2014Student Poster Presenters.Pdf

Total Page:16

File Type:pdf, Size:1020Kb

2014Student Poster Presenters.Pdf AMERICAN COLLEGE OF PHYSICIANS STUDENT ABSTRACTS COMPETITION Student Vignette Page 1 Contents CLINICAL VIGNETTE PODIUM PRESENTATIONS ..........................................................11 COLORADO PODIUM PRESENTATION - Anna Kuropatkina ..........................................12 Led Astray: Diagnosing Granulomatosis with Polyangiitis in a Patient with Complex Risk Factor Profile and Negative Serology MICHIGAN PODIUM PRESENTATION - Aaron Sacheli ..................................................13 Influenza vaccine induced CNS demyelination in a fifty year old male. NEW JERSEY PODIUM PRESENTATION - Matthew P Deek...........................................14 Extensive Arterial and Venous Thrombi as a Presentation of Hypereosinophilic Syndrome with a Unique Complication of Hemolytic Anemia and Poor Response to Treatment RHODE ISLAND PODIUM PRESENTATION - Ella Anne Damiano .................................15 Infliximab Induced Severe Hypertriglyceridemia and Eruptive Xanthomas CLINICAL VIGNETTE POSTER FINALISTS.......................................................................16 ARKANSAS POSTER FINALIST – M Phillip C Fejleh ......................................................17 Brodie's Abscess Caused by Salmonella oranienburg CALIFORNIA POSTER FINALIST - YouRong Sophie Su .................................................18 Seeing the Big Picture: IIH as the presenting symptom of VHK CALIFORNIA POSTER FINALIST - Lauren Marshall .......................................................19 Protein-Losing Enteropathy and Lytic Bone Lesions in an HIV-positive male CALIFORNIA POSTER FINALIST – Michael Liu .............................................................20 Testosterone-induced erythrocytosis can cause reversible Aquagenic Pruritus CALIFORNIA POSTER FINALIST – Clare Richardson .....................................................21 An Undifferentiated Cause of Epistaxis CALIFORNIA POSTER FINALIST – Michael D Ramirez ..................................................22 Cotton Fever: A Transient Self-Limiting Syndrome in IV Drug Abusers CALIFORNIA POSTER FINALIST – Anita Wong .............................................................23 Disseminated Varicella Zoster Virus with Asymptomatic Central Nervous System Involvement as the Initial Presentation of Acquired Immunodeficiency Syndrome COLORADO POSTER FINALIST - Carlie Field ................................................................24 Necrotizing Retinitis in an Atypical Presentation of Disseminated Coccidioidomycosis COLORADO POSTER FINALIST - Warren Woodrich Pettine ...........................................25 Coexisting primary Hyperparathyroidism and Parathyroid Hormone-related Peptide producing Endothelioid Angiosarcoma causing Malignant Hypercalcemia FLORIDA POSTER FINALIST - Christine McLaughlin .....................................................26 Insidious Subacute Endocarditis Student Vignette Page 2 FLORIDA POSTER FINALIST - Andrew Kozlov ..............................................................27 Treatment of refractory hematuria secondary to benign prostatic hypertrophy (BPH) with prostatic artery embolization (PAE) FLORIDA POSTER FINALIST - Milla Kviatkovsky ..........................................................28 The Bloody Aortic Stenosis: A Case of Heyde Snydrome. FLORIDA POSTER FINALIST - Sophia Ang Ma...............................................................29 Abdominal Pain, Jaundice, and Pancytopenia, A “Histo”-logic Diagnosis. FLORIDA POSTER FINALIST - Michaela Gaffley ............................................................30 Elderly onset systemic lupus erythematosus in a male presenting with mental status changes and motor deficit: A diagnostic challenge FLORIDA POSTER FINALIST – Mohamad Zetir ..............................................................31 "Straightening out SMA Syndrome" GEORGIA POSTER FINALIST – David Latov ..................................................................32 The Importance of the History: A Run-of-the-Mill Case of Noncompliance of Dialysis HAWAII POSTER FINALIST – James Duca ......................................................................33 Rare Presentation of Thiamine Deficiency as Cause for Lactic Acidosis and Gastrointestinal Symptoms ILLINOIS POSTER FINALIST - Virali Patel......................................................................35 From Portugal to India: A rare case of Machado-Joseph Disease ILLINOIS POSTER FINALIST – Jessica George ................................................................36 Lumps, Bumps, and Constipation: Exploring the Differential of Constipation in Immunocompromised ILLINOIS POSTER FINALIST - Janushe Patel...................................................................37 "Make My Heart Hole Again" A rare case of adult onset partial anomalous pulmonary venous return ILLINOIS POSTER FINALIST - Corbin Rayfield...............................................................39 Anterograde Amnesia in the Oncology Setting IOWA POSTER FINALIST - Maria T Story .......................................................................42 Ultrasound: Window to her Heart, Portal to my Soul MAINE POSTER FINALIST - John L Daggett Jr................................................................43 Cryptic loin pain and hematuria: Thin basement membrane nephropathy as a putative etiology MAINE POSTER FINALIST - Amy E Riviere ....................................................................44 Hemiballismus in an 86 Year-old Male with Type II Diabetes Mellitus MASSACHUSETTS POSTER FINALIST - Andrew J Piper................................................45 A Case of Domperidone Toxicity in a Mother Seeking Increased Milk Supply Student Vignette Page 3 MASSACHUSETTS POSTER FINALIST – Sharon Li .......................................................46 Swallowing-induced Tachyarrhythmia MICHIGAN POSTER FINALIST - Amanda Zukkoor .........................................................47 A case of Euglycemic Diabetic Ketoacidosis in a patient with type 1 Diabetes Mellitus MICHIGAN POSTER FINALIST - John David ..................................................................48 Mitochondrial Encephalopathy, Lactic Acidosis, and Stroke (MELAS) MICHIGAN POSTER FINALIST – Tanvir K Kahlon .........................................................49 Considering medicine overuse headache with an underlying etiology of headache MICHIGAN POSTER FINALIST - Tina Ozbeki .................................................................50 Recurrent Hyperhemolysis Syndrome in Sickle Cell Disease MICHIGAN POSTER FINALIST - Kimberley Grady .........................................................51 Coil Embolization as Palliative Treatment in Diffuse Type I Hepatopulmonary Syndrome MINNESOTA POSTER FINALIST - Maros Cunderlik .......................................................52 OPQRST - Do you know your ABCs? Cognitive bias and diagnostic error MINNESOTA POSTER FINALIST – Benjamin W Meyer ..................................................53 An Internist’s Dilemma: Paraneoplasia vs. Primary Rheumatologic Disease MISSOURI POSTER FINALIST - Robert Harper ...............................................................54 Autoimmune Hepatitis in a Patient with False Positive Viral Hepatitis Antibodies MISSOURI POSTER FINALIST - Erin Engelhardt .............................................................55 Hepatopulmonary Syndrome: Orthodeoxia in a patient with end-stage Liver Disease. NEPAL POSTER FINALIST - Rhisti Shrestha ....................................................................56 Acute-onset Hemiparesis in an elderly man with a high grade Glioma NEPAL POSTER FINALIST - Sumesh Khanal, MBBS.......................................................57 Treatment-related acute non-lymphocytic leukemia in a patient with chronic lymphocytic leukemia NEPAL POSTER FINALIST - CLINICAL VIGNETTE Ritesh Prasad Shrestha, MBBS ......58 Leptomeningeal carcinomatosis in epidermal growth factor receptor-mutant non-small cell lung cancer NEVADA POSTER FINALIST - Joshua Gabel ...................................................................59 Hepatocellular Carcinoma in an HIV/HCV Co-Infected Patient: A Call for Increased Surveillance NEW YORK POSTER FINALIST - Daniel Jipescu.............................................................60 Multiple Myeloma presenting as CVA secondary to Marantic Endocarditis NEW YORK POSTER FINALIST - Kelly Lyons ................................................................61 A Rare Presentation of Fusobacterium necrophorum Bacteremia Student Vignette Page 4 NEW YORK POSTER FINALIST - David M Haughey.......................................................62 PRES After Renal Transplantation: A Simple Solution for a Complicated Patient NORTH CAROLINA POSTER FINALIST - Mark Dakkak .................................................63 Demystifying Hemophagocytic Lymphohistiocytosis OHIO POSTER FINALIST - Emily Bowers ........................................................................64 Men1 Syndrome presenting as an anterior mediastinal mass in a healthy young man OHIO POSTER FINALIST - Sung In Kim ..........................................................................65 Asymptomatic Ascending Aortic Dissection in Pregnancy OHIO POSTER FINALIST - Marilyn Wickenheiser............................................................66 Tuberculosis—The great mimicker OHIO POSTER FINALIST - Narayana Sarma V Singam ....................................................67 Optimizing heart failure management: Catheter ablation in a patient with
Recommended publications
  • Practical Cardiac Auscultation
    LWW/CCNQ LWWJ306-08 March 7, 2007 23:32 Char Count= Crit Care Nurs Q Vol. 30, No. 2, pp. 166–180 Copyright c 2007 Wolters Kluwer Health | Lippincott Williams & Wilkins Practical Cardiac Auscultation Daniel M. Shindler, MD, FACC This article focuses on the practical use of the stethoscope. The art of the cardiac physical exam- ination includes skillful auscultation. The article provides the author’s personal approach to the patient for the purpose of best hearing, recognizing, and interpreting heart sounds and murmurs. It should be used as a brief introduction to the art of auscultation. This article also attempts to illustrate heart sounds and murmurs by using words and letters to phonate the sounds, and by presenting practical clinical examples where auscultation clearly influences cardiac diagnosis and treatment. The clinical sections attempt to go beyond what is available in standard textbooks by providing information and stethoscope techniques that are valuable and useful at the bedside. Key words: auscultation, murmur, stethoscope HIS article focuses on the practical use mastered at the bedside. This article also at- T of the stethoscope. The art of the cardiac tempts to illustrate heart sounds and mur- physical examination includes skillful auscul- murs by using words and letters to phonate tation. Even in an era of advanced easily avail- the sounds, and by presenting practical clin- able technological bedside diagnostic tech- ical examples where auscultation clearly in- niques such as echocardiography, there is still fluences cardiac diagnosis and treatment. We an important role for the hands-on approach begin by discussing proper stethoscope selec- to the patient for the purpose of evaluat- tion and use.
    [Show full text]
  • Bates' Pocket Guide to Physical Examination and History Taking
    Lynn S. Bickley, MD, FACP Clinical Professor of Internal Medicine School of Medicine University of New Mexico Albuquerque, New Mexico Peter G. Szilagyi, MD, MPH Professor of Pediatrics Chief, Division of General Pediatrics University of Rochester School of Medicine and Dentistry Rochester, New York Acquisitions Editor: Elizabeth Nieginski/Susan Rhyner Product Manager: Annette Ferran Editorial Assistant: Ashley Fischer Design Coordinator: Joan Wendt Art Director, Illustration: Brett MacNaughton Manufacturing Coordinator: Karin Duffield Indexer: Angie Allen Prepress Vendor: Aptara, Inc. 7th Edition Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins. Copyright © 2009 by Wolters Kluwer Health | Lippincott Williams & Wilkins. Copyright © 2007, 2004, 2000 by Lippincott Williams & Wilkins. Copyright © 1995, 1991 by J. B. Lippincott Company. All rights reserved. This book is protected by copyright. No part of this book may be reproduced or transmitted in any form or by any means, including as photocopies or scanned-in or other electronic copies, or utilized by any information storage and retrieval system without written permission from the copyright owner, except for brief quotations embodied in critical articles and reviews. Materials appear- ing in this book prepared by individuals as part of their official duties as U.S. government employees are not covered by the above-mentioned copyright. To request permission, please contact Lippincott Williams & Wilkins at Two Commerce Square, 2001 Market Street, Philadelphia PA 19103, via email at [email protected] or via website at lww.com (products and services). 9 8 7 6 5 4 3 2 1 Printed in China Library of Congress Cataloging-in-Publication Data Bickley, Lynn S. Bates’ pocket guide to physical examination and history taking / Lynn S.
    [Show full text]
  • Transampullary Septectomy for Papillary Stenos S
    HPB Surgery, 1996, Vol.9, pp.199-207 (C) 1996 OPA (Overseas Publishers Association) Reprints available directly from the publisher Amsterdam B.V. Published in The Netherlands Photocopying permitted by license only by Harwood Academic Publishers GmbH Printed in Malaysia Transduodenal Sphincteroplasty an.d Transampullary Septectomy for Papillary Stenos s S.B. KELLY and B.J. ROWLANDS Depa,rtment of Surgery, Institute of Clinical Science, Royal Victoria Hospital, Grosvenor Road, Belfast. BT12 6BJ (Received 10 February 1994) Twenty patients received transduodenal sphincteroplasty and transampullary septectomy between 1987 and 1993. Seven patients had post-cholecystectomy pain which was much improved or abolished in 5 of 7 patients at a mean follow-up of 4 years and 5 months. Four of five patients with chronic pancreatitis were improved at 3 years and 2 months. Three of five patients with recurrent acute pancreatitis were improved at 4 years and 5 months. One of three patients with chronic abdominal pain of hepatobiliary origin was improved at 3 years. Transduodenal sphincteroplasty and transampullary septectomy can relieve pain in patients with post-cholecystectomy pain, recurrent acute pancreatitis, chronic pancreatitis, and chronic abdominal pain of hepatobiliary origin, presumably by improving drainage of the obstructed ducts. KEY WORDS: Transduodenal sphincteroplasty transampullary septectomy papillary stenosis INTRODUCTION without hyperamylassaemia requires a transduodenal operation. Transduodenal sphincteroplasty and trans- The indications
    [Show full text]
  • Online Supplement
    Online Supplement Definition, discrimination, diagnosis, and treatment of central breathing disturbances during sleep. An ERS Statement Randerath W*#1, Verbraecken J*#2, Andreas S3, Arzt M4, Bloch KE5, Brack T6, Buyse B7, De Backer W2, Eckert DJ8, Grote L9, Hagmeyer L1, Hedner J9, Jennum P10, La Rovere MT11, Miltz C1, McNicholas WT12, Montserrat J13, Naughton M14, Pepin J-L15, Pevernagie D16, Sanner B17, Testelmans D7, Tonia T18, Vrijsen B7, Wijkstra P19, Levy P#15 *contributed equally as first authors #co-chaired the Task Force 1 Bethanien Hospital, Institute of Pneumology, Solingen, Germany 2 Dept of Pulmonary Medicine, Antwerp University Hospital and University of Antwerp, Edegem, Belgium 3 Cardiology and Pneumology, University Medical Center Göttingen, Germany and Lung Clinic Immenhausen, Krs. Kassel, Germany 4 Department of Internal Medicine II University Hospital Regensburg, Germany 5 University Hospital Zurich, Department of Pulmonology and Sleep Disorders Center, Zurich, Switzerland 6 Department of Internal and Pulmonary Medicine, Kantonsspital Glarus, Switzerland 7 Department of Pulmonary Medicine – KU Leuven, Leuven, Belgium 8 8 Neuroscience Research Australia (NeuRA) and the University of New South Wales, Sydney, New South Wales, Australia 9 Sleep Disorders Center, Dept. of Pulmonary Medicine, Sahlgrenska University Hospital, Göteborg, Sweden 10 Center for Healthy Aging and Danish Center for Sleep Medicine, Faculty of Health Sciences, University of Copenhagen, Denmark 1 11 Department of Cardiology, Fondazione S. Maugeri, IRCCS, Istituto Scientifico di Montescano (Pavia), Italy 12 Pulmonary and Sleep Disorders Unit, St. Vincent’s University Hospital and University College Dublin, Dublin, Ireland 13 Laboratori del Son, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain. 14 General Respiratory and Transplantation, Alfred Hospital and Monash University, Melbourne, Victoria, Australia 15 Laboratoire du sommeil explorations fonct.
    [Show full text]
  • Biliary Dyspepsia: Functional Gallbladder and Sphincter of Oddi Disorders
    Chapter 7 Biliary Dyspepsia: Functional Gallbladder and Sphincter of Oddi Disorders Meena Mathivanan, Liisa Meddings and Eldon A. Shaffer Additional information is available at the end of the chapter http://dx.doi.org/10.5772/56779 1. Introduction Biliary-type abdominal pain is common and often presents a clinical challenge for physicians. True biliary colic consists of episodes of steady pain across the right upper quadrant and epigastric regions, lasting from 30 minutes to 6 hours [1]. Such abdominal pain, when it lasts longer than 6 hours, is likely due to complications of gallstone disease such as acute cholecys‐ titis or acute pancreatitis, or represents a non-biliary source of pain [1]. 1.1. Cholelithiasis, biliary pain and atypical dyspepsia Classical biliary pain that occurs in the setting of gallstones represents symptomatic choleli‐ thiasis. The symptoms associated with gallstones however are frequently confusing. In fact, only 13% of people with gallstones ever develop biliary pain when followed for 15–20 years [2], meaning that most (70-90%) patients with gallstones never experience biliary symptoms. Vague dyspeptic complaints like belching, bloating, flatulence, heartburn and nausea are not characteristic for biliary disease [3, 4]. Therefore, it is not surprising that cholecystectomy often fails to relieve such ambiguous symptoms in those with documented gallstones. In fact, cholecystectomy fails to relieve symptoms in 10-33% of patients with documented gallstones [5]. If the abdominal pain is misdiagnosed and instead due to functional gut disorders like irritable bowel syndrome, cholecystectomy would not provide a favorable outcome [4, 5, 6]. 1.2. Functional gallbladder disease Biliary-type abdominal pain (also termed biliary colic) in the context of a structurally normal gallbladder has been referred to as “biliary dyspepsia”.
    [Show full text]
  • Topic: MITRAL HEART DISEASES: BASIC SYMPTOMS and SYNDROMES on the BASIS of CLINICAL and INSTRUMENTAL METHODS of EXAMINATION
    Topic: MITRAL HEART DISEASES: BASIC SYMPTOMS AND SYNDROMES ON THE BASIS OF CLINICAL AND INSTRUMENTAL METHODS OF EXAMINATION 1. What hemodynamic changes cause complaints of patients with mitral stenosis for cough, shortness of breath, hemoptysis? A. reduction of systemic blood pressure; B. increased pressure in the small circulatory system; C. stagnation of blood in the liver; D. enlargement of the left atrium and contraction of the mediastinum; E. Reduction of blood flow from the left ventricle. 2. What complaints are caused by a decrease in minute volume of blood in patients with mitral stenosis? A) cough, shortness of breath, hemoptysis; C) fever, joint pain, general weakness; C) heartache, heart failure, palpitations; D) lower extremity swelling, heaviness in the right hypochondrium; E) headache, dizziness, general weakness, fatigue. 3. Data palpation of the heart area with mitral stenosis: A) no change is observed; B) apex beat displaced to the left, resistant; C) apex beat weakened or undetectable; D) there is an increased pulsation in the second intercostal space to the left; E) there is a systolic "cat murmur" in the second intercostal space to the right. 4. What forced position can occupy a patient with mitral stenosis? A) knee-elbow; B) a Bedouin who prays; C) orthopnoe; D) opistotonus; E) outside the pointing dog 5. What does the face of a patient with mitral stenosis look like? A) swollen, cyanotic; B) swollen, pale, enophthalmos observed; C) the face of a "wax doll"; D) swollen, pale, with swelling under and above the eyes; E) pale, with cyanotic blush, cyanosis of the tip of the nose, ear lobes, chin.
    [Show full text]
  • CARDIOLOGY Section Editors: Dr
    2 CARDIOLOGY Section Editors: Dr. Mustafa Toma and Dr. Jason Andrade Aortic Dissection DIFFERENTIAL DIAGNOSIS PATHOPHYSIOLOGY (CONT’D) CARDIAC DEBAKEY—I ¼ ascending and at least aortic arch, MYOCARDIAL—myocardial infarction, angina II ¼ ascending only, III ¼ originates in descending VALVULAR—aortic stenosis, aortic regurgitation and extends proximally or distally PERICARDIAL—pericarditis RISK FACTORS VASCULAR—aortic dissection COMMON—hypertension, age, male RESPIRATORY VASCULITIS—Takayasu arteritis, giant cell arteritis, PARENCHYMAL—pneumonia, cancer rheumatoid arthritis, syphilitic aortitis PLEURAL—pneumothorax, pneumomediasti- COLLAGEN DISORDERS—Marfan syndrome, Ehlers– num, pleural effusion, pleuritis Danlos syndrome, cystic medial necrosis VASCULAR—pulmonary embolism, pulmonary VALVULAR—bicuspid aortic valve, aortic coarcta- hypertension tion, Turner syndrome, aortic valve replacement GI—esophagitis, esophageal cancer, GERD, peptic OTHERS—cocaine, trauma ulcer disease, Boerhaave’s, cholecystitis, pancreatitis CLINICAL FEATURES OTHERS—musculoskeletal, shingles, anxiety RATIONAL CLINICAL EXAMINATION SERIES: DOES THIS PATIENT HAVE AN ACUTE THORACIC PATHOPHYSIOLOGY AORTIC DISSECTION? ANATOMY—layers of aorta include intima, media, LR+ LRÀ and adventitia. Majority of tears found in ascending History aorta right lateral wall where the greatest shear force Hypertension 1.6 0.5 upon the artery wall is produced Sudden chest pain 1.6 0.3 AORTIC TEAR AND EXTENSION—aortic tear may Tearing or ripping pain 1.2–10.8 0.4–0.99 produce
    [Show full text]
  • Copyrighted Material
    Subject index Note: page numbers in italics refer to fi gures, those in bold refer to tables Abbreviations used in subentries abdominal mass patterns 781–782 GERD – gastroesophageal refl ux disease choledochal cysts 1850 perception 781 IBD – infl ammatory bowel disease mesenteric panniculitis 2208 periodicity 708–709 mesenteric tumors 2210 peripheral neurogenic 2429 A omental tumors 2210 pharmacological management 714–717 ABCB1/MDR1 484 , 633 , 634–636 abdominal migrane (AM) 712 , 2428–2429 physical examination 709–710 , 710 ABCB4 abdominal obesity 2230 postprandial 2498–2499 c h o l e s t e r o l g a l l s t o n e s 1817–1818 , abdominal pain 695–722 in pregnancy 842 1819–1820 a c u t e see acute abdominal pain prevalence 695 functions 483–484 , 1813 acute cholecystitis 784 rare/obscure causes 712–713 , 712 intrahepatic cholestasis of pregnancy 848 acute diverticulitis 794–796 , 795 , 1523–1524 , red fl ags 713 low phospholipid-associated 1527 relieving/aggravating factors 709 cholelithiasis 1810 , 1819–1820 , 2393 acute mesenteric ischemia 2492 right lower quadrant 794 m u t a t i o n p h e n o t y p e s 2392 , 2393 a c u t e p a n c r e a t i t i s 795 , 1653 , 1667 right upper quadrant 794 progressive familial intrahepatic cholestasis-3 acute suppurative peritonitis 2196 sickle cell crisis 2419 494 adhesions 713 s i t e 703 , 708 ABCB11 see bile salt export pump (BSEP) AIDS 2200 special pain syndromes 718–720 ABCC2/MRP2 485 , 494 , 870 , 1813 , 2394 , 2395 anxiety 706–707 sphincter of Oddi dysfunction 1877 ABCG2/BCRP 484–485 , 633
    [Show full text]
  • An Audio Guide to Pediatric and Adult Heart Murmurs
    Listen Up! An Audio Guide to Pediatric and Adult Heart Murmurs May 9, 2018 Dr. Michael Grattan Dr. Andrew Thain https://pollev.com/michaelgratt679 Case • You are working at an urgent care centre when a 40 year old recent immigrant from Syria presents with breathlessness. • You hear the following on cardiac auscultation: • What do you hear? • How can you describe what you hear so another practitioner will understand exactly what you mean? • What other important information will help you determine the significance of your auscultation? Objectives • In pediatric and adult patients: – To provide a general approach to cardiac auscultation – To review the most common pathologic and innocent heart murmurs • To emphasize the importance of a thorough history and physical exam (in addition to murmur description) in determining underlying etiology for heart problems Outline • A little bit of physiology and hemodynamics (we promise not too much) • Interactive pediatric and adult cases – https://pollev.com/michaelgratt679 – Get your listening ears ready! • Systolic murmurs (pathologic and innocent) • Diastolic murmurs • Continuous murmurs • Some other stuff Normal Heart Sounds Normal First & Second Sounds Splitting of 2nd heart sound Physiological : • Venous return to right is increased in inspiration – causes delayed closure of the pulmonary valve. • Simultaneously, return to left heart is reduced - premature closure of the aortic valve. • Heart sounds are unsplit when the patient holds breath at end expiration. Fixed: • No alteration in splitting with respiration. • In a patient with ASD – In expiration there is reduced pressure in the right atrium and increased pressure in the left atrium. • Blood is shunted to the right and this delays closure of the pulmonary valve in the same way as would occur in inspiration.
    [Show full text]
  • The Cardiovascular Examination
    CHAPTER 1 The Cardiovascular Examination KEY POINTS • The cardiovascular examination lends itself to a systematic approach. • The examination should be thorough but should be directed by the history to areas likely to be relevant. • Certain cardiovascular signs are quite sensitive and specific. • When the examination is well performed, many unnecessary investigations can be avoided. CASE 1 SCENARIO: TARA WITH 3. Pick up the patient’s hand. Feel the radial pulse. DYSPNOEA Inspect the patient’s hands for clubbing. Demon- strate Schamroth’s sign (Fig. 1.1). If there is no 34-year-old Tara was referred to the hospital by her general clubbing, opposition of the index finger (nail to practitioner. She presented with increasing dyspnoea for the nail) demonstrates a diamond shape; in clubbing last 2 weeks. She has found it difficult to lie flat in bed and this space is lost. Also look for the peripheral has been waking up frequently feeling breathless. She also stigmata of infective endocarditis. Splinter haemor- has a dry cough and has felt extremely tired for weeks. She rhages are common (and are usually caused by also has high fever with a shake. She is an intravenous drug trauma), whereas Osler’s nodes and Janeway lesions user and her general practitioner (GP) found a loud murmur (Fig. 1.2) are rare. Look quickly, but carefully, at on auscultation. each nail bed, otherwise it is easy to miss key signs. Please examine the cardiovascular system. Note the presence of an intravenous cannula and, if an infusion is running, look at the bag to see The cardiovascular system should be examined in what it is.
    [Show full text]
  • Transampullary Septectomy for Papillary Stenos S
    HPB Surgery, 1996, Vol.9, pp.199-207 (C) 1996 OPA (Overseas Publishers Association) Reprints available directly from the publisher Amsterdam B.V. Published in The Netherlands Photocopying permitted by license only by Harwood Academic Publishers GmbH Printed in Malaysia Transduodenal Sphincteroplasty an.d Transampullary Septectomy for Papillary Stenos s S.B. KELLY and B.J. ROWLANDS Depa,rtment of Surgery, Institute of Clinical Science, Royal Victoria Hospital, Grosvenor Road, Belfast. BT12 6BJ (Received 10 February 1994) Twenty patients received transduodenal sphincteroplasty and transampullary septectomy between 1987 and 1993. Seven patients had post-cholecystectomy pain which was much improved or abolished in 5 of 7 patients at a mean follow-up of 4 years and 5 months. Four of five patients with chronic pancreatitis were improved at 3 years and 2 months. Three of five patients with recurrent acute pancreatitis were improved at 4 years and 5 months. One of three patients with chronic abdominal pain of hepatobiliary origin was improved at 3 years. Transduodenal sphincteroplasty and transampullary septectomy can relieve pain in patients with post-cholecystectomy pain, recurrent acute pancreatitis, chronic pancreatitis, and chronic abdominal pain of hepatobiliary origin, presumably by improving drainage of the obstructed ducts. KEY WORDS: Transduodenal sphincteroplasty transampullary septectomy papillary stenosis INTRODUCTION without hyperamylassaemia requires a transduodenal operation. Transduodenal sphincteroplasty and trans- The indications
    [Show full text]
  • Clinical Diagnosis of Heart Failure
    Review of Clinical Signs Series Editor: Bernard M. Karnath, MD Clinical Diagnosis of Heart Failure Muralikrishna Gopal, MBBS Bernard Karnath, MD eart failure is a common clinical syndrome that results from the impaired ability of the EVALUATION OF HEART FAILURE ventricle to fill with or eject blood. The term heart failure is preferred over the older term • Coronary artery disease is believed to be the under- Hcongestive heart failure because not all patients with lying cause of heart failure in approximately two heart failure have volume overload. Heart failure re- thirds of patients with heart failure. sults from multiple causes, including coronary artery • The cardinal symptoms of heart failure include disease, hypertension, valvular heart disease, and idio- dyspnea and fatigue that can occur at rest in severe pathic dilated cardiomyopathy. The cardinal symptoms cases and with exertion in milder cases. of heart failure include dyspnea and fatigue that can • For the dyspneic patient in the acute care setting, occur at rest in severe cases and with exertion in mild- a history, physical examination, chest radiograph, er cases. The diagnosis of heart failure was traditionally and electrocardiogram should be performed. made at the bedside based on clinical evaluation that • The presence of a third heart sound is a strong pre- combined characteristic symptoms from the history dictor of heart failure, with a specificity of 99%. with various signs on physical examination. Other than • If heart failure is suspected, measurement of serum the obvious need to determine whether a patient has brain natriuretic peptide may help exclude heart heart failure, it is also important to determine what failure.
    [Show full text]