Wednesday, January 21, 2015

Short Case with Dr. Shahrin

Patient 1

Middle-aged man on nasal prong, had intercostal recession. On respiratory examination, chest expansion reduced at lower lungs, with reduced air entry. Coarse crepitations heard bilaterally.

1. Provisional diagnosis?
Bronchiectasis with underlying COPD

2. How to differentiate JVP and Carotid pulse? (taken from this website)

Patient 2

Middle-aged man sitting comfortably at 45' on one pillow. Respiratory examination revealed a deviated trachea to the left side. Chest expansion was reduced at left lower lobe with reduced air entry, dull on percussion and reduced vocal resonance.

1. Differential diagnoses?
Lung collapse and Pleural Effusion

2. How to differentiate between these two?
Taken from UM Xpress Revision

3. Other differentials?
Pulmonary fibrosis, AECOPD and Bronchiectasis

4. How to differentiate between COPD and Asthma?
Taken from CPG Management of COPD

5. Causes of pansystolic murmur?

6. Causes of Mitral Regurgitation?
  • Rheumatic heart disease
  • Infective endocarditis
  • Papillary muscle dysfunction eg. left ventricular failure, cardiomyopathy, MI
  • Connective tissue disease eg. RA, AS, Marfan's
  • Congenital eg. mitral valve prolapse, endocardial cushion defect
  • Surgery or trauma

7. Differences between UMN and LMN?
Taken from this website

8. How do you know that a lesion originates from a spinal cord?
Look if patient has sensory level or urinary/bowel incontinence

9. How do you test for facial nerve?
Taken from this website

10. Give 5 causes of LMN palsy.
  • Idiopathic (Bell's palsy)
  • Parotid tumour
  • CPA tumour
  • Otitis media
  • Ramsay Hunt syndrome

More causes here:
Taken from this website

11. How do you perform cerebellar examination? (PINARD'SH)
  • Past pointing
  • Intention tremor
  • Nystagmus
  • Ataxia
  • Rebound
  • Dysdiadokinesia
  • Slurred speech
  • Heel to shin test

Read the complete examination at this website

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