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CONTINUED PROFESSIONAL DEVELOPMENT PROGRAMME

CONTINUED PROFESSIONAL DEVELOPMENT PROGRAMME. SHARPEN YOUR CLINICAL SKILLS 18 TH JANUARY, 2012. Prof. Dr. S. Arulrhaj, MD., FRCP(Glasg). X RAY. LESSON : CAVITY COMMON IN TUBERCULOSIS. 68 yr/f came with c/o cough with expectoration & breathlessness.

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CONTINUED PROFESSIONAL DEVELOPMENT PROGRAMME

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  1. CONTINUED PROFESSIONAL DEVELOPMENT PROGRAMME SHARPEN YOUR CLINICAL SKILLS 18TH JANUARY, 2012 Prof. Dr. S. Arulrhaj, MD., FRCP(Glasg)

  2. X RAY LESSON : CAVITY COMMON IN TUBERCULOSIS 68 yr/f came with c/o cough with expectoration & breathlessness. O/E: B/L extensive rhonchi & rales in RT midzone. Clinical diagnosis ? COPD with consolidation RT Mid & Lower zone . X ray for evaluation ? Opacity RT 2/3rd of lung with cavitation, Patches on LT lower & midzone. What is CT chest finding? Multiple nodules in periphery of both lungs with centrally cavitating consolidation in both lungs. How to proceed? Bronchoscopy- revealed RT Lower lobe consolidation, extraluminal growth compression effect in RT lower lobe . Biopsy taken-Inconclusive Sputum AFB –ve, ATA & ADA +ve, Staph aureus in culture. Final diagnosis? RT tuberculous pneumonia with tuberculomas.

  3. USG ABDOMEN 35 yr/m alcoholic, smoker admitted with severe lt. hypochondriac pain and vomiting. Sr amylase - 230 U/L & Sr calcium – 9.4 mg % What are the possibilities? Alcoholic Gastritis, ALD, Pancreatitis. USG Abdomen finding ? Suggestive of Acute Pancreatitis. Read the CT Abdomen. Necrotizing Pancreatitis. LESSON : CT GOLD STANDARD FOR PANCREATITIS

  4. CT CHEST 17 Yr/m came with c/o high grade fever, cough with blood stained sputum since 4days, past H/O recurrent winter bronchitis + What does the x-ray show? RT lower lobe consolidation. How to confirm ? CT chest-Rt lower lobe consolidation How to proceed? Bronchoscopy-revealed RT LL inflammation. ATA +ve, Sputum AFB –ve, Antibiotics & ATT started & patient settled. LESSON : BASAL TB IS A REALITY

  5. MRI BRAIN 36 yr/m, Diabetic, came with c/o LT side weakness. O/E: LT brachial monoparesis +. Clinical diagnosis? Young stroke ? Ischemic ? Haemorhagic. What are possibilities? Vascular syndrome, Demyelination Multiple sclerosis, Vit B12 Def., CPM, Arteritis. How to proceed? Carotid doppler-normal, CSF hyperglobulinemia, ADA +ve Read the CT brain Multiple small lesions- multi infarct state. MRI findings? Peripherally enhancing long TR hyperintense lesion in RT mid frontal , LT ant. Frontal & LT occipital deep matter with mild mass effect. Final diagnosis Demyelinating syndrome. LESSON : YOUNG STROKE REMEMBER DEMYELINATION

  6. COLONOSCOPY 43 yr/m had loose motion, Flatulence & Abdomen pain. O/E: Abdomen mild tenderness+, USG abdomen- Normal. Colonoscopy for Diagnosis Mucosal erosions with purulent discharge seen. How to proceed ? Biopsy-Inflammatory bowel disease. Management Anti Inflammatory Drugs. LESSON : IBD COMMON CAUSE OF CHRONIC DIARRHOEA

  7. GASTROSCOPY 55 year male came with c/o dysphagia for solid and liquid for 3 month, weight loss +. O/E: Thin built, pallor +, P/A- Normal USG-Normal. What is endoscope diagnosis? Membranous stricture lower end esophagus. What is the treatment? Esophageal dilatation. What is outcome? Good. LESSON – EVERY DYSPHAGIA ENDOSCOPY IS VITAL

  8. CLINICAL PHOTO 30 yr male came for master heath checkup . Clinical photo for diagnosis? Post Herpes Zoster scar mark What else to look for? Immunodeficiency What are the differential diagnosis? Congenital mole, Pigmentation LESSON : RADICULAR LESION HERPES COMMON

  9. CLINICAL VIDEO 40 yr old obese male admitted with c/o chest pain, ECG showing acute MI, emergency angioplasty to LAD done. O/E : Hypertrophy of calf muscle +. What are the causes? Muscular dystrophy, myxoedema, glycogen storage disorder, athelets What clinches the diagnosis? Pseudomyotonic ankle jerk Video findings? Delayed ankle reflex Final diagnosis? Hypothyroidism LESSON : HYPOTHYROIDISM & CAD ARE ASSOCIATES

  10. ECG 70 yr/m came with c/o palpitation, O/E: conscious, BP 90/60 mm of Hg Immediately ECG taken shows? Monomorphic VT What are the causes? CAD, Electrolyte Imbalance, Cardiomyopathy, Heart failure, myocarditis, drugs What is treatment of choice? Synchronised cadioversion 2nd ECG shows Sinus rhythm, VPC+ How to proceed? CAG & ICD LESSON : VT IS LIFE THREATENING

  11. ECHO 15 months old baby with recurrent LRI CVS: Continuous murmur in chest What are the possibilities? PDA, aorto pulmonary window, AV fistula, Systolicodiastolic murmurs What does the ECHO shows? Aorta to LT pulmonary artery shunt seen, PDA What is the treatment stratergy? Control respiratory infection Elective PDA ligation at age 4/ PDA coil closure LESSON : PDA COMMONEST CAUSE OF CONTINUOUS MURMUR

  12. SAH wishes all our colleagues a LIFE SAFE Healthy & prosperous New Year & Pongal

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