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17 Cards in this Set
- Front
- Back
- 3rd side (hint)
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In this is cardiology ward, there is a 30 year old lady with abrupt onset dyspnoea. On examination there is edema of right lower limb. The arterial pulsations are absent in left lower limb. There is no edema of the left lower limb and all peripheral pulses are present in right lower limb.
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Paradoxical Embolism
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Patient is in cardiology ward
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A 42 year old man presents with complaints of 2 hrs of severe sub-sternal chest pain. PR 92 RR 60, BP 120/80 JVP 12cm. Auscultation of heart is unremarkable. The lung fields are clear. An ECG shows ST elevation of 2 mm in leads II III and aVF. 15 min later his systolic BP falls to 58 mm Hg.
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Right Ventricular Infarction
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Only indication for IV fluid therapy in Acute MI
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A 50 year old woman came with acute chest pain & dyspnoea. She described the pain as “much worse than child birth”. PR 100 BP 190/110 B/L basal creps. A 3/6 systolic murmur with a short diastolic component is heard at the LSB. ECG LVH with strain. A portable X-ray showed a left pleural effusion & mediastinal widening.
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Aortic Aneurysm
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Tracheal tug
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A 48 year old carpenter comes with h/o sudden onset dyspnoea while attempting to lift a heavy log of wood. Previously asymptomatic. Pulse 96. BP:160/40 JVP 0 S1 normal S2 muffled No S3 or S4. A long grade IV/VI superficial murmur is best heard near LSB. A long murmur almost filling the diastole is also heard in the same area. ECG Tall R wave in V1 & normal axis.
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RSOV Rupture
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Not a PDA murmur
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A 56 year old man with alcohol abuse, presented with fever, dry cough, and left pleuritic chest pain. 9 days earlier, he had been admitted for a GI bleed for which he received endoscopic sclerotherapy. O/E febrile; dullness over left lung base and reduced breath sounds. CXR left effusion. Thoracentesis reveals a cloudy fluid. Glucose: 42. Protein 3.1 gm (serum protein: 2.9 gm) PH is 6.3 Pleural fluid amylase is 5000 units and LDH 650 units.
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Esophageal Rupture
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Two origins for amylase
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A 52 year old bank officer presents with acute knee pain which woke him out of sleep. The night before he had attended a new year eve celebration. There is no h/o trauma. Exam revealed a swollen painful, erythematous right knee. An X-ray of knee showed effusion. A synovial fluid aspiration, Cell count 50000/mm, P 85%, Glucose 120 (RBS 130). Protein 3.5g. Gram stain is negative.
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Acute Gout
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Not seen in the classical site alone
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A 32 year old man presents with a dull headache, increasing in intensity since last several months. It is constant and worsens with head movement. The pain bores right between his eyes, but massaging the forehead does not help. The only relief he gets is by lying down. Alcohol makes it worse. A neurological examination is significant only for a positive right Babinski’s sign, which you are unable to elicit again when the medical student wants to see.
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ICSOL
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Not nessessarly severe headache
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A 45 year old man, a politician, comes under investigation for hepatomegaly. USS revealed multiple hypo echoic areas. With a diagnosis of amoebic liver abscess aspiration was done which yielded a blood stained thick fluid. He was a lay smoker, and complained of chronic cough with no h/o hemoptysis. Recently cough was aggravated by taking food. He was posted for a barium swallow because of dysphasia. The date was given after 3 weeks. Because symptoms got aggregated, the patient threatened to jump out of the window of the pay ward room.
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Tracheo-esophageal Fistula
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A 67 year old man presents with history of several weeks of intermittent fevers, muscle aches, arthralgia and headaches. He has pain and headache upon wearing glasses. There is no arthritis or hepato-spleno-megaly. CVS and RS are WNL. Blood shows mild normo-chromic anemia. TWBC10000 P50L50. ESR 110. Blood Biochemistry is normal. CPK is also normal.
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Temporal Arteritis
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Polymyalgia Rheumatica
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A 28 year old man gives h/o difficulty in walking since child hood. There is similar illness in his maternal uncle. O/E high arched unwind turned foot. Lateral curvature of spine and deformed high arched plate. The patient is ataxic and clumsy with coarse nystagmus and intention tremor. Patient is dysarthric with an explosive speech. Heel knee shin test + B/L. Knee and ankle jerks are absent. Plantar reflexes extensor. Rambergism is +
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Freireich's Ataxia
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An 18 year old girl with recurrent episodes of seeing funny things followed by complaints of bad headaches 43 year old man with migraine has shimmering vision and vomiting & peri-orbital edema but no headaches A 32 year old woman with visual scotomas, diplopia, mydriasis and a throbbing headache ameliorated by ipsilateral carotid compression 34 year old woman with unilateral headaches that have occurred like clock work every night at 9 pm and associated with right facial pain and eye watering. A 23 year old man with predictably recurrent episodes of throbbing headache, who wants narcotic analgesics |
Migraine Syndromes |
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A middle aged woman came with h/o dysphasia of 6 months duration. She is tall and has smooth and shiny skin. The fingers are long, cold and cyanosed. Atrophy of finger pulps. Pigmentation over the face and telengectasia. There is polyarthritis involving small joints of fingers and knee joints. RS scattered creps. CVS HR:76/ BP:140/80; normal heart sounds and no murmur.
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Scleroderma
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A 55 year old stout and obese lady comes with complaints of pain and numbness of hands. There is paraesthesias in the palm and fingers which are particularly bad at night. O/E positive signs were confined to the first 3 fingers of the hands. There was wasting of thenar muscles, weakness of abduction, flexion and opposition of the thumb. Keeping both wrists to 60 degree for a period of 60 seconds produced prompt exacerbation of paraesthesia which was rapidly relieved when flexion was discontinued.
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Carpal Tunnel Syndrome
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A 46 year old female comes with difficulty in swallowing & chewing. The face shows lack of expressions. The mouth is slack. The patient marks when she tries to smile. She cannot whistle. The voice is weak and has nasal quality. There is ptosis accentuated by upward gaze. Variable strabismus with diplopia is present. Palatal movements and hearing are normal, so also the movements of tongue. There is proximal muscle weakness. DTR normal and plantar flexor B/L.
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Gullain Barre Syndrome
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No sensory ddficits on examination
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An 18 year old girl was admitted to the ward with h/o vomiting and diarrhea of one day duration. Now she was diminished vision also. She was suffering from headaches since last 4 years. She was also suffering from primary amenorrhea. O/E moderately built, ill looking. Pallor +. No hepatosplenomegaly/ascites. She was sexually infantile with absence of secondary sexual characters. CNS examination showed Bitemporal hemianopia and Bilateral optic atrophy. No neurological deficits. RS and CVS were normal.
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Pitiutary Microadennoma
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A 48 year old lady suffering from carcinoma of esophagus and was under treatment from RCC. Patient was in distress Pulse 110 BP 110/70 JVP 0 Cardio-megaly present. S1S2 Normal, No S3/S4. A crunching sound was heard along with heart sounds. There was no evidence of cardiac tamponade.
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Pneumo mediastinum
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It was neither a pericardial nor a pleural rub.
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A 45 year old man having multivalvular heart disease developed high grade fever with chills and rigor. His pulse rate was originally 72 per minute. The next day the pulse came down to 28 per minute. The BP was 180/80 mmHg. Irregular canon waves were observed in the neck.
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Acute Aortic Regurgitation due to Myocardial abscess
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