Causes of stridor foreign bodies infections – croup, epiglottitis, tracheitis; retropharyngeal or other deep neck space infection anaphylaxis / angioedema laryngeal or tracheal trauma vocal cord paralysis lesions of the vocal cords – benign or malignant In very young children: laryngomalacia … Continue reading
Blackwater fever This is the popular name for the haemolytic anaemia associated with severe malaria. It appears to be more commonly associated with Plasmodium falciparum, quinine therapy and recurrent malaria infection. Signs / symptoms: fever / rigors jaundice haemolytic anaemia … Continue reading
Causes of miosis Toxins – opiates, organophosphates / nerve gas, clonidine, olanzapine Pontine haemorrhage or space occupying lesions Horner’s syndrome Anterior uveitis
The following lumbar spine x-ray is from a 60 year old patient who walked into the department with a chief complaint of lumbar back pain after a surfing accident. What can you see in the x-ray? Here is a magnified view:
Signs and symptoms of cholinergic syndrome SLUDGE is the usual mnemonic used. And “the 3 killer Bs”. But I don’t like mnemonics. So if we start from head and go down: CNS depression / coma seizures lacrimation miosis salivation bronchorea / … Continue reading
Brown-Sequard syndrome Usually due to trauma and transsection of the hemicord. Signs: ipsilateral paralysis below the level of the lesion ipsilateral loss of pain and pinprick at the level of the lesion ipsilateral loss of vibration and position sense below the … Continue reading
Central cord syndrome - usually occurs in the cervical cord, and the upper limbs are weaker than the lower limbs - dissociated sensory loss, with loss of pain and temperature and preservation of other modalities Causes: trauma – especially hyperextension of the … Continue reading
Cinchonism = toxidrome caused by quinine or cinchona bark overdose Signs and symptoms: tinnitus, impaired hearing blurred vision headache vertigo skin rash nausea & vomiting Severe cases: reversible deafness blindness which can be irreversible arrhythmias hypotension hypoglycaemia death
Dieulafoy ulcer = upper GI bleeding caused by persistence of an arteriole in the stomach mucosa, that can bleed even with minuscule mucosal erosion; usually within 6 cm of the gastroesophageal junction on the lesser curvature of the stomach - NOT associated … Continue reading
It is 1am and you are seeing a 12 year old boy who has presented with a painful foot on the lateral aspect due to an inversion injury which was sustained when he fell off his skateboard earlier in the evening. The … Continue reading