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6月5日 challenge yourself 5A 71-year-old male patient was admitted to the emergency Dept. because of a sudden onset of chest discomfort, shortness of breath, palpitation and syncopye
The patient had a long history of paroxismal chest discomfort, shortness of breath and palpitation for 30 years, howerer, syncope is newly onset. The patient had no history of hypertension, no diabetes, no hyperlipidemia, no alcohol nor cigarette abuse.
The physical examination was unremarkable except for irregular heart beat and pulse, while the EKG was indicating.
Q: As an cardiologist, what's your impression, and your management suggestion?
Challenge rank:  Challenge yourself 4A 15-year-old boy had the sudden onset of sharp, piercing, centralized chest pain while at rest. He had no important medical history. He also reported a sore throat and said there had been no history of trauma. The results of a physical examination, routine complete blood count, and serum biochemistry profiles were unremarkable. A chest radiograph and a tomography were then requested as follows,
What's your impression on the radiograph and essential differential diagnosis to your impression?
What will you do next as an ER resident?
Challenge rank: 6月4日 About challenge yourself原本想在space上放一些病例讨论之类的，希望拓宽大家的思路，引起大家的积极讨论。无论大家以后从事哪一科室，心电图和读片都是比较重要的基本功，每周一练帮大家复习一些基本知识。可惜没人踊跃发言，我也不知道题目难度如何，该怎么走下去，新生事物可能就是这样迷茫的吧...
ps:大家有好的素材也可以提供给我，不胜欢迎。 A to Q for challenge yourself 2Answer: Unilateral pulmonary edema and the presence of a chest tube in the right thorax suggest reexpansion pulmonary edema as the diagnosis.
Case in detail: A 50-year-old smoker presented with acute-onset breathlessness and right-sided chest pain of four days' duration. There was no history of chest trauma. A posteroanterior chest radiograph (Panel A) demonstrated a right-sided pneumothorax. His symptoms improved immediately on placement of a chest tube. Two hours later, he again became breathless, and examination revealed extensive right-sided chest crackles. Chest radiography was repeated and showed a fully expanded right lung (Panel B), albeit with features of pulmonary edema. The arrowheads in Panel B show the position of the chest tube. The patient's condition improved after continuous positive airway pressure was delivered through a face mask overnight. The chest tube was removed after three days. At follow-up six weeks later, the patient was asymptomatic and well. The results of further investigations were consistent with the presence of mild chronic obstructive pulmonary disease. A to Q for challenge yourself 1Answer: The lateral chest radiograph shows complete left atrial calcification. In combination with the Starr Edwards mitral prosthesis, the most likely diagnosis is rheumatic heart disease.
Case in detail: A 71-year-old man who had had rheumatic fever as a child presented with prosthetic-valve endocarditis. A mitral valvotomy had been performed 37 years before, and 21 years later, his mitral valve was replaced with a Starr–Edwards prosthesis. Lateral chest radiography showed complete calcification of the left atrial wall (Panel A, arrows). A transesophageal echocardiogram showed calcification of the interatrial septum (Panel B, arrow). This rare condition was first described in 1898, in association with chronic rheumatic mitral disease, and is more common in women, most of whom have symptoms for more than 20 years. The condition is assumed to be the end result of extensive rheumatic pancarditis. The calcification may be confined to the left atrial appendage or, rarely, to the posterior left atrial wall — owing to a regurgitant mitral jet — in which case the calcified patch is called the MacCallum's patch. Massive calcification usually spares the interatrial septum, but when the septum is affected (as in Panel B, arrow), any further surgery near the mitral valve is hazardous. Radiography of the left lateral side of the chest is recommended to assess long-standing rheumatic mitral-valve disease. Complete calcification has been described as a "coconut atrium" or "porcelain atrium." 5月30日 Challenge yourself 3A 77-year-old man with a remote history of atrial fibrillation presented to the emergency department reporting fatigue and weakness. The patient said he had not made any recent changes in his diet and that he did not have nausea, vomiting, or diarrhea. He also said he had no palpitations or sensations of a rapid heart rate. He was not taking any atrioventricular nodal blocking agents. An electrocardiogram was obtained. (panel A)
Laboratory values were remarkable only for a serum potassium level of 2.8 mmol/L. One month before this visit, the patient had begun to receive 25 mg of hydrochlorothiazide daily for hypertension. And an EKG was obtained as contrast. (panel B)
What's your impression on the EKG in this visit?
Challenge rank:  5月29日 Challenge yourself 2Q: What is the most likely cause of the abnormality on the chest radiograph?
Challenge rank: Challege yourselfNow ZSdebate features some of the most compelling medical graphics and illustrations found anywhere. The Challenge yourself provides our members an opportunity to use these images to test their diagnostic and visual skills.
At least one image and question will appear weekly. The answer will be available in one week. We require your passion and participation.
Q: What diagnosis explains the combination of findings on this lateral chest radiograph? Challenge rank: |
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