Quiz of the day 08/08/2021

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Describing an ECG

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Sir, this is a 12 lead ECG of Mr. blah blah. It is correctly calibrated. Heart rate is around 60/min, but there is a slight irregularity. P waves are normal and all p waves are followed by QRS complexes. Therefore, it is in sinus rhythm, and the irregularity is most likely to be due to sinus arrhythmia. The cardiac axis is normal. PR interval is normal. There are small Q waves in inferior and lateral leads. QRS complexes are normal and there is good R wave progression in anterior leads. There are prominent ST elevations in leads II, III and aVF. There are also mild ST elevations in V5 and V6. There is ST segment depression in aVL. T waves are upright and the QT interval appears to be normal. In conclusion, this patient has an ACUTE INFERIOR ST ELEVATION MI with possible lateral extension and reciprocal ECG changes in lead aVL. There is sinus arrhythmia, but no evidence of AV nodal dysfunction. I would like to do V4R and V7-V9 to look for right ventricular and posteri...
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Picture of the day - An elderly lady with shortness of breath

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A 62 years old lady presented with a history of shortness of breath for 2 years. She denied cough or wheezing. There was no history of ischemic chest pain in the past. Family history was unremarkable. On examination she was tachycardic. Blood pressure was 110/80mmHg. The house officer could not detect a murmur. Lungs were clear. In view of the cardiomegaly on the Xray, the house officer started IV frusemide and aspirin. The next day during the ward round, the consultant asked the HO to re-auscultate the patient. What is the diagnosis?
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2 min read - Crohn's disease

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A 21 years old boy presented with a painful perianal lump. He had taken treatment 4 times from a another doctor during the last two years for similar symptoms. He made an incision and drained the abscess under local anaesthesia. Started the patient on oral coamoxyclav and sent him home. If you were the doctor, what would you have done? In any patient presenting with recurrent perianal disease including abscesses and fistulae, you have to suspect Crohn's disease. Is it common? It certainly is, but only if you are vigilant enough to suspect it and diagnose. Why should you bother, if it's a fistula or abscess you can just drain it or do a surgical intervention, isn't it? NO! Perianal involvement in crohn's disease is nasty. It can badly affect the patients quality of life. Imagine having to live the rest of life with discharging wounds in the perineum.  How can you make the diagnosis of crohn's disease? A good history and examination will help you...
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