Medical Data Interpretation

Cardiac axis Cardiac axis describes the overall direction of electrical spread within the heart. In a healthy individual the axis should spread from 11 o’clock to 5 o’clock. To determine the cardiac axis you need to look at leads I,II and III. Normal cardiac axis In normal cardiac axis:     Lead II has the most positive deflection compared to Leads I and III . Right axis deviation In right axis deviation:      Lead III has the most positive deflection and Lead I should be negative      This is commonly seen in individuals with right ventricular hypertrophy Left axis deviation In left axis deviation:      Lead I has the most positive deflection      Leads II and III are negative      Left axis deviation is seen in individuals with heart conduction defects

Chest X Ray - Four Patterns Lung abnormalities with an increased density - also called opacities - are the most common. A practical approach is to divide these into four patterns: Consolidation Interstitial Nodules or masses Atelectasis  Whenever you see an area of increased density within the lung, it must be the result of one of these four patterns.   Consolidation   - any pathologic process that fills the alveoli with fluid, pus, blood, cells (including tumor cells) or other substances resulting in lobar, diffuse or multifocal ill-defined opacities.   Interstitial   - involvement of the supporting tissue of the lung parenchyma resulting in fine or coarse reticular opacities or small nodules.   Nodule or mass   - any space occupying lesion either solitary or multiple.   Atelectasis   - collapse of a part of the lung due to a decrease in the amount of air in the alveoli resulting in volume loss and increased den...

What is  Air bronchogram Air bronchogram  refers to the phenomenon of  air -filled bronchi (dark) being made visible by the opacification of surrounding alveoli (grey/white). It is almost always caused by a pathologic airspace/alveolar process, in which something other than  air  fills the alveoli.

Bacterial Conjunctivitis Vs other causes A clinical scoring system has been developed to distinguish bacterial from other causes of conjunctivitis in healthy adults who did not wear contact lenses.  A score of +5 to −3 is determined as follows: ~ Two glued eyes (+5); one glued eye (+2); history of conjunctivitis (−2); eye itching (−1). ~ A score of +5, +4, or +3 is useful in ruling in bacterial conjunctivitis with specificities of 100%, 94%, and 92%, respectively. ~ Scores of −1, −2, or −3 are useful in ruling out bacterial conjunctivitis with sensitivities of 98%, 98%, and 100%,  respectively. Allergic conjunctivitis is typically bilateral and accompanied by eye itching. Giant papillary conjunctivitis is a type of allergic reaction, most commonly to soft contact lenses

Consolidation The lung is said to be consolidated when the alveoli and small airways are filled with dense material. This dense material may consist of: •  Pus (pneumonia) •  Fluid (pulmonary oedema) •  Blood (pulmonary haemorrhage) •  Cells (cancer) Lobar consolidation: – Alveolar space filled with inflammatory exudate – Interstitium and architecture remain intact – The airway is patent – Radiologically: •  A density corresponding to a segment or lobe •  Air bronchogram, and •  No significant loss of lung volume

Air Bronchogram A tubular outline of an airway made visible due to the filling of the surrounding alveoli by fluid or inflammatory exudates. Conditions in which air bronchograms are seen: •  Lung consolidation •  Pulmonary oedema •  Non-obstructive pulmonary atelectasis •  Interstitial disease •  Neoplasm •  Normal expiration

Silhouette Sign •  The loss of the lung/soft tissue interface due to the presence of fluid in the normally air-filled lung •  If an intrathoracic opacity is in anatomic contact with a border, then the opacity will obscure that  border •  Commonly seen with the borders of the heart, aorta, chest wall, and diaphragm

Monitoring Glucose Levels in DM • HbA 1c gives an estimate of the degree of glucose control over 2 to 3 months. • The American Diabetes Association recommends a treatment goal of HbA 1c <7.0%. In general, HbA 1c >10% is poor control, 8.5% to 10% is fair control, 7.0% to 8.5% is good control, and <7.0% is ideal. • The American Diabetes Association recommends keeping fasting blood glucose level <130 mg/dL and peak postprandial blood glucose <180 mg/dL.

Some causes of breast lumps • Cyst   • Fibroadenoma   • Carcinoma   • Fat necrosis   • Hamartoma   • Lipoma   • Epidermoid cyst   • Cystosarcoma     

 Risk factors for breast cancer in females • Advancing age   • Breast cancer in a first-degree relative  • BRCA genes   • Previous cancer in the other breast   • Early menarche (<12 years)   • Late menopause (>55 years)   • Nulliparity (no pregnancies)   • No previous breastfeeding   • Previous radiotherapy—e.g., mantle radiotherapy for Hodgkin’s disease • Oral contraceptive pill or hormone therapy      

Some important causes of a swollen knee • RA    • Ruptured Baker’s cyst    • Pseudogout    • Gout    • Edematous states (e.g., CHF, nephrotic syndrome) • Trauma    • Charcot’s knee    • Septic arthritis    • Hemarthrosis    

Causes of hyperuricemia • Drugs: diuretics, ethanol, low-dose salicylates, pyrazinamide, ethambutol, nicotinic acid, and cyclosporine   • Chronic renal failure   • Myeloproliferative and lymphoproliferative disorders (↑ purine metabolism)   • Obesity   • Hypertension   • Hypothyroidism   • Hyperthyroidism   • Familial   • Excessive dietary purines      ➤ It is more common in the summer months because of reduced fluid intake and increased fluid loss.

CAGE questionnaire A positive response to any of the four questions may indicate someone at risk of alcohol abuse. A positive answer to two or more questions makes the presence of alcohol dependence likely. C     Have you ever felt that you should  C ut down your drinking? A     Have you ever got  A ngry when someone suggested that you should cut down?  G     Do you ever feel  G uilty about your drinking? E     Do you ever need an  E ye-opener in the morning to steady your nerves or get rid of a hangover?           

Sites of abdominal pain and embryological origins • Epigastric:  foregut (stomach, duodenum, liver, pancreas, gallbladder)  • Periumbilical:  midgut (small and large intestines including appendix)  • Suprapubic:  hindgut (rectum and urogenital organs)     

Venous eczema  occurs as a result of venous hypertension causing fluid to collect in the tissues. The stasis of this fluid in the soft tissues results in activation of the innate immune response and subsequent inflammation. Venous eczema has the following clinical characteristics: ·          Itchy red, blistered and crusted  plaques ; or dry fissured and  scaly   plaques  on one or both lower legs (commonly mistaken for cellulitis) ·          Atrophie Blanche (white irregular scars surrounded by red spots) ·          Orange-brown patches pigmentation due to haemosiderin deposition ·          Lipodermatosclerosis If you’re not sure if the patient has venous eczema, ask “Is it itchy?” Varicose eczema is often intensely pruritic and this is a common indication for intervention.

Grading Volume of a Heart Murmurs: The experienced examiner should be able to give the murmur a grade according to its loudness:    Grade 1 – very faint murmur which is only audible during prolonged auscultation Grade 2 – a faint murmur, immediately audible with a stethoscope Grade 3 – loud murmur with NO thrill Grade 4 – loud murmur WITH a thrill Grade 5 – loud murmur WITH a thrill, heard with only half of the stethoscope touching the chest Grade 6 – loud murmur WITH a thrill, heard WITHOUT the stethoscope touching the chest Top tip: Never describe a murmur as grade 1 or 2 in OSCE examinations as it is commonly accepted that only expert cardiologists can detect these murmurs! The grading system can be made easier by remembering that grade 4 and above requires the presence of a thrill.

 Some causes of neck masses   Midline • Lesions of the thyroid gland, thyroglossal cysts (lump moves when patient sticks out tongue), midline dermoids, submental lymph nodes, parathyroid gland enlargement (very rare) Lateral • Neoplasia (primary cancer, lymphoma, schwannoma, metastatic cancer), infection (mumps, glandular fever, TB, HIV), autoimmune (e.g., Sjogren’s syndrome), normal variants (a transverse process of C2, cervical rib, elongated styloid process), sarcoidosis, branchial cyst     

Hi, Here are some gum changes in systemic conditions • Chronic lead poisoning: Punctuate blue lesions • Phenytoin treatment: Firm and hypertrophied • Scurvy: Soft and hemorrhagic • Cyanotic congenital heart disease: Spongy and hemorrhagic Phenytoin Gum Hypertrophy

 This signifies thoracic inlet obstruction (e.g., retrosternal goiter).    • Ask the patient to raise both arms above the head.     •   Patients with inlet obstruction may develop signs of venous compression (a facial plethora, cyanosis, dizziness, syncope).    • Look at neck veins for congestion and listen for stridor.

Trousseau’s sign     Inflate a blood pressure cuff just above the systolic pressure for 3 minutes. When hypocalcemia has caused muscular irritability, the hand will develop flexor spasm. Chvostek’s sign     Gently tap over the facial nerve (in front of the tragus of the ear). The sign is positive if there is a contraction of the lip and facial muscles on the same side of the face.