Day-to-day medicine for medical students, interns and enthusiastic doctors!

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?

A 76 years old male patient admitted to the medical casualty ward with low-grade fever for 2 days with rhinitis and cough. He was on losartan for hypertension. His grandchild also has had similar symptoms a couple of days back. On examination the lungs were clear. WBC - 7.6, Hb 11.8, Plt 234, RBS 92, CRP 4.2 How will you manage the patient? Well, the upper respiratory tract infection will settle on its own. You might not have to do anything. If there is an epidemic of influenza you may use oseltamivir. Chest Xray shows some features of hyperinflation. So, take a history of smoking and other exposure. If the patient has exertional SOB you can manage as COPD. But, if you look carefully, chest Xray also shows a rib that's too white! What is it? That's due to sclerotic bone mets, probably from a prostate carcinoma.

A 32 years old patient came with vomiting for one day after outside food consumption. He had vomited about 20 times during the last couple of hours. He complained of upper abdominal pain due to repeated vomiting. He had several episodes of cough and developed shortness of breath. Xray was taken to exclude aspiration. What would you do? This Xray on the first glance looks quite normal. But when you closely have a look you might see some abnormality in the right upper zone. However, if you look even more closely you will pick that there are some streaky air shadows along both sides of the trachea.  This is pneumomediatinum. In the context of vomiting you will have to consider the possibility of esophageal rupture. Which has the fancy name 'Boerhaave Syndrome'. What are the other features? A classical sign would be surgical emphysema. That is not a sign you should ever miss. Do you really have to know this? It should be rare isn't it? Rare indeed. But in Sri